The Influence of Climate Variation and Change on Diarrheal Disease in the Pacific Islands.

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Singh RB, Hales S, de Wet N, Raj R, Hearnden M, Weinstein P

Ecology and Health Research Centre, Wellington School of Medicine, Wellington, New Zealand.

[Record supplied by publisher]

Freshwater resources are a high-priority issue in the Pacific region. Water shortage is a serious problem in many small island states, and many depend heavily on rainwater as the source of their water. Lack of safe water supplies is an important factor in diarrheal illness. There have been no previous studies looking specifically at the relationship between climate variability and diarrhea in the Pacific region. We carried out two related studies to explore the potential relationship between climate variability and the incidence of diarrhea in the Pacific Islands. In the first study, we examined the average annual rates of diarrhea in adults, as well as temperature and water availability from 1986 to 1994 for 18 Pacific Island countries. There was a positive association between annual average temperature and the rate of diarrhea reports, and a negative association between water availability and diarrhea rates. In the second study, we examined diarrhea notifications in Fiji in relation to estimates of temperature and rainfall, using Poisson regression analysis of monthly data for 1978-1998. There were positive associations between diarrhea reports and temperature and between diarrhea reports and extremes of rainfall. These results are consistent with previous research and suggest that global climate change is likely to exacerbate diarrheal illness in many Pacific Island countries.

PMID: 11266326

2J Health Popul Nutr 2000 Dec;18(3):157-62Related Articles, Books

Bacteriological quality of weaning food and drinking water given to children of market women in Nigeria: implications for control of diarrhoea.

Iroegbu CU, Ene-Obong HN, Uwaegbute AC, Amazigo UV

Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria. [email protected]

[Medline record in process]

Bacteriological quality of weaning food and drinking water given to 2 groups of children aged < or = years was evaluated by estimating bacterial cell count. One group consisted of those taken to market and the other of those left at home in the care of older siblings or house-helps. Bacterial counts (geometric mean) ranged from 5.02 +/- 1.82 to 8.70 +/- 1.0 log10 cfu per g or mL of food, and from 1.15 +/- 1.67 to 6.53 +/- 0.81 log10 cfu per g or 100 mL of water. Analysis of variance showed no significant difference in counts between types of food and between meals (breakfast and lunch). Bacterial contamination increased significantly with storage time, and was, in all circumstances except the water samples, significantly higher in foods given to children left at home. Reheated leftover foods also had significantly higher bacterial load than the freshly-cooked food. Coliform count varied significantly with source of drinking water. Poor hygiene standard (inferred from bacterial contamination) was generally observed among mothers weaning < or = 2-year-old children, while they were engaged in trading activities in the market, thus exposing their children to high risk of diarrhoea. Hygiene was significantly poorer in weaning of children left at home in the care of older siblings or house-helps. This implies that, in spite of their trading activities in the market, mothers still take better care of their babies than the older siblings or house-helps who may be inexperienced. These mothers may need education on childcare and food hygiene to suit to their trading activities, for example, during their monthly meetings. There is also a need to establish ORT (oral rehydration therapy) corners in the markets as part of the municipal services. This can be used not only for efficient and quick management of diarrhoea in the market but also for reinforcing hygiene education.

PMID: 11262769

3J Health Popul Nutr 2000 Dec;18(3):151-6Related Articles, Books

Risk factors and gender differentials for death among children hospitalized with diarrhoea in Bangladesh.

Mitra AK, Rahman MM, Fuchs GJ

ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka 1000, Bangladesh. [email protected]

[Medline record in process]

To identify risk factors for death among children with diarrhoea, a cohort of 496 children, aged less than 5 years, admitted to the intensive care unit of a diarrhoeal disease hospital in Bangladesh, was studied during November 1992-June 1994. Clinical and laboratory records of children who died and of those who recovered in the hospital were compared. Deaths were significantly higher among those who had altered consciousness, hypoglycaemia, septicaemia, paralytic ileus, toxic colitis, necrotizing enterocolitis, haemolytic-uraemic syndrome, invasive or persistent diarrhoea, dehydration, electrolyte imbalances, and malnutrition. Females experienced a 2-fold higher risk of death than males (p = 0.003). Several indices of severe infections were identified more frequently among females than males. Females with severe infections were less frequently brought to the hospital than their male counterparts. The time lapse between onset of symptoms and hospital admission was significantly higher in females than males. This study suggests initiation of programmes to alleviate social disparity between genders for healthcare in poor communities. The study-results may also help physicians identify either prognostic indicators or risk factors for death among children hospitalized with severe illnesses associated with diarrhoea.

PMID: 11262768

4J Health Popul Nutr 2000 Dec;18(3):139-44Related Articles, Books

Treatment of childhood diarrhoea in Nigeria: need for adaptation of health policy and programmes to cultural norms.

Omotade OO, Adeyemo AA, Kayode CM, Oladepo O

Institute of Child Health, University College Hospital Ibadan, Nigeria. [email protected]

[Medline record in process]

A community survey of treatment regimens for acute diarrhoea in children was carried out in 10 villages in the Ona Ara Local Government Area of Oyo State, Nigeria, using a combination of qualitative (focus-group discussions) and quantitative (weekly surveillance of diarrhoea) methods. Focus-group discussions were conducted with parents of children aged less than 5 years, while a surveillance of diarrhoea among 550 children of same age was carried out during a 6-month period. The findings of the study showed that not all types of diarrhoea were recognized as illnesses, and only those considered to be illnesses were treated. Treatment often involved an adhoc group which comprised adults who were present at the time the illness occurred (including parents, neighbours, relatives, and elders). Certain beliefs and practices, such as associating types of diarrhoea with occupation or ethnic groups, categorizing the severity on perceived causes, and withholding certain foods during episodes of diarrhoea, were common factors in decision-making for seeking treatment. Antimicrobial agents were used in the case of 46.8% of 205 diarrhoeal episodes, and 28.5% were not at all treated. The usual practice of focusing on a target group, such as mothers, during educational interventions may need to be modified in communities where nearly every adult has a role in decision-making in relation to health. The need to adapt health policy and programmes to cultural norms should be addressed to improve the impact of programmes.

PMID: 11262766

5Trop Med Int Health 2001 Jan;6(1):46-54Related Articles, Books

Irrigation water as a source of drinking water: is safe use possible?

Van Der Hoek W, Konradsen F, Ensink JH, Mudasser M, Jensen PK

International Water Management Institute, Colombo, Sri Lanka; Department of Veterinary Microbiology, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark.

[Medline record in process]

BACKGROUND In arid and semi-arid countries there are often large areas where groundwater is brackish and where people have to obtain water from irrigation canals for all uses, including domestic ones. An alternative to drawing drinking water directly from irrigation canals or village water reservoirs is to use the water that has seeped from the irrigation canals and irrigated fields and that has formed a small layer of fresh water on top of the brackish groundwater. The objective of this study was to assess whether use of irrigation seepage water for drinking results in less diarrhoea than direct use of irrigation water and how irrigation water management would impact on health. METHODS: The study was undertaken in an irrigated area in the southern Punjab, Pakistan. Over a one-year period, drinking water sources used and diarrhoea episodes were recorded each day for all individuals of 200 households in 10 villages. Separate surveys were undertaken to collect information on hygiene behaviour, sanitary facilities, and socio-economic status. RESULTS: Seepage water was of much better quality than surface water, but this did not translate into less diarrhoea. This could only be partially explained by the generally poor quality of water in the in-house storage vessels, reflecting considerable in-house contamination of drinking water. Risk factors for diarrhoea were absence of a water connection and water storage facility, lack of a toilet, low standard of hygiene, and low socio-economic status. The association between water quality and diarrhoea varied by the level of water availability and the presence or absence of a toilet. Among people having a high quantity of water available and a toilet, the incidence rate of diarrhoea was higher when surface water was used for drinking than when seepage water was used (relative risk 1.68; 95% CI 1.31-2.15). For people with less water available the direction of the association between water quality and diarrhoea was different (relative risk 0.80; 95% CI 0.69-0.93). This indicates that good quality drinking water provides additional health benefits only when sufficient quantities of water and a toilet are available. In a multivariate analysis no association was found between water quality and diarrhoea but there was a significant effect of water quantity on diarrhoea which was to a large extent mediated through sanitation and hygiene behaviour. CONCLUSIONS: Increasing the availability of water in the house by having a household connection and a storage facility is the most important factor associated with reduced diarrhoea in this area. Safe use of canal irrigation water seems possible if households can pump seepage water to a large storage tank in their house and have a continuous water supply for sanitation and hygiene. Irrigation water management clearly has an impact on health and bridging the gap between the irrigation and drinking water supply sectors could provide important health benefits by taking into account the domestic water availability when managing irrigation water.

PMID: 11251895

6Rev Inst Med Trop Sao Paulo 2001 Jan-Feb;43(1):21-4Related Articles, Books, LinkOut

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Etiology of acute diarrhea among children in Ribeirao Preto-SP, Brazil.

Medeiros MI, Neme SN, Silva Pd, Capuano DM, Errera MC, Fernandes SA, Valle GR, Avila FA

Laboratorio I, Instituto Adolfo Lutz, Ribeirao Preto, SP, Brasil.

[Medline record in process]

To study the main enteropathogens causing diarrhea in the region of Ribeirao Preto regarding serogroups and serotypes, the feces of 1836 children under 10 years old, from both sexes, attack of acute gastroenteritis, were analysed during a period of 4 years in Adolfo Lutz Institute – Ribeirao Preto, SP. The pathogens identified by standard methods were the following: Escherichia coli, Salmonella spp., Shigella spp., Campylobacter spp., Yersinia spp., and Cryptosporidium spp. Positive samples were 22.8% (419) with 1.7% association of pathogens. Larger isolates were mainly from children 0 to 11 months old. Enteropathogenic E. coli (EPEC) was most frequent (8.7%) with predominance of serogroup O119 (40.2%), followed by Shigella (6.2%), 63.6% of which S. sonnei.

PMID: 11246278

7Indian J Public Health 1999 Oct-Dec;43(4):136-9Related Articles, Books

Influence of recall period on estimates of diarrhoea morbidity in infants in rural Tamilnadu.

Ramakrishnan R, Venkatarao T, Koya PK, Kamaraj P

Institute for Research in Medical Statistics, Chennai.

[Medline record in process]

Data collected on 689 infants, in a study to assess the incidence of diarrhoea and acute respiratory infections during infancy, is used here to quantify the extent of under-reporting in diarrhoea morbidity surveys. The study area consisted of two contiguous primary health centres in Villupuram health unit district in Tamil Nadu, South India. Each day of infancy was assigned a recal period and proportion of diarrhoeal days for various recall period computed. The proportion of diarrhoea was 11.3%, 12.0% and 11.2% for zero, one and two days of recall period, respectively, after which the proportion decreased. The under-reporting of diarrhoea was approximately 15%, 26% and 45% with three, six and 7-13 days of recall period, respectively. As there is considerable under-reporting of diarrhoea morbidity when recall period exceeds three days, it would be best to collect information on diarrhoea at least twice a week in diarrhoeal morbidity surveys.

PMID: 11243060

8Cent Afr J Med 2000 Jun;46(6):150-3Related Articles, Books

An outbreak of dysentery in a rural district of Zimbabwe: the role of personal hygiene at public gatherings.

Midzi SM, Tshimanga M, Siziya S, Marufu T, Mabiza ET

Department of Community Medicine, University of Zimbabwe, PO Box A178, Avondale, Harare, Zimbabwe.

[Medline record in process]

OBJECTIVES: To characterize the nature and extent of the outbreak; to determine the risk factors associated with contracting shigellosis; and to institute disease control and preventive measures. DESIGN: Case control study. SETTING: Nyaure Ward, Goromonzi District, Mashonaland East Province, Zimbabwe. SUBJECTS: 52 cases and 52 controls. A case was defined as any resident of Nyaure Ward who presented with bloody diarrhoea (three or more loose stools/day) between 25 July and 25 October 1997. MAIN OUTCOME MEASURES: Frequencies of symptoms, types of treatment received, risk factors for contracting the illness. RESULTS: The median age was 17 (Q1 = 8, Q3 = 30) years for cases and 19 (Q1 = 7, Q3 = 28) years for controls. Prominent symptoms were abdominal cramps (96.2%), malaise and fever (92.3%), nausea and vomiting (50.0%). The median duration of diarrhoea was 13 (Q1 = 6, Q3 = 14) days. Eighteen (34.6%) cases were admitted and of these five were referred to a central hospital and two of them complicated with haemolytic uraemic syndrome. The case fatality rate was 1.6%. Twenty four(46.1%) of the cases had Shigella dysenteriae type I, sensitive to Nalidixic acid, Kanamycin, and Doxycycline but resistant to Metronidazole, isolated from the stool specimen. Water samples did not yield any pathogens. Significant risk factors associated with contracting dysentery were shared hand washing in the same standing water at gatherings[OR = 8.47, 95% CI: (2.43-31.33)] or within homes[OR = 60.43, 95% CI: (15.73 to 256.00)]. The use of Blair toilets was a protective factor[OR = 0.03, 95% CI: (0.01 to 0.11)]. CONCLUSION: The epidemiologic evidence implicated contamination of water used for shared hand washing before meals as the source of the infection. The common practice of shared hand washing in standing water should be discouraged at all gatherings and within households to avoid future outbreaks.

PMID: 11235056

9Int J Infect Dis 2000;4(4):179-186Related Articles, Books

Changes over Time in the Epidemiology of Diarrhea and Malnutrition among Children in an Urban Brazilian Shantytown, 1989 to 1996.

Moore SR, Lima AA, Schorling JB, Barboza MS Jr, Soares AM, Guerrant RL

Division of Geographic Medicine and International Health, University of Virginia School of Medicine, Charlottesville, Virginia, USA.

[Record supplied by publisher]

BACKGROUND: Endemic diarrhea and its associated malnutrition remain leading causes of childhood morbidity and mortality in developing countries. This study was undertaken to describe changes in the incidence of diarrhea and prevalence of malnutrition among children in an urban Brazilian shantytown from 1989 to 1996. A secondary purpose was to examine associations between malnutrition and increased incidence and duration of diarrhea. METHODS: From August 1989 through December 1996 a dynamic birth cohort of 315 children was followed for surveillance of diarrhea and nutrition. Study homes were visited twice or thrice weekly to assess the occurrence of diarrhea. Length and weight of the subjects were measured quarterly. Poisson regression was used to test for associations between prior nutritional status and subsequent diarrhea during a quarter. Multiple regression was used to test for an association between nutritional status and episode duration. RESULTS: Declines in both age-adjusted attack rates (6.0 episodes/child-year in 3-year-olds to 2.5 episodes/child-year in 8-year-olds) and days with diarrhea per child-year (30.8 days/child-year in 3-year-olds to 8.5 days/child-year in 8-year-olds) were highly correlated with yearly improvements in mean nutritional status (R2= 0.84, P < 0.05, for mean length-for-age with mean number of episodes/child-year). Both length- and weight-for-age were significant predictors of diarrhea incidence, including persistent episodes (314 d), but not duration. CONCLUSIONS: These results demonstrate marked changes over time in the diarrhea burden and nutritional status of children in this population and provide further evidence of a significant association between malnutrition and increased incidence of diarrhea. EEEE

PMID: 11231179

10Am J Trop Med Hyg 2000 Apr;62(4):513-7Related Articles, Books, LinkOut

New insights on the emergence of cholera in Latin America during 1991: the Peruvian experience.

Seas C, Miranda J, Gil AI, Leon-Barua R, Patz J, Huq A, Colwell RR, Sack RB

Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima.

After a century of absence, in late January 1991, Vibrio cholerae invaded the Western Hemisphere by way of Peru. Although a number of theories have been proposed, it is still not understood how that invasion took place. We reviewed the clinical records of persons attending hospital emergency departments in the major coastal cities of Peru from September through January of 1989/1990 and 1990/1991. We identified seven adults suffering from severe, watery diarrhea compatible with a clinical diagnosis of cholera during the four months preceding the cholera outbreak, but none during the previous year. The patients were scattered among five coastal cities along a 1,000 km coastline. We postulate that cholera vibrios, autochthonous to the aquatic environment, were present in multiple coastal locations, and resulted from environmental conditions that existed during an El Nino phenomenon. Once introduced into the coastal communities in concentrations large enough for human infection to occur, cholera spread by the well-known means of contaminated water and food.

PMID: 11220769

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