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A hierarchical model for studying risk factors for childhood diarrhoea: a case-control study in a middle-income country.

Ferrer, S.R.; Strina, A.; Jesus, S.R.; Ribeiro, H.C.; Cairncross, S.; Rodrigues, L.C.; Barreto, M.L.;
Int J Epidemiol, 2008; 37(4):805-15
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Centre for Maternal, Reproductive and Child Health (MARCH)
Centre for Global Non-Communicable Diseases (NCDs)
Vaccine Centre

pub_id
18515864
pubmedid
18515864
ISI
257963500023
reference_type
author
Ferrer, S.R.; Strina, A.; Jesus, S.R.; Ribeiro, H.C.; Cairncross, S.; Rodrigues, L.C.; Barreto, M.L.;
title
A hierarchical model for studying risk factors for childhood diarrhoea: a case-control study in a middle-income country.
secondary_title
Int J Epidemiol
ISBNISSN
1464-3685
volume
37
number
4
pages
805-15
year
2008
abstract
OBJECTIVE: To identify factors associated with diarrhoea occurrence in children in a city in a middle-income country, with high access to water and sanitation. METHODS: A case-control study in the city of Salvador, north-eastern Brazil was conducted from November 2002 to August 2004. The study population consisted of children presenting at a health facility. A total of 1688 cases of diarrhoea and 1676 controls were selected. Data collection was by a questionnaire and structured observation during home visits. The explanatory variables were grouped according to a conceptual model defined previously. Analysis was done using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhoea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated. RESULTS: Socioeconomic factors contributed most to determining diarrhoea occurrence, followed by interpersonal contact, while factors related to food preparation, the environment and water and sanitation made a smaller contribution. CONCLUSION: The findings indicate that the transmission of diarrhoea is influenced by factors from all hierarchical levels, with interpersonal transmission playing a relatively higher role than previously thought. This is compatible with a predominance of viruses and other agents spread by interpersonal routes including Shigella, Giardia and Cryptosporidium. Diarrhoea control strategies in similar settings (middle-income countries in which a large proportion of the population has access to water and sanitation) must give greater emphasis to policies geared towards reducing person-to-person transmission for the prevention of diarrhoea.
keywords
secondary_author
place_published
publisher
number_of_volumes
tertiary_author
tertiary_title
edition
date
type_of_work
subsidiary_author
alternate_title
call_number
accession_number
custom_1
WOS OK
custom_2
Unknown
custom_3
custom_4
10.1093/ije/dyn093
custom_5
Free
custom_6
10
label
2016-10-18
notes
Journal Article
url
author_address
Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
library
dyn093 10.1093/ije/dyn093 18515864
date_accepted
date_online
created
2008-06-09 15:36:47
modified
2016-07-08 00:00:00
library

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