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Diarrhea in children under 5 years of age from Ifakara, Tanzania: a case-control study
J Gascón1, M Vargas, D Schellenberg
1Tropical Section, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain. jgascon@medicina.ub.es
Insights
Diarrheal diseases in Tanzanian children under 5 are linked to fewer siblings and greater distance from water sources. Shigella was the only pathogen significantly associated with diarrhea.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Diarrheal diseases pose a significant health burden on children under 5 years of age, particularly in resource-limited settings.
- Understanding the specific risk factors and causative agents is crucial for effective prevention and treatment strategies.
Purpose of the Study:
- To investigate the risk factors and etiology of diarrheal diseases in children under 5 in Ifakara, Tanzania.
- To identify specific enteropathogens associated with diarrhea in this population.
Main Methods:
- A matched case-control study was conducted with 103 cases and 206 controls, matched for sex and age.
- Data were collected using precoded questionnaires and stool samples were analyzed for bacterial, parasitological, and viral pathogens.
Main Results:
- Factors associated with reduced risk of diarrhea included a high number of siblings, surviving siblings, birth order, and proximity to water sources.
- Shigella species were the only enteropathogen significantly associated with diarrhea (OR, 2.90; P < 0.029).
- High rates of enteropathogen isolates (52.23%) were found in children without diarrhea; E. coli strains, Giardia lamblia, and Salmonella species were not statistically related to diarrhea.
Conclusions:
- Family size and water source proximity are important factors influencing diarrhea risk in young children.
- Shigella species represent a key bacterial pathogen linked to childhood diarrhea in this Tanzanian setting.
- Further research is needed to understand the high prevalence of enteropathogens in asymptomatic children.
Abstract:
A matched case-control study was conducted in the Maternal and Child Health Clinic (MCH) in Ifakara, Tanzania, during the rainy season in order to elucidate the risk factors for and etiology of diarrheal diseases in children under 5 years of age. Cases (103) and controls (206) were matched for sex and age group. Precoded questionnaires with demographic details, clinical history, and physical signs were completed. Stools samples were collected for bacterial, parasitological, and viral studies. A high number of siblings (odds ratio [OR], 0.86; P = 0.027), the number of siblings surviving (OR, 0.82; P = 0.007), the birth order (OR, 0.85; P = 0.018) and the distance from the house to the water source (OR, 0.33; P = 0.011) were associated with the risk of diarrhea. There were high rates of enteropathogen isolates in stool samples from children without diarrhea (52.23%). Shigella species were the only enteropathogen statistically related with diarrhea (OR, 2.90; P < 0.029). Enterotoxigenic, enteropathogenic, and enteroaggregative strains of Escherichia coli were not related with diarrhea, and neither were Giardia lamblia or Salmonella species.