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Day care center attendance and diarrheal morbidity in Colombia
S D Hillis1, C M Miranda, M McCann
1Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill.
Insights
Day care attendance increases diarrheal disease risk in young children in urban, developing settings. This risk is most significant for children under 3 attending full-time, highlighting the need for improved hygiene in early childhood education.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrheal diseases pose a significant threat to child morbidity and mortality in developing countries.
- Understanding risk factors for diarrheal disease in early childhood is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between day care center attendance and diarrheal disease risk in Colombian children.
- To identify specific age groups and attendance patterns associated with increased risk.
Main Methods:
- A prospective study interviewed mothers of 493 Colombian children (under 5 years) weekly regarding diarrheal episodes.
- Data collected included day care attendance, child's age, and environmental factors like water and sanitation.
- Statistical analyses controlled for confounding variables to assess diarrheal risk.
Main Results:
- Day care attendees had a higher incidence of diarrhea (3.2 episodes/child-year) compared to nonattendees (2.0 episodes/child-year).
- Children under 2 years attending day care showed a significantly higher risk (7.2 vs 3.5 episodes/child-year).
- Increased risk was specifically linked to children under 3 years attending over 30 hours/week, after controlling for socioeconomic and environmental factors.
Conclusions:
- Day care attendance presents a modest but important increase in diarrheal disease risk for young children, particularly those attending full-time.
- The findings underscore the need for enhanced hygiene and infection control measures in day care settings serving vulnerable populations.
- Socioeconomic status influenced the duration of diarrheal episodes differently between attendees and nonattendees.
Abstract:
This study was designed to determine whether day care center attendance was associated with increased risk of diarrheal disease among poor children in an urban, developing country setting. From July 17 to December 18, 1988, mothers of 493 Colombian children less than 5 years old (241 attendees and 252 nonattendees) were interviewed weekly about diarrheal events during the previous week. The incidence of diarrhea was greater for day care center attendees than for nonattendees (3.2 vs 2.0 episodes per child-year, P < .0005). For children less than 2 years of age, attendees experienced 7.2 episodes/child-year vs 3.5 episodes per child-year for nonattendees (P < .0005). Analyses controlling for water source and availability, excreta disposal, socioeconomic status, and duration of follow-up showed that the increased diarrheal risk was limited to children younger than 3 years of age spending more than 30 hours per week in the centers. In addition, although the risk among attendees of suffering diarrheal episodes of longer duration was fairly constant across levels of socioeconomic status, this risk was inversely proportional to socioeconomic status for nonattendees. In summary, the increase in risk of diarrhea among young, full-time day care attendees was modest, yet important, because diarrhea continues to be a major cause of morbidity and mortality in Colombian children.