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Diarrheal disease in Cambodian children at a camp in Thailand
J D Arthur1, L Bodhidatta, P Echeverria
1Department of Bacteriology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand.
Insights
Persistent diarrhea in Cambodian children was linked to multiple infectious agents, not single persistent infections. Key risk factors included close contact with other young children and malnutrition.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Epidemiology
Background:
- Acute and persistent diarrhea pose significant health risks to young children, particularly in resource-limited settings.
- Understanding the causative agents and risk factors is crucial for effective prevention and treatment strategies.
Purpose of the Study:
- To determine the etiology of acute and persistent diarrhea in Cambodian children under five years old.
- To identify potential risk factors associated with persistent diarrhea in this population.
Main Methods:
- A case-control study was conducted in a refugee camp on the Thai-Cambodian border.
- Microbiologic methods, DNA probe hybridization, and tissue culture adherence assays were used to identify pathogens.
- Environmental samples were also analyzed.
Main Results:
- The same bacterial, viral, or parasitic agents were found in children with both acute and persistent diarrhea.
- Persistent infection with a single organism was rare; only Cryptosporidium was identified in one child for an extended period.
- Living with other young children (OR=2.0) and undernourishment (OR=2.6) were significant risk factors for persistent diarrhea.
Conclusions:
- Persistent diarrhea in this cohort was associated with multiple infectious agents rather than prolonged infection by a single pathogen.
- Public health interventions should address common infectious agents and risk factors like close proximity to other children and nutritional status.
Abstract:
The etiology of acute diarrhea (less than or equal to 3 days duration) and persistent diarrhea (greater than or equal to 14 days duration) was determined in Cambodian children under age 5 years in a refugee camp on the Thai-Cambodian border between May and October 1989; potential risk factors associated with persistent diarrhea were examined in an age-matched case-control study. Specimens collected from children and environmental sources were examined by standard microbiologic methods; Escherichia coli isolates were examined for hybridization with specific DNA probes and in tissue culture adherence assays. The same bacterial, viral, or parasitic agents were identified in 79 children with persistent diarrhea and in 408 children with acute diarrhea. Only one of nine children with persistent diarrhea excreted the same organism, Cryptosporidium, for that extended period. The most important risk factors identified for developing persistent diarrhea were living with other young children (odds ratio (OR) = 2.0, 95% confidence interval (Cl) 1.2-3.4) and being undernourished (OR = 2.6, 95% Cl 1.2-5.7). Persistent diarrhea in children in this camp was associated with several different agents rather than persistent infections with a single organism.