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Diarrhea in children newly enrolled in day-care centers in Houston
M A Staat1, A L Morrow, R R Reves
1Department of Pediatrics, University of Texas Medical School, Houston 77030.
Insights
Diarrhea is common in children attending day-care centers (DCC). Children recently enrolled in DCCs experience a significantly higher incidence of diarrhea during their first four weeks compared to later periods.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Diarrhea is a frequent childhood illness, particularly in day-care settings.
- Understanding the temporal patterns of diarrhea incidence in day-care centers (DCC) is crucial for public health interventions.
Purpose of the Study:
- To investigate the hypothesis that diarrhea incidence is higher in the initial months of day-care center (DCC) enrollment.
- To quantify the risk of diarrheal illness associated with recent enrollment in DCCs.
Main Methods:
- A prospective cohort study followed 442 children under two years old in 13 randomly selected day-care centers (DCCs) for 14.5 months.
- Data on diarrhea occurrence were collected through parental questionnaires and twice-weekly research nurse visits, including stool specimen collection.
- Statistical analyses included incidence rates, rate ratios, and confidence intervals to compare diarrhea risk between early and later enrollment periods.
Main Results:
- The incidence rate of diarrhea was significantly higher in the first four weeks of DCC enrollment (4.4 cases/child-year) compared to subsequent periods (2.7 cases/child-year).
- Recent enrollment was identified as a significant risk factor for diarrhea, independent of gender, ethnicity, age, DCC size, prior attendance, or season.
- While rotavirus was detected in 18% of cases, it did not correlate with recent enrollment. Males and younger children exhibited higher diarrhea incidence.
Conclusions:
- Diarrhea incidence is significantly elevated during the initial four weeks of day-care center (DCC) attendance.
- Early enrollment in DCCs represents a critical period for increased diarrheal illness risk in young children.
- Further research into targeted interventions for newly enrolled children in DCCs is warranted.
Abstract:
Diarrhea is a common illness among children in day-care centers (DCC). We hypothesized that the incidence of diarrhea was greater among children in their first 1 or 2 months after enrollment in a DCC than in any subsequent period in day care. We followed 442 children younger than 2 years of age enrolled in 13 randomly selected DCCs for the occurrence of diarrhea during a 14 1/2-month period. Parents completed standardized baseline questionnaires and research nurses visited the DCC twice weekly to record the occurrence of diarrhea and to collect stool specimens. Incidence rates, rate ratios, chi square statistics and 95% confidence intervals were calculated for crude and stratified analyses. The diarrheal incidence rate of 4.4 cases/child-year in the first 4 weeks in the centers was significantly (rate ratio, 1.6; confidence interval, 1.3 to 2.1; P less than 0.01) higher than the 2.7 cases/child-year incidence rate of diarrhea in subsequent weeks. The effects of gender, ethnicity, age, DCC size, previous DCC attendance and season were examined and did not account for the association observed between recent enrollement and risk of diarrheal illness. Rotavirus was identified in 18% of cases of diarrhea, but no association was seen with recent enrollment in DCC. A significantly higher incidence of diarrhea occurred in males compared with females (P less than 0.002) and in younger children (P less than 0.001) compared with older children. Diarrhea is common in children in DCCs and occurs significantly more frequently in children during their first 4 weeks in a DCC.