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Risk factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan: a prospective cohort
Adam R Aluisio1, Zabihullah Maroof2, Daniel Chandramohan2
1Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Emergency Medicine, Division of International Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, New York, United States of America.
Insights
Childhood diarrheal illnesses are a major public health issue in low-income settings. Maternal hand washing and improved sanitation significantly reduce recurrent diarrheal disease risk in children, highlighting key prevention strategies.
Area of Science:
- Pediatric infectious diseases
- Public health and epidemiology
- Global child health
Background:
- Childhood diarrheal illnesses represent a significant global public health challenge, particularly in low-income regions.
- Data on disease burden and contributing factors are often limited, hindering effective prevention.
- This study investigated factors associated with recurrent diarrheal illnesses in young children in Kabul, Afghanistan.
Purpose of the Study:
- To identify key factors associated with recurrent diarrheal illnesses in infants in Kabul, Afghanistan.
- To inform public health strategies for diarrhea prevention in similar settings.
Main Methods:
- A prospective cohort study followed 3,045 infants aged 1-11 months for 18 months.
- Diarrheal episodes were monitored through active and passive surveillance.
- Data on child health, socioeconomic status, water/sanitation, and hygiene were collected and analyzed using regression models.
Main Results:
- Over 14,998 diarrheal episodes were recorded (3.51 episodes/child-year).
- Maternal education, hand washing with soap, and improved sanitation facilities were associated with reduced diarrheal risk.
- Malnutrition and household poverty significantly increased the risk of recurrent diarrheal illness.
Conclusions:
- Maternal hand washing and improved sanitation are critical protective factors against childhood diarrhea.
- Discrepancies in soap availability versus reported use indicate potential barriers to access and knowledge.
- Multi-sectoral interventions addressing maternal education, economic status, hygiene, and sanitation are recommended for effective diarrhea prevention.
Introduction:
Childhood diarrheal illnesses are a major public health problem. In low-income settings data on disease burden and factors associated with diarrheal illnesses are poorly defined, precluding effective prevention programs. This study explores factors associated with recurrent diarrheal illnesses among children in Kabul, Afghanistan.
Methods:
A cohort of 1-11 month old infants was followed for 18 months from 2007-2009. Data on diarrheal episodes were gathered through active and passive surveillance. Information on child health, socioeconomics, water and sanitation, and hygiene behaviors was collected. Factors associated with recurrent diarrheal illnesses were analyzed using random effects recurrent events regression models.
Results:
3,045 children were enrolled and 2,511 (82%) completed 18-month follow-up. There were 14,998 episodes of diarrheal disease over 4,200 child-years (3.51 episodes/child-year, 95%CI 3.40-3.62). Risk of diarrheal illness during the winter season was 63% lower than the summer season (HR = 0.37, 95%CI 0.35-0.39, P<0.001). Soap for hand washing was available in 72% of households and 11.9% had toilets with septic/canalization. Half of all mothers reported using soap for hand washing. In multivariate analysis diarrheal illness was lower among children born to mothers with post-primary education (aHR = 0.79, 95%CI 0.69-0.91, p = 0.001), from households where maternal hand washing with soap was reported (aHR = 0.83, 95%CI 0.74-0.92, p<0.001) and with improved sanitation facilities (aHR = 0.76, 95%CI 0.63-0.93, p = 0.006). Malnourished children from impoverished households had significantly increased risks for recurrent disease [(aHR = 1.15, 95%CI 1.03-1.29, p = 0.016) and (aHR = 1.20, 95%CI 1.05-1.37, p = 0.006) respectively].
Conclusions:
Maternal hand washing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and utilization suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population and these findings support multi-sector interventions to combat illness.
Trial Registration:
www.ClinicalTrials.gov NCT00548379 https://www.clinicaltrials.gov/ct2/show/NCT00548379.
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