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Risk of diarrheal disease in Ecuadorian day-care centers
F Sempértegui1, B Estrellá, J Egas
1Corporación Ecuatoriana de Biotecnología, Pontificia Universidad Católica de Quito, Ecuador.
Insights
Children in day-care centers (DCC) face a higher risk of diarrheal disease (DD) compared to those cared for at home (RH). Poor hygiene practices, like reusing water, significantly increase DD risk in DCC settings.
Area of Science:
- Pediatrics
- Public Health
- Infectious Diseases
Background:
- Diarrheal disease (DD) is a significant health concern in early childhood.
- Day-care centers (DCC) may present unique transmission risks for infectious diseases.
- Understanding risk factors in urban slum environments is crucial for targeted interventions.
Purpose of the Study:
- To compare the incidence of diarrheal disease (DD) in children attending day-care centers (DCC) versus those cared for at home (RH).
- To identify specific risk factors associated with DD in a poor urban slum setting in Quito, Ecuador.
- To investigate the prevalence of specific pathogens and their antimicrobial resistance patterns.
Main Methods:
- A prospective, age-, sex-, and locale-controlled study was conducted.
- 115 children in DCC and 115 children in RH (ages 12-42 months) were monitored.
- Data on DD incidence, hygienic practices, and causative agents (Shigella, Aeromonas, rotavirus, Giardia) were collected.
Main Results:
- The overall incidence of DD was 46/1000 child weeks.
- DD was significantly more common in DCC (Relative Risk [RR] = 1.75) than in RH.
- Poor hygienic practices, including the use of reused water for handwashing and washing raw vegetables, were strongly associated with increased DD risk in DCC (RR = 4.08 and 3.90, respectively).
- Shigella, Aeromonas, rotavirus, and Giardia were more prevalent in DCC.
- Over 40% of Shigella and Aeromonas isolates showed resistance to trimethoprim-sulfamethoxazole.
Conclusions:
- Day-care centers in poor urban settings pose a higher risk for diarrheal disease.
- Implementing improved hygiene practices, particularly concerning water use, is critical in DCC.
- The prevalence of specific pathogens and antimicrobial resistance highlights the need for effective treatment and prevention strategies.
Abstract:
To determine the risk for diarrheal disease (DD) in day-care centers (DCC) for children residing in a poor urban slum area of Quito, Ecuador, compared with that for children from the same environment but cared for in their own residential home (RH), a prospective age-, sex- and locale-controlled study of DD was conducted, including 115 children in DCC and 115 in RH, ages 12 to 42 months. The overall incidence of DD was 46/1000 child weeks. Diarrhea was more common in DCC than in RH (relative risk (RR), 1.75; 95% confidence interval (CI), 1.38 to 2.22; P < 0.001). Poor hygienic practices were more prevalent in DCC than in RH. The use of reused water for child handwashing before eating and for washing raw vegetables was associated with a higher risk of DD in DCC than in RH (RR = 4.08, CI 2.93 to 5.67, P < 0.001; RR = 3.90, CI 2.79 to 5.44, P < 0.001, respectively). These two practices were risk factors in the DCC (RR = 2.74, CI 2.08 to 3.68, P < 0.001; RR = 2.05, CI 1.55 to 2.71, P < 0.001, respectively) when compared with their absence in the same DCC. Shigella (RR = 3.58, CI 1.19 to 10.78, P < 0.02), Aeromonas (RR = 10.47, CI 1.35 to 81.05, P < 0.01), rotavirus (RR = 2.86, CI 1.87 to 4.39, P < 0.001) and Giardia (RR = 1.59, CI 1.00 to 2.59, P < 0.05) were more common in DCC than in RH. More than two-fifths of the Shigella and Aeromonas isolates were resistant to trimethoprim-sulfamethoxazole.(ABSTRACT TRUNCATED AT 250 WORDS)