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Pathogen-specific risk factors and protective factors for acute diarrheal disease in urban Brazilian infants
P A Blake1, S Ramos, K L MacDonald
1Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, GA 30333.
Insights
Diarrheal disease in urban infants is linked to hospitalization, daycare, and low income. Breast-feeding and boiling water significantly reduce infant diarrhea risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute diarrheal disease remains a significant health concern for infants globally.
- Identifying risk and protective factors is crucial for developing effective prevention strategies in urban settings.
Purpose of the Study:
- To investigate risk and protective factors associated with acute diarrheal disease in urban infants.
- To analyze the role of specific pathogens and preventive measures in disease occurrence.
Main Methods:
- A case-control study involving 500 infants with diarrhea and 500 age-matched controls in a São Paulo emergency room.
- Multivariate analysis was employed to identify significant risk and protective factors.
- Microbiological analysis was performed to identify causative agents like EPEC, Salmonella, and rotavirus.
Main Results:
- Risk factors included prior hospitalization (OR, 3.4), daycare exposure (OR, 2.0), household diarrhea (OR, 4.4), and low family income (OR, 1.8).
- Protective factors were breast-feeding (OR, 0.3) and boiling drinking water (OR, 0.4).
- Enteropathogenic Escherichia coli (EPEC) and Salmonella infections were linked to hospitalization, while rotavirus was associated with daycare.
Conclusions:
- Specific preventive strategies, such as promoting breast-feeding and ensuring safe drinking water, can substantially reduce diarrheal disease in Brazilian infants.
- Understanding the interplay between socio-economic factors, environmental exposures, and infectious agents is key to public health interventions.
Abstract:
To evaluate potential risk factors and protective factors for acute diarrheal disease in urban infants, 500 infants < or = 12 months old with diarrhea and 500 age-matched control subjects coming to a São Paulo emergency room were studied. On multivariate analysis, these apparently sporadic community-acquired cases of diarrhea were significantly associated with hospitalization in the month before onset (odds ratio [OR], 3.4), day care center exposure (OR, 2.0), prior diarrhea in another household member (OR, 4.4), and low family income (OR, 1.8). Breast-feeding infants < 6 months old (OR, 0.3) and boiling household drinking water (OR, 0.4) were protective. Enteropathogenic Escherichia coli (EPEC; OR, 12.0) and Salmonella (OR, 7/0, discordant pairs) infections were associated with prior hospitalization, rotavirus infections were associated with day care (OR, 6/0), and breast-feeding was protective against EPEC infections (OR, 0.1). These results suggest that certain preventive strategies can prevent a substantial proportion of cases of diarrheal disease in Brazilian infants.