Risk factors for contracting watery diarrhoea in Kadoma City, Zimbabwe, 2011: a case control study

BMC Infectious Diseases

Lucia Takundwa¹  Gerald Shambira¹  Mufuta Tshimanga¹  Notion T Gombe¹  Daniel Chirundu²  Brian A Maponga¹ 

[1]Field Epidemiology Training Program, University of Zimbabwe, P.O. Box A178, Avondale, Harare, Zimbabwe

[2]Kadoma City Health Department, P.O. Box 460, Kadoma, Zimbabwe

关键词: Kadoma City Zimbabwe;    Risk Factors;    Watery Diarrhoea;   

Others  :  1138259
DOI  :  10.1186/1471-2334-13-567

 received in 2013-04-12, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Kadoma City experienced an increase in watery diarrhoea from 27 cases during week beginning 5^th September, to 107 cases during week beginning 26^th September 2011. The weekly diarrhoea cases crossed the threshold action line during week beginning 5^th September at the children’s clinic in Rimuka Township, and the remaining four clinics reported cases crossing threshold action lines between week beginning 12^th September and week beginning 26^th September. Eighty-two percent of the cases were children less than 5 years old. We conducted a case controlstudy to determine risk factorsfor contracting watery diarrhoea in children less than 5 years in Kadoma City.

Methods

An unmatched 1:1 case control study was conducted in Ngezi and Rimuka townships in Kadoma City, Zimbabwe. A case was a child less than 5 years old, who developed acute watery diarrhoea between 5^th September and 1^st October 2011. A control was a child less than 5 years old who stayed in the same township and did not suffer from diarrhoea. A structured questionnaire was administered to caregivers of cases and controls.Laboratory water quality tests and stool test results were reviewed.Epi Info™ statistical software was used to analyse data.

Results

A total of 109 cases and 109 controls were enrolled. Independent protective factors were: having been exclusively breastfed for six months [AOR = 0.44; 95% CI (0.24-0.82)]; using municipal water [AOR = 0.38; 95% CI (0.18-0.80)]; using aqua tablets, [AOR = 0.49; 95% CI (0.26–0.94)] and; storing water in closed containers, [AOR = 0.24; 95% CI (0.07–0.0.83). The only independent risk factor for contracting watery diarrhoea was hand washing in a single bowl, [AOR = 2.89; 95% CI (1.33–6.28)]. Salmonella, Shigella, Rotavirus, and Enteropathogenic Escherichia coli were isolated in the stool specimens. None of the 33 municipal water samples tested showed contamination with Escherichia coli, whilst 23 of 44 (52%) shallow well water samples and 3 of 15(20%) borehole water samples tested were positive for Escherichia coli.

Conclusions

The outbreak resulted from inadequate clean water and use of contaminated water. Evidence from this study was used to guide public health response to the outbreak.

【 授权许可】

   
2013 Maponga et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]World Health Organization: Diarrhea, Factsheet Number 330. 2009. Available on URL: http://www.who.int/mediacentre/factsheets/fs330/en/ webcite. Accessed 05.08.11
• [2]Farthing M, Lindberg G, Dite P, et al.: World Gastroenterology Organization practice guideline: Acute diarrhoea. 2008. Available on URL: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/01_acute_diarrhea.pdf webcite. Accessed 29.09.11
• [3]Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year? Lancet 2003, 361(9376):2226-2234.
• [4]Central Statistical Office: Zimbabwe Census Report 2002. Zimbabwe Government Printers (now renamed Printflow), Harare, Zimbabwe; 2003:5-12, 145.
• [5]Kadoma City Engineering Department: Report on water supply. Kadoma, Zimbabwe: Kadoma City Council Offices; 2011:1.
• [6]Kadoma City: Rotavirus Outbreak Report. Kadoma, Zimbabwe: Kadoma City Council Offices; 2007:1-2.
• [7]Kadoma City Health Department: Cholera Outbreak Report. Kadoma, Zimbabwe: Kadoma City Council Offices; 2010:1.
• [8]Kadoma City Health Department: Cholera Outbreak Report. Kadoma, Zimbabwe: Kadoma City Council Offices; 2009:1-2.
• [9]Fricker RD Jr, Hegler BL, Dunfee DA: Assessing the Performance of the Early Aberration Reporting System (EARS) Syndromic Surveillance Algorithms. United States of America: Naval Postgraduate School; 2007:1-5. Accessed on 30.10.13
• [10]Slutsker L, Ries AA, Maloney K, et al.: A Nationwide Case–control Study of Escherichia coli O157: H7 Infection in the United States. J Infect Dis 1998, 177(4):962-966. Available on URL: http://jid.oxfordjournals.org/content/177/4/962.long webcite. Accesssed on 16.10.11
• [11]United States Environmental Protection Agency: Water: Monitoring and Assessment. Available on URL: http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/01_acute_diarrhea.pdf webcite (Accessed on 15.08.13)
• [12]Curtis V, Cairncross S: Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis 2003, 3:5. 275-81.Available on URL: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(03)00606-6/fulltext webcite. Accessed on 12.10.11
• [13]Mangizvo RV: The Problem of Burst Sewage Pipes and Sewerage Outflows in East View Suburb in Kadoma City, Zimbabwe. Journal of Sustainable Development in Africa 2009, 11(1):393-397. Clarion University of Pennsylvania, Clarion, Pennsylvania
• [14]Khan SA, Ahmed A, Khalid SM: Diarrhea Due To Rotavirus and Probability of Sewage Contamination. Journal of Islamic Academy of Sciences 1992, 5(2):142-144.
• [15]Lantagne DS, Quick R, Mintz ED: Household Water Treatment and Safe Storage Options in Developing Countries: a Review of Current Implementation Practices. U.S. Centers for Disease Control and PreventionPages 3-6. Available on URL: http://www.wilsoncenter.org/sites/default/files/WaterStoriesHousehold.pdf webcite. Accessed on 12.10.11
• [16]Kramer MS, Chalmers B, Hodnett ED, et al.: Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA 2001, 285(4):413-20.
• [17]Mølbalk K, Jensen H, Ingholt L, Aaby P: Risk factors for diarrheal disease incidence in early childhood: a community cohort study from Guinea-Bissau. Am J Epidem 1997, 146:273-2.
• [18]World Health Organization: Zimbabwe launches nutritional survey report. Health Harare 2010, 7:1-2. Available on URL: http://www.afro.who.int/index.php?option=com_docman&task=doc_download&gid=5519 webcite. Accessed on 28.11.13