Risk Factors Associated with Recurrent Diarrheal Illnesses among Children in Kabul, Afghanistan: A Prospective Cohort Study
Risk Factors Associated with Recurrent Diarrheal Illnesses among Children in Kabul, Afghanistan: A Prospective Cohort Study
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DOI：
10.1371/journal.pone.0116342
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发表时间：
2015-02-13
期刊：
影响因子：
3.7
通讯作者：
Ensink, Jeroen H. J.
中科院分区：
文献类型：
--
作者：
Aluisio, Adam R.;Maroof, Zabihullah;Ensink, Jeroen H. J.
儿童期腹泻病是一个主要的公共卫生问题。在低收入环境中，关于疾病负担和与慢性疾病相关的因素的数据定义不清，妨碍了有效的预防方案。本研究探讨了与儿童在喀布尔，Afghanistan.MethodsA队列的1-11个月大的婴儿复发性牙周炎的疾病相关的因素，从2007年至2009年进行了为期18个月。通过主动和被动监测收集了关于疟疾发作的数据。收集了有关儿童健康、社会经济学、水和卫生以及卫生行为的信息。采用随机效应复发事件回归模型分析与复发性腹泻相关的因素。结果3,045名儿童入组，2,511名（82%）完成了18个月的随访。在4,200个儿童年中，有14,998次腹泻病发作（3.51次/儿童年，95% CI 3.40-3.62）。冬季发病率比夏季低63%（HR = 0.37，95% CI 0.35-0.39，P < 0.001）。72%的家庭有洗手肥皂，11.9%的家庭有化粪池/渠化厕所。所有母亲中有一半报告说使用肥皂洗手。在多变量分析中，受过小学以上教育的母亲所生的儿童中，（aHR = 0.79，95% CI 0.69-0.91，p = 0.001），来自报告母亲用肥皂洗手的家庭（aHR = 0.83，95%CI 0.74-0.92，p < 0.001）和改善的卫生设施（aHR = 0.76，95%CI 0.63-0.93，p = 0.006）。来自贫困家庭的营养不良儿童患复发性疾病的风险显著增加[（aHR = 1.15，95% CI 1.03-1.29，p = 0.016）和（aHR = 1.20，95%CI 1.05-1.37，p = 0.006）]。结论产妇洗手和改善卫生设施是保护性的，是公共卫生工作中的重要预防点。肥皂的可得性和利用率之间的差异表明了获取和知识的障碍，同时解决这些方面的方案可能是有益的。加强产妇教育和经济地位的保护，在这一人群中，这些研究结果支持多部门干预措施，以打击疾病。
IntroductionChildhood 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.MethodsA 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.Results3,045 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].ConclusionsMaternal 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.