Abstract
The causes of infectious diarrhea among the migrant worker population in Qatar are not well understood. We conducted a prospective observational study to understand the demographic and clinical characteristics and infectious causes of diarrhea among migrant workers in Doha, Qatar. A total of 126 male workers presenting to the Qatar Red Crescent Worker's Health Center outpatient clinic or emergency department were studied over a 5-month period in 2015–2016. Epidemiologic surveys were administered to all subjects and the prevalence of 22 different stool pathogens was determined using multiplex polymerase chain reaction (PCR) (FilmArray® Gastrointestinal PCR). A target pathogen was identified in 62.7% of subjects. Enteropathogenic Escherichia coli was the most prevalent pathogen and was detected in 24.6% of subjects, followed by Salmonella (22.2%), enteroaggregative E. coli (15.1%), Giardia lamblia (9.5%), and enterotoxigenic E. coli (8.7%). Multiple pathogens were identified in 49.3% of positive stool samples. In a multivariable analysis, the presence of a heart rate ≥ 90 (adjusted odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.4–10.0) and > 5 fecal leukocytes/high-power field (adjusted OR = 2.8, 95% CI = 1.2–7.0) were significant predictors of detecting an acute inflammatory pathogen by PCR. Use of multiplex PCR enabled the detection of gastrointestinal pathogens in a high proportion of cases, illustrating the utility of this diagnostic tool in epidemiologic studies of infectious diarrhea.
Highlights
Infectious diarrhea is an important cause of morbidity and mortality worldwide, resulting in considerable economic and public health burdens in both developed and developing countries.[1,2,3,4] In Qatar and the greater Gulf region, few studies have been undertaken to characterize the epidemiology of infectious diarrhea.[5,6] This is the case among Qatar’s migrant worker population, over half a million of whom are young and middle-aged men from the Indian subcontinent and other Asian countries who have come to work in Qatar’s surging construction sector.[7]
Most were from the Indian subcontinent, and 6.3% reported having returned to Qatar from their home country within 21 days of clinical presentation for diarrhea
Our study offers a detailed picture of the epidemiology of infectious diarrhea in the migrant worker population in
Summary
Infectious diarrhea is an important cause of morbidity and mortality worldwide, resulting in considerable economic and public health burdens in both developed and developing countries.[1,2,3,4] In Qatar and the greater Gulf region, few studies have been undertaken to characterize the epidemiology of infectious diarrhea.[5,6] This is the case among Qatar’s migrant worker population, over half a million of whom are young and middle-aged men from the Indian subcontinent and other Asian countries who have come to work in Qatar’s surging construction sector.[7]. Data from Qatar’s Ministry of Public Health suggest that a large proportion of the country’s annual foodborne disease outbreaks occur in this community. From February 2013 to December 2014, for example, 17 suspected foodborne disease outbreaks were reported in Qatar and 15 of them occurred in the migrant worker community. Nearly 70% of 2,612 reported cases of foodborne illness from 2010 to 2014 occurred among the 20- to 39-year-old male migrant worker demographic (Qatar Ministry of Public Health, unpublished data). Concerns have been raised over the possibility of underdetection of foodborne disease outbreaks in the migrant worker community and over the possibility of imported gastrointestinal pathogens. The unprecedented mass gathering anticipated during 2022 World Cup further motivates the need to understand the current epidemiology of diarrheal diseases in the country
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