Risk Factors For Diarrhea Research Articles

HYGIENE AS RISK FACTORS FOR DIARRHEA AMONG TODDLERS IN MULYOREJO PRIMARY HEALTH CENTER, SURABAYA

Background: Mulyorejo Primary Health Center (PHC) ranks 12th in Surabaya for diarrhea morbidity in toddlers, and there was one case of under-five deaths due to diarrhea in 2020. Purpose: This study aims to analyze hygiene as a risk factor for diarrhea in toddlers at Mulyorejo PHC, Surabaya. Methods: This study was conducted with a case-control design from December 2022 to October 2023. The case population was all toddlers aged 12-59 months at Mulyorejo PHC who had diarrhea at least in the last month. The control population consisted of toddlers aged 12-59 months living in the Mulyorejo PHC working area who had not experienced diarrhea for at least one month. The sample size amounted to 114, with a ratio of 1 1, using a simple random sampling technique. The independent variables were handwashing with soap (HWWS), food hygiene practices, latrine ownership, healthy latrines, feces disposal, and access to drinking water. Data were collected using questionnaires and observation. Chi-Square Test and Multiple Logistics Regression analyzed data. Results: HWWS (p=0.001), food sanitation (p=0.061), latrine ownership (p=0.032), and proper disposal of toddler feces (p=0.024) had a significant association with the incidence of diarrhea in toddlers at Mulyorejo PHC. Conclusion: Only the HWWS variable determines the incidence of diarrhea in toddlers at Mulyorejo PHC. Good handwashing habits with soap can prevent the occurrence of diarrhea in toddlers.

The Influence of Environmental Hygiene Factors and Water Consumption on Diarrhea: A Literature Review

Diarrhea is a major cause of morbidity and mortality in all age groups and regions in the world. Environmental factors and drinking water are risk factors for diarrhea. it is important to examine the influence of environmental hygiene factors and drinking water on the incidence of diarrhea. Therefore, this study presents information regarding the influence of environmental cleanliness and drinking water on diarrhea by reviewing empirical studies in previous and current research. In order to identify the influence of environmental cleanliness and drinking water factors on the incidence of diarrhea, a review of literature collected from the PubMed, Scopus, Google Scholar databases in English and Indonesian was carried out. Literature taken from the last 10 years, namely from 2014 to 2024 and in the form of full text publications. Environmental sanitation factors and good drinking water play an important role in determining how susceptible a person is to gastroenteritis or diarrhea. The availability of clean drinking water is the most important factor in preventing diarrhea. Lack of clean water has emerged as one of the main factors causing diarrhea. Access to proper and clean drinking water is obtained from protected drinking water sources, including tap water (taps), public hydrants, public taps, water terminals, rainwater reservoirs or protected springs and wells, drilled wells/pumps that are at least a distance away 10 meters from waste disposal facilities can prevent diarrhea.

A study to evaluate WASH interventions and risk factors of diarrhoea among children under five years, Anloga district, Ghana: A research protocol.

Good Water, Sanitation and Hygiene (WASH) practices, introduction of Rotavirus vaccination, zinc supplementation and improved nutrition have contributed significantly to the reduction of diarrhoea morbidity and mortality globally by 50%. In spite of these gains, diarrhoea still remains a leading cause of morbidity and mortality in children under-five. Causes of diarrhoea are multifaceted with many factors such as seasonality, behaviour, pathogenicity, epidemiology, etc. However, assessments on the causes of diarrhoea have generally been tackled in silos over the years focusing only on particular causes. In this study, we describe an integrated approach (evaluating WASH interventions implantation processes, assessing epidemiolocal risk factors, and identifying pathogens causing diarrhoea) for assessing determinants of diarrhoea. The study has ethical approval from the Ghana Health Service Ethical Review Committee (GHSERC:020/07/22). It will employ three approaches; a process evaluation and a case-control study and laboratory analysis of diarrhoea samples. The process evaluation will assess the detailed procedures taken by the Anloga district to implement WASH interventions. A desk review and qualitative interviews with WASH stakeholders purposively sampled will be done. The evaluation will provide insight into bottlenecks in the implementation processes. Transcribed interviews will be analysed thematically and data triangulated with reviews. A 1:1 unmatched case-control study with 206 cases and 206 controls to determine risk factors associated with diarrhoea in children under-five will also be done. Odds ratios at 5.0% significance level would be calculated. Stool samples of cases will be taken and tested for diarrhoea pathogens using Standard ELISA and TAQMAN Array Card laboratory procedures. It is expected that this framework proposed would become one of the robust approaches for assessing public health community interventions for diseases. Through the process evaluation, epidemiological case-control study and pathogen identification, we would be able to identify the gaps in the current diarrhoea assessments, come up with tailored recommendations considering the existing risk and assumptions and involve the relevant stakeholders in reducing the diarrhoea burden in a coastal setting in Ghana.

Effect of exclusive breastfeeding and other infant and young child feeding practices on childhood morbidity outcomes: associations for infants 0–6 months in 5 South Asian countries using Demographic and Health Survey data

BackgroundDespite growing evidence of the impacts of exclusively breastfeeding infants during the first 6 months of life on preventing childhood infections and ensuring optimal health, only a small number of studies have quantified this association in South Asia.MethodsWe analyzed data from the Demographic and Health Surveys in Afghanistan (2015; n = 3462), Bangladesh (2017–2018; n = 1084), India (2019–2021; n = 26,101), Nepal (2022; n = 581), and Pakistan (2017–2018; n = 1,306), including babies aged 0–6 months. Multivariate logistic regression models were used to determine the association between exclusive breastfeeding in the last 24 h and diarrhoea, acute respiratory infections, and fever in the two weeks before the survey. We also examined the association between other infant and young feeding indicators and these outcomes.ResultsInfants who were exclusive breastfed had decreased odds of diarrhoea in Afghanistan (AOR: 0.49, 95% CI 0.35, 0.70), India (AOR: 0.80, 95% CI 0.70, 0.91), and Nepal (AOR: 0.42, 95% CI 0.20, 0.89). Compared with infants who were not exclusive breastfed, infants who were exclusively breastfed were less likely to have fever in Afghanistan (AOR: 0.36, 95% CI 0.26, 0.50) and India (AOR: 0.75, 95% CI 0.67, 0.84). Exclusive breastfeeding was associated with lower odds of acute respiratory infections in Afghanistan (AOR: 0.57, 95% CI 0.39, 0.83). Early initiation of breastfeeding was protective against diarrhoea in India. Bottle feeding was a risk factor for diarrhoea in India and for fever in Afghanistan and India. Bottle feeding was also a risk factor for acute respiratory infection in Afghanistan and India.ConclusionsNot exclusive breastfeeding is a risk factor for diarrhoea, acute respiratory infections, and fever in some South Asian countries. These findings could have substantial implications for global and national efforts to increase exclusive breastfeeding rates. More support, advocacy, and action are required to boost breastfeeding rates as a crucial public health measure.

Household waste management and the incidence of diarrhea in toddler

Diarrhea is a big problem in developing countries that can cause death, especially in toddlers, and cause extraordinary events. There are three risk factors for Diarrhea: environmental, social demographics, and behavior. Environmental factors include waste management. This research aims to determine the relationship between waste management and the incidence of Diarrhea in toddlers. The research design is quantitative analytical with a cross-sectional research design. The population in this study is the total number of children under five in mid-2023, totaling 1428. The sampling technique was proportional random sampling. Data collection method using interviews. Data were analyzed statistically using the chi-square test. The research results showed that the majority of waste management was poor: 68 (87.2%) experienced Diarrhea, and the majority of waste management did not experience Diarrhea well, 12 (66.7%). The results of the data analysis show that the p-value = 0.002, so there is a significant relationship between household waste management and the incidence of Diarrhea in toddlers. The community should always practice clean and healthy living (PHBS), such as good waste management, washing hands with running water, and using soap, especially before feeding toddlers.

Analysis of risk factors and prognosis of diarrhea after renal transplantation.

Diarrhea is a prevalent complication after renal transplantation. To examine the risk factors for diarrhea after renal transplantation, evaluate their combined predictive values, and analyze the prognosis. Clinical data of patients who underwent allogeneic renal transplantation in the Second People's Hospital of Shanxi Province from January 2019 to March 2020 were retrospectively analyzed, cases were screened and grouped, independent risk factors for diarrhea after renal transplantation were analyzed by univariate analysis and multivariate analysis, and their predictive value was evaluated by receiver operating characteristic (ROC) curve. The survival time of recipient grafts in diarrhea and non-diarrhea groups were evaluated by Kaplan-Meier and log-rank test. We included 166 recipients in the study and the incidence of diarrhea was 25.9%; univariate and logistic regression multivariate analyses revealed that independent risk factors for diarrhea in recipients were that the type of renal transplant donor was DCD (donation after circulatory death), immunity induction was onducted with basiliximab + antithymocyte globulin (ATG), and ATG alone, the type of mycophenolic acid (MPA) used was mycophenolate mofetil capsules, and delayed graft function (DGF) occurred after transplantation. The ROC curve indicated that the combination of the four factors had good accuracy in predicting the occurrence of diarrhea in recipients. The graft survival rate two years after the operation in the diarrhea group was significantly lower than that in the non-diarrhea group. Diarrhea affected the two-year survival rate of the graft. The type of donor, immunity induction scheme, and the type of MPA and DGF were independent risk factors for diarrhea in recipients, and the combination of the four factors had good prognostic prediction value.

Prevalence and risk factors of childhood diarrhea among wastewater irrigating urban farming households in Addis Ababa.

Childhood diarrhea is one of the major contributors to the morbidity of under-five children in Ethiopia. Although researchers determine the risk factors varyingly, the exposure route to the pathogens is usually complicated. This study aims to investigate the prevalence and risk factors of diarrhea among children under the age of five among wastewater irrigation farming households in Addis Ababa, Ethiopia. Cross-sectional study was conducted among 402 farming households from November 2021 to February 2022. Data was collected using a face-to-face interviewer-administered questionnaire. Stata version 14 software was used to analyze data. Factors associated with the prevalence of diarrhea was identified using binary logistic regression. Multivariable analysis was carried out to determine an adjusted odds ratio at a confidence level of 95% and level of significance at 0.05. The overall prevalence of under-five children diarrheal cases was 22.3%. The odds of diarrhea are associated with a multitude of variables. Major wastewater-related determinants associated with diarrhea are body washing with irrigation water [AOR: 37.7, 95%CI (3.1, 358)], contaminated cloth with irrigation water [AOR:10.8,95%CI(0.6, 205)], use of protective clothing during farm work [28.9,95%CI (3.9, 215)], use of farm work cloths at home [AOR: 31.7, 95%CI (4.4, 226)], and bringing unwashed farm tools to home [94 (5.7, 1575)]. The high prevalence of under-five children diarrheal disease among wastewater irrigation households was strongly associated with factors related to occupational exposure. Thus, to decrease childhood diarrheal among urban agriculture farmers, appropriate precautions need to be taken.

Risk Factor of Child Diarrhea in Indonesia: A Systematic Review

Bakcground: Diarrhea is the leading cause of death among children worldwide, including in Indonesia. However, there is no scientific research on the most common risk factors for diarrhea among children in Indonesia. A systematic literature review was conducted to highlight the most predisposing risk factors of diarrhea based on the epidemiological triangle, in order to improve preventive measures by society to reduce the incidence of childhood diarrhea. Methods: A systematic review of observational studies without limitation of year of publication was performed in 2023 based on PRISMA protocol. Results: A total of 2607 studies were identified from the Pubmed database, only 9 studies were extracted and assessed using the STROBE method. The risk factors were divided into 3 categories: environmental, host and other, to follow the rule of the epidemiologic triangle of disease. The highest odds ratios were found for the factor "child defecation in open places" (OR=10.47) from the environmental category and for the factor "child eating by hand" (OR=5.6) from the host category. Lower maternal education from the host category was also influential (OR=1.52). Conclusion: Improper public disposal of child feces, child behavior of eating with hand and low maternal education are the most significant contributing risk factors of child diarrhea in Indonesia.

Effects of prebiotics on the gut microbiota in vitro associated with functional diarrhea in children.

Diarrhea is among the top five causes of morbidity and mortality in children. Dysbiosis of the gut microbiota is considered the most important risk factor for diarrhea. Prebiotics have shown efficacy in treating diarrhea by regulating the balance of the gut microbiota in vivo. In this study, we used an in vitro fermentation system to prevent the interference of host-gut microbe interactions during in vivo examination and investigated the effect of fructo-oligosaccharides (FOS) on gut microbiota composition and metabolism in 39 pediatric patients with functional diarrhea. 16S rRNA sequencing revealed that FOS significantly improved α- and β-diversity in volunteers with pediatric diarrhea (p < 0.05). This improvement manifested as a significant increase (LDA > 2, p < 0.05) in probiotic bacteria (e.g., Bifidobacterium) and a significant inhibition (LDA > 2, p < 0.05) of harmful bacteria (e.g., Escherichia-Shigella). Notably, the analysis of bacterial metabolites after FOS treatment showed that the decrease in isobutyric acid, isovaleric acid, NH3, and H2S levels was positively correlated with the relative abundance of Lachnoclostridium. This decrease also showed the greatest negative correlation with the abundance of Streptococcus. Random forest analysis and ROC curve validation demonstrated that gut microbiota composition and metabolites were distinct between the FOS treatment and control groups (area under the curve [AUC] > 0.8). Functional prediction using PICRUSt 2 revealed that the FOS-induced alteration of gut microbiota was most likely mediated by effects on starch and sucrose metabolism. This study is the first to evince that FOS can modulate gut microbial disorders in children with functional diarrhea. Our findings provide a framework for the application of FOS to alleviate functional diarrhea in children and reduce the use of antibiotics for managing functional diarrhea-induced disturbances in the gut microbiota.

Determinants of the Risk Factors for Diarrhea in Toddlers at the Limboto Health Center, Gorontalo Regency

Parenting is one of the factors that are closely related to the growth and development of children, including several things, namely food, which is a source of nutrition, vaccination, exclusive breastfeeding, treatment when sick, and environmental cleanliness and clothing. This study aims to determine the effect of maternal care patterns for stunting in children aged 0-23 months in the Gorontalo District. This type of descriptive-analytical research has a population of 1614 mothers under two and a sample of 188 mothers under two. The research results were the effect of parenting style on the incidence of stunting in children aged 0-23 months (p-value=0.022), parenting health, and sanitation parenting patterns on the incidence of stunting in children aged 0-23 months (p- value = 0.000). The most influential factor is the factor of healthy parenting (p-value = 0.001). This study concludes that the mother’s parenting style influences the incidence of stunting in children aged 0-23 months in Gorontalo Regency, with the most dominant influencing factor, namely health parenting factors. Future researchers are expected to be able to conduct further research on stunting outside of other variables besides maternal parenting.

Determinan Kejadian Diare di Kelurahan Tangkahan, Medan Labuhan

Diarrhea is the second cause of death in children under the age of 5, which is around 760,000 cases/year. In Indonesia, diarrhea affects all age groups with the most cases occurring in children under 5 years of age, which is around 16.7%. There are several factors related to the incidence of diarrhea, namely the limited supply of clean water, water contaminated with feces, lack of sanitation facilities, unhygienic disposal of feces, poor personal and environmental hygiene, and inappropriate food preparation and storage. This study aims to determine the risk factors for diarrhea that occur in the community in Tangkahan Village, Medan Labuhan in 2022. The type of research used is quantitative with descriptive analytic methods and uses a cross sectional approach. Taking respondents with the Cluster Sampling technique as many as 210 respondents. The statistical test in analyzing the research data uses the Chi-square method. The results of this study indicate that there is a relationship between unhealthy food consumption (p-value = 0.029) and the incidence of diarrhea in Tangkahan Village in 2022.

Analysis of community perspectives regarding the hygiene-sanitation and socio-economic factors influencing the occurrence of diarrhea in toddlers: A literature review

Diarrhea is a disease that causes the second highest morbidity and mortality rate in toddlers after pneumonia. Poor and developing countries generally exhibit high incidence rates of diarrhea, thus diarrhea is often associated with poor socio-economic conditions and inadequate sanitation. Understanding the caregivers' perspectives on the factors contributing to diarrhea is crucial for the prevention and management of diarrhea, aiming to reduce the morbidity and mortality rates among toddlers. The aim of this research is to analyze the community perspectives on the factors of hygiene-sanitation and socio-economic factors influencing the occurrence of diarrhea in toddlers. The research methodology employed is a literature review, which assesses the occurrence of diarrhea in toddlers based on both hygiene-sanitation factors and socio-economic factors from the community's perspective. The data used consists of a minimum of 10 scientific journals obtained from Google Scholar and ResearchGate databases. The research findings indicate that, in terms of hygiene-sanitation, the factors contributing to diarrhea include the lack of cleanliness and hygiene practices implemented by caregivers of toddlers, untreated or unprotected water sources, inadequate availability of water, low utilization of sanitation facilities, unhygienic living conditions, and water contamination during the rainy season. Meanwhile, in terms of socio-economic factors, it is influenced by the knowledge and education of caregivers, financial status, resource limitations, and community acceptance of interventions for improving water, sanitation, and hygiene. From these results, it can be concluded that there is a correlation between the risk factors of diarrhea and the occurrence of diarrhea in toddlers, as observed from both hygiene-sanitation and socio-economic perspectives.

Analysis of prevalence and risk factors of diarrhea in dairy calf using a rapid diagnostic kit in Gyeonggi province

Analysis of prevalence and risk factors of diarrhea in dairy calf using a rapid diagnostic kit in Gyeonggi province

Risk Factors of Diarrhea in Toddlers at Andi Makkasau Hospital Parepare City

Diarrheal disease is a major problem in developing countries, including Indonesia. Aside from being a cause of death, diarrhea is also a major cause of malnutrition which can lead to death. Besides being caused by malnutrition, in terms of public health science, there are other factors related to the incidence of diarrhea. The dominant factors causing diarrhea in Indonesia are clean water, sanitation, and feces disposal facilities. This study aimed to determine the risk factors for diarrhea in toddlers at Andi Makkasau Hospital, Parepare City. Analytical survey research methods and case-control study designs. The sampling technique used purposive sampling. This study's sample was all children under five treated at Andi Makkasau Hospital, Parepare City, namely as many as 50 toddlers. The sample was divided into two groups, where 25 toddlers were in the case group (diarrhea), and 25 were in the control group (no diarrhea). Data analysis used the Odds Ratio (OR) test. The results obtained from the risk factors for diarrhea in toddlers are the availability of clean water (OR=1.263), hand washing habits (OR=1.658), food sanitation (OR=3.273), availability of healthy latrines (OR=17.250) and management garbage (OR=5,762). This study concludes that clean water, hand washing habits, food sanitation, availability of healthy latrines, and waste management are risk factors for diarrhea in toddlers at Andi Makkasau Hospital, Parepare City. Parents are expected to improve clean living behavior to prevent diarrheal disease in toddlers.

Incidence Rate and Risk Factors for Diarrhea in Yarsi Medical Faculty Students Batch 2019

Introduction: Diarrhea is a bowel movement with a mushy or liquid consistency, which can even be water only with a frequency more often than usual (usually three or more times) in one day (Depkes RI 2011). The prevalence of diarrhea in Indonesia according to its characteristics based on the 2018 Riskesdas recorded 18,225 (9%) children with diarrhea aged &lt;1 year, 73,188 (11.5%) children with diarrhea aged 1-4 years, 182,338 (6.2%) children with diarrhea aged 5-14 years, and 165,644 (6.7%) children with diarrhea aged 15-24 years (Ministry of Health, 2019). Diarrhea can occur due to factors such as open defecation, hand washing without soap, food and beverage management, waste safety, and liquid waste safety.Methodology: This study is a correlational study with a cross sectional design. The study population was YARSI medical students. The sampling technique was purposive sampling. The total sample was 166 students.Results: In student respondents, the results showed that the incidence rate of diarrhea in medical students of Yarsi in the last 3 months was quite high because the majority had diarrhea. It is also known that several risk factors studied have a relationship with the incidence rate of diarrhea, namely hand washing behavior and also the source of water drunk. Meanwhile, the level of knowledge, gender, and location of food purchases are not related to the incidence of diarrhea in students.Conclusion: The results of the study found the prevalence of diarrhea and several risk factors associated with the incidence of diarrhea.

Long-term quality of life and nutritional results of stomach-preserving surgery after sentinel node evaluation in patients with early gastric cancer: A multicenter, randomized phase 3 trial (SENORITA).

4070 Background: In the SENORITA trial, laparoscopic sentinel node navigation surgery (LSNNS) showed no significant difference in overall and disease specific survivals compared with laparoscopic standard gastrectomy (LSG). Here, we present the effect of stomach preservation surgery on QoL and nutritional outcomes, and identify risk factors affecting QoL in stomach preservation surgery. Methods: SENORITA was a prospective multicenter randomized trial. Patients diagnosed with early gastric cancer of 3 cm or less were randomly allocated (1:1) to LSNNS or LSG. The primary endpoint was 3-year disease-free survival. This analysis focuses on long-term quality of life and nutritional outcomes of patients who finally underwent stomach-preservation surgery in the LSNNS group. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and stomach module (STO22) at 3, 12, 24, and 36 months after surgery. Linear mixed model analyses were used to evaluate differences between treatment groups. This trial is registered with ClinicalTrials.gov, NCT01804998. Results: From March 2013 to March 2017, a total of 580 patients were randomly assigned in the SENROTA trial. Among them, 258 patients underwent sentinel node navigation surgery and 198 finally underwent stomach preservation surgery. QoL data was available in 194 patients and compared with those of 257 patients who underwent standard gastrectomy. The stomach-preservation group had better QoL in physical function, dyspnea, and appetite loss of C30 and dysphagia, pain, reflux symptoms, eating restriction, anxiety, taste change, body image, and total score of STO22. Regarding nutritional outcomes, body mass index, hemoglobin, protein, and albumin levels were significantly higher in the stomach-preservation group than in the gastrectomy group. In multivariate analyses, tumor location (greater curvature) was an independent favorable factor affecting global health status, reflux symptoms, eating restriction, and total score of STO22 at 3 months in the stomach-preservation group. Segmental resection was a risk factor for diarrhea and eating restriction at postoperative 3 year. Conclusions: The stomach-preservation surgery had better long-term QoL and nutritional outcomes compared with standard gastrectomy. These findings can help decision making about treatment for patients with early gastric cancer, especially or elderly or nutritionally high risk patients. Clinical trial information: NCT01804998 .

Risk of Diarrhea in Infants on Breastfeeding Exclusive and Non-Exclusive Breastfeeding

Diarrheal disease is a significant risk factor for morbidity and mortality worldwide in children under five years of age. The study aimed to analyze the risk factors for diarrhea in infants with and without exclusive breastfeeding. The research approach used a case-control analysis with observational analytic methods. The population was all mothers who gave birth to babies aged 6-12 months. By determining the sample using the Lemeshow formula, the example was 152 babies with details of 76 cases and 76 controls. The results of the chi-square test showed (p-value= 0,000), which means that there was an effect of exclusive breastfeeding and non-exclusive breastfeeding with the incidence of diarrhea in infants with a value of OR=12,065, which means that mothers who did not breastfeed their babies 12,065 times more at risk of suffering from diarrhea higher inversely compared to mothers who exclusively breastfeed their babies. In conclusion, infants who are not exclusively breastfed are at risk of suffering from diarrhea than infants who are exclusively breastfed.

Hubungan Kepemilikan Jamban dengan Kejadian Diare di Desa Bagan Laguh, Kecamatan Bunut, Riau

Diarrhea is an endemic disease that can cause Extraordinary Events (KLB). In 2017, there were 21 occurrences of diarrhea spreading across 12 provinces with a total of 1,725 patients and 34 deaths (CFR 1.97%). There are three risk factors for diarrhea, namely individual characteristics, preventive behavior, and environment. This research is to determine the correlation between toilet ownership and the occurrence of diarrhea in Bagan Laguh Village, Riau. The research population was all residents of Bagan Laguh Village listedin the Integrated Social Welfare Data (DTKS) and 59 residents were selected as the research sample using the simple random sampling technique. The primary data were obtained from the questionnaires filled out by the respondents and then analyzed using the Chi-Square test. The results of this research indicated that respondents' level of education and income are not significantly correlated with the occurrence of diarrhea(P values= 0.115 and 0.421 respectively); however, respondents' knowledge, attitude, and toilet ownership are correlated with the occurrence of diarrhea significantly (P-values = 0.007, 0.001, and 0.002 respectively).

Development and validation of a predictive model for diarrhea in ICU patients with enteral nutrition.

The aim of this study was to build and validate a risk prediction model for diarrhea in patients in the intensive care unit (ICU) receiving enteral nutrition (EN) by identifying risk factors for diarrhea in these patients. The risk factors for diarrhea were analyzed to build a prediction model for EN diarrhea in patients in the ICU based on the data collected from 302 patients receiving EN in the ICU. Subsequently, the model was validated by the area under the curve. In this study, the collected data were divided into two groups: a derivation cohort and a validation cohort. The results showed that 54.03% (114) of patients had diarrhea in the derivation cohort and 56.04% (51) of patients had diarrhea in the validation cohort. Moreover, days of EN, high urea nitrogen levels, probiotics, respiratory system disease, and daily doses of nutrient solution were included as predictive factors for diarrhea in patients receiving EN in the ICU. The predictive power of the model was 0.81 (95% CI, 0.752~0.868) in the derivation cohort and 0.736 (95% CI, 0.634~0.837) in the validation cohort. In accordance with the predictive factors, the model, characterized by excellent discrimination and high accuracy, can be used to clinically identify patients in the ICU with a high risk of EN diarrhea.

Diarrhea illness in livestock keeping households in Cambodia: An analysis using a One Health framework

BackgroundMost of human diarrheal pathogens are zoonotic, and transmission of the pathogens can occur by contaminated food, water, environment and direct contact with animals especially for livestock keepers. Yet little is known of the relative importance of different risk factors especially in under-studied countries. The objectives of this study were to identify risk factors for diarrhea in livestock keepers in Cambodia and detect diarrhea-causing pathogenic bacteria in both humans and livestock within a One Health approach. Of special interest were the links between diarrhea and food consumption and livestock-keeping.Materials and methodsWe used an existing dataset from a questionnaire survey conducted in 400 livestock farms in Prey Veng and Kampot Prefectures between February and March 2013 as well as laboratory results on bacterial isolation from fecal and swab samples from livestock and poultry, and human stool samples. Laboratory results were available for up to three animals of each species kept by a household, and for up to three human samples from households reporting at least one case of human diarrhea in the previous 2 weeks. Presence of Escherichia coli, Shigella spp. and Salmonella spp. was investigated in both animal and human samples, in addition to Aeromonas spp., Vibrio spp. and Plesiomonas spp. in animal samples and Campylobacter spp. in human samples. Univariable and multivariable risk factor analyses were performed by generalized linear mixed model.ResultsHousehold-level diarrhea incidence rate was 9.0% (36/400). The most statistically significant factor associated with diarrhea in multivariable analysis was water treatment for drinking and cooking (OR = 0.33, 95%CI: 0.16–0.69, p = 0.003), followed by number of days consuming egg within 2 weeks (OR = 1.16, 95%CI: 1.04–1.29, p = 0.008), number of children under 5 years old (OR = 1.99, 95%CI: 1.14–3.49, p = 0.016) and keeping poultry (OR = 0.36, 95%CI: 0.14–0.92, p = 0.033). Animal samples for bacterial culture test were collected at 279 cattle, 165 pig and 327 poultry farms, and bacteria were detected from 6 farms with the isolation of Escherichia coli O157 (non H7) from 1 cattle and 1 pig sample, Aeromonas caviae from 1 pig sample and Salmonella spp. from 3 chicken samples. In human samples, 17 out of 67 individual samples were positive for the culture test, detecting Escherichia coli O157 (non H7) from 7 samples and Shigella spp. from 10 samples. None of the households where target bacteria were detected from animal samples had human samples collected due to lack of diarrhea episodes in the household.ConclusionsIt has often been hypothesized that keeping livestock may increase the incidence of diarrhea through multiple pathways. Contrary to this, we found livestock-keeping was not associated with increased risk, but food-related behavior and children under 5 years of age were strongly associated with increased risk. We discuss mediating and confounding factors and make recommendations for reducing the burden of diarrheal disease in Cambodia and more widely in low- and middle-income countries.