Diarrhea Morbidity Research Articles

Outcomes and implications of diarrhea in patients with SARS-CoV-2 infection

Background and aims Diarrhea was not uncommon in patients with coronavirus disease 2019 (COVID-19), but the significance remains undetermined. Methods This retrospective study included 157 diarrhea cases form 564 hospitalized COVID-19 patients who were admitted to Wuhan Union Hospital from January 20 to February 29, 2020. Clinical characteristics, the course and the outcome of patients with diarrhea were analyzed. The correlation between diarrhea and fecal presence of coronavirus was also determined. Results The overall morbidity of diarrhea was 27.8% (157/564) in COVID-19 patients. Among them, 38 cases presented only with diarrhea, and 119 cases in both diarrhea and respiratory symptoms. Patients with diarrhea and respiratory symptoms had higher levels of inflammatory activity, longer hospital stay (27.5 vs. 23.0 vs. 22.0 days, p = .029) and higher odds ratio of mortality (3.2 times and 2.2 times, respectively) than those with diarrhea only or respiratory symptoms only. However, patients with diarrhea had longer time from onset to admission (14.5 days vs. 11.0 days, p = .04), higher positive viral RNA in stool (80.0% vs. 52.4%, p = .016) than those with both diarrhea and respiratory symptoms. Conclusions Diarrhea caused by high enteric viral burden may lead to long course and poor outcome in COVID-19 patients. The patients with diarrhea and respiratory symptoms were prone to serious condition, and had worse outcomes. However, the patients with diarrhea alone showed mild illness but delayed health-seeking.

Analysis of Priority of Health Problems in Sleman District Yogyakarta

Health development is carried out through the implementation of improvements through: Health efforts, health financing, human resources, pharmaceuticals, medical devices, foods, health information management, and community empowerment. Priority analysis of health problems is the basic activity used to plan health programs. This study was intended to describe the priority of health problems in Sleman District, Indonesia. This study used descriptive design. Data collected through assessment from documentation and interviews. Interviews were conducted with health workers at the Sleman District Health Office. Health problems measured their rank using the Hanlon method. In this valuation method is based on four components, namely the magnitude of the problem, the seriousness of the problem, the estimated effectiveness of the solution, and PEARL (propriety, economy, acceptability, availability of resources, legality). The results of this study were found in five main health problems in Sleman, namely; (1) Measles, there was an outbreak even though measles immunization coverage 90% nationally and at least 80% at the district level (Score 37.5). (2) Maternal Mortality Rate (83.30 per 100,000 live births in 2014, 63.27 per 100,000 live births in 2013 (score 36). (3) DHF-related deaths were 4 people with IR of 50.6 per 100,000 population (score 24) (4) Morbidity of diarrhea in 2014 was 214 per 1000 inhabitants (score 22). (5) In 2014 new cases of smear + TB were 442 people, with a total number of cases (prevalence) 546 (score 20). The five main health problems in Sleman District were measles, maternal mortality, DHF, diarrhea, and tuberculosis. Measurements with the Hanlon Method are easy to do, and the costs incurred are relatively low, so they can be routinely carried out in Sleman District. Keywords: analysis, health, problem priority, Sleman

Exploring the association between childhood diarrhea and meteorological factors in Southwestern Ethiopia

Childhood diarrhea has been one of the major public health concerns in countries that have limited resources like Ethiopia. Understanding the association between childhood diarrhea and meteorological factors would contribute to safeguard children from adverse health effects through early warning mechanisms. Thus, this study aimed at exploring the association between childhood diarrhea and meteorological factors to enable reducing health risks. A retrospective study design was used to explore the association between meteorological factors and childhood diarrhea in southwestern Ethiopia from 2010 to 2017. Mann Kendall trend test and Spearman's correlation were computed to test the association of childhood diarrhea and meteorological factors. The space-time permutation model was used to identify the risky periods, seasons with most likely clusters, and high childhood diarrhea. Similarly, a negative binomial regression model was fitted to determine the predictability of meteorological factors for childhood diarrhea. The highest childhood diarrhea morbidity was 92.60 per 1000 per under five children. The risk of childhood diarrhea increased by 16.66% (RR: 1.1666; 95% CI: 1.164–1.168) per increase in 1 °C temperature. Furthermore, rainfall was found to be a significant risk factor of childhood diarrhea, with 0.16% (RR: 1.00167; 95% CI: 1.001306–1.001928) per 1 mm increase in rainfall. The temperature was positively correlated with the occurrence of childhood diarrhea. But the association with rainfall showed spatial variability. The space-time permutation model revealed that dry season was found to be a high-risk period with excess childhood diarrhea. The results showed that the observed association between meteorological factors and childhood diarrhea could be used as evidence for early warning systems for the prevention of childhood diarrhea.

A comparative study on the effect of household water treatment on diarrhoea morbidity among under-fives in Plateau State, Nigeria using two treatment modalities

Background: Consumption of unsafe water contributes to diarrhoeal burden in sub-Sahara Africa. This burden can be reduced by simple and affordable methods of household water treatment. The study aims at comparing the effect of two of such methods on diarrheal burden among under-fives in rural communities of Plateau State.
 Methodology: A community-based quasi experimental study was conducted among 202 underfive-caregiver pairs in two selected rural communities of Plateau State, involving household water treatment with flocculant-disinfectant powder in intervention group and sodium hypochlorite solution in control group respectively. History of diarrhoea before intervention, at 2 weekly intervals during the intervention and after intervention was assessed. Data obtained was analyzed using SPSS version 23. Prevalence and incidence of diarrhoea were calculated and compared among the two groups.
 Result: Diarrhoea prevalence at pre-intervention was 19.6% in flocculant-disinfectant group and 17.0% in sodium hypochlorite group. At post intervention, the prevalence reduced significantly by 94.7% (19.6% to 1%) in intervention group and by 76.5% (17% to 4.2%) in control group. There was no statistical significant difference in the prevalence of diarrhoea between the two groups, however, diarrhoea incidence in the sodium hypochlorite group (1.12 episode per child per year) was significantly higher than the incidence in the flocculant-disinfectant group (0.59 episodes per child per year) with a risk-ratio of 1.93 (95% CI: 1.037 - 3.703).
 Conclusion: Household water treatment with flocculant-disinfectant reduced diarrhoea burden better than sodium hypochlorite. This technology should be made more available and assessible to rural communities where diarrhea burden is high.

Rapid and efficient detection methods of pathogenic swine enteric coronaviruses.

Porcine enteric coronaviruses (CoVs) cause highly contagious enteric diarrhea in suckling piglets. These COV infections are characterized by clinical signs of vomiting, watery diarrhea, dehydration, and high morbidity and mortality, resulting in significant economic losses and tremendous threats to the pig farming industry worldwide. Because the clinical manifestations of pigs infected by different CoVs are similar, it is difficult to differentiate between the specific pathogens. Effective high-throughput detection methods are powerful tools used in the prevention and control of diseases. The immune system of piglets is not well developed, so serological methods to detect antibodies against these viruses are not suitable for rapid and early detection. This paper reviews various PCR-based methods used for the rapid and efficient detection of these pathogenic CoVs in swine intestines.Key points Swine enteric coronaviruses (CoVs) emerged and reemerged in past years.Enteric CoVs infect pigs at all ages with high mortality rate in suckling pigs.Rapid and efficient detection methods are needed and critical for diagnosis.

A Stepped Wedge Cluster-Randomized Trial Assessing the Impact of a Riverbank Filtration Intervention to Improve Access to Safe Water on Health in Rural India

Sustainable and low-cost methods for delivery of safe drinking water in resource-limited settings remain suboptimal, which contributes to global diarrhea morbidity. We aimed to assess whether delivery of riverbank filtration-treated water to newly installed water storage tanks (improved quality and access, intervention condition) reduced reported diarrhea in comparison to delivery of unfiltered river water (improved access alone, control condition) in rural Indian villages. We used a stepped wedge cluster-randomized trial (SW-CRT) design involving four clusters (villages). Selection criteria included village size, proximity to a river, and lack of existing or planned community-level safe water sources. All adults and children were eligible for enrollment. All villages started in the control condition and were sequentially randomized to receive the intervention at 3-month intervals. Our primary outcome was 7-day-period prevalence of self- or caregiver-reported diarrhea, measured at 3-month intervals (five time points). Analysis was by intention to treat. Because blinding was not possible, we incorporated questions about symptoms unrelated to water consumption to check response validity (negative control symptoms). We measured outcomes in 2,222 households (9,836 participants). We did not find a measurable reduction in diarrhea post-intervention (RR: 0.98 [95% CI: 0.24-4.09]); possible explanations include low intervention uptake, availability of other safe water sources, low baseline diarrheal prevalence, and reporting fatigue. Our study highlights both the difficulties in evaluating the impact of real-world interventions and the potential for an optimized SW-CRT design to address budgetary, funding, and logistical constraints inherent in such evaluations.

Maternal Diarrhea and Antibiotic Use are Associated with Increased Risk of Diarrhea among HIV-Exposed, Uninfected Infants in Kenya.

.HIV-exposed, uninfected (HEU) children are a growing population at particularly high risk of infection-related death in whom preventing diarrhea may significantly reduce under-5 morbidity and mortality in sub-Saharan Africa. A historic cohort (1999–2002) of Kenyan HEU infants followed from birth to 12 months was used. Maternal and infant morbidity were ascertained at monthly clinic visits and unscheduled sick visits. The Andersen–Gill Cox model was used to assess maternal, environmental, and infant correlates of diarrhea, moderate-to-severe diarrhea (MSD; diarrhea with dehydration, dysentery, or related hospital admission), and prolonged/persistent diarrhea (> 7 days) in infants. HIV-exposed, uninfected infants (n = 373) experienced a mean 2.09 (95% CI: 1.93, 2.25) episodes of diarrhea, 0.47 (95% CI: 0.40, 0.55) episodes of MSD, and 0.34 (95% CI: 0.29, 0.42) episodes of prolonged/persistent diarrhea in their first year. Postpartum maternal diarrhea was associated with increased risk of infant diarrhea (Hazard ratio [HR]: 2.09; 95% CI: 1.43, 3.06) and MSD (HR: 2.89; 95% CI: 1.10, 7.59). Maternal antibiotic use was a risk factor for prolonged/persistent diarrhea (HR: 1.63; 95% CI: 1.04, 2.55). Infants living in households with a pit latrine were 1.44 (95% CI: 1.19, 1.74) and 1.49 (95% CI: 1.04, 2.14) times more likely to experience diarrhea and MSD, respectively, relative to those with a flush toilet. Current exclusive breastfeeding was protective against MSD (HR: 0.30; 95% CI: 0.15, 0.58) relative to infants receiving no breast milk. Reductions in maternal diarrhea may result in substantial reductions in diarrhea morbidity among HEU children, in addition to standard diarrhea prevention interventions.

Disease burden and risk factors of diarrhoea in children under five years: Evidence from Kenya’s demographic health survey 2014

ObjectiveThis study aimed at examining the socio-demographic, environmental and behavioural determinants of diarrhoea in children under five years in Kenya. MethodsThe study entailed an analysis of secondary data from the Kenya Demographic Health Survey (DHS) 2014 using STATA Corp 2010. A total of 19,889 children <5 years were in the study, out of whom 2,906 had diarrhoea in the last two weeks prior to the survey. Descriptive analysis of independent variables and logistic regression model was used to analyse risk factors associated with diarrhoea in children <5 years. ResultsThe most significant risk factors (p < 0.05) associated with diarrhoea morbidity in children <5 years were child age (AOR 2.26 95% CI 1.64, 3.11), low level of caregiver’s education (AOR 1.45 95% CI 1.11, 1.90) and unsafe disposal of children’s faeces (AOR 1.29 95% CI 1.03, 1.61). Wealthier households (AOR 0.83 95% CI 0.68, 1) were protective for diarrhoea in children <5 years. ConclusionIncreasing caregiver education, wealthier households and promoting hygienic behaviours in poor households were associated with reducing diarrhoea. Programmes aimed at reducing diarrhoea may achieve better results in targeting caregivers with children in high risk age cohorts of 6–23 months.

SUPLEMENTASI VITAMIN A PADA ANAK DIARE USIA 12– 59 BULAN

Diarrhea is the leading cause of infant mortality in Indonesia. Data from the Bantul District Health Office showed that the diarrhea morbidity rate in 2015 was 4.57 per 1000 population. World Health Organization launched program to reduce morbidity and mortality due to pneumonia and diarrhea by recommending supplementation of vitamin A as an effort to maintain health since baby was born. The purpose of this study was to determine the correlation of vitamin A supplementation with the incidence of diarrhea in children aged 12 - 59 months in Kasihan 1 Public Health Center. This study was used case control design with a retrospective approach. The number of control and case group were 44 children of each. Researcher collected data of children aged 12 - 59 months who suffered diarrhea last 6 months then conducted a home visit to ask about the history of vitamin A supplementation in children. There was no statistically significant correlation between vitamin A supplementation and the incidence of diarrhea in children aged 12 - 59 months. Health workers especially nurses need to increase public awareness of vitamin A supplementation to children under five years old as a form of support for government program to prevent diarrhea.

Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria.

Introductiondiarrhoea remains a public health problem globally with majority of diarrhoea morbidity and mortality occurring in low resource settings. This study assessed the prevalence of diarrhoea and factors associated with diarrhoea in a rural community in Enugu, South East Nigeria.Methodsa community-based cross-sectional survey was conducted between May and June, 2017. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhoea history was obtained from 534 community residents using a structured interviewer administered questionnaire. Data were analyzed using descriptive statistics, Chi-square and logistic regression tests at 5% level of significance.Resultsprevalence of diarrhoea in the two weeks preceding the study was 7.47% and 10.77% among all ages and children younger than five years respectively. Of 469 residents aged five years and above, 206 (43.92%) accessed source of drinking water within 30 minutes round trip walking distance from their households, 275 (58.64%) practiced open defecation while 456 (97.23%) and 455 (97.01%) reported washing hands with soap or ash and water before eating and after using the toilet respectively. Two or more households sharing a toilet facility [AOR = 4.78 (95% CI 2.03-11.24)] was a risk factor for diarrhoea while washing hands with soap or ash and water before eating [AOR = 0.23 (95% CI 0.06-0.90)] and after using the toilet [0.16 (95% CI 0.04-0.55)] protected against diarrhoea.Conclusionincreasing access to improved sanitary sewage disposal methods and promoting hand washing with soap and water at critical moments would improve diarrhoeal disease control.

Prevalence of Diarrheal Disease Among Under-Five Children in Worabe Town, Southern Ethiopia

<i>Background:</i> Globally, childhood diarrheal diseases accounts for 18% of childhood death. Diarrhea was most common among children of age 6-23 months. It is the second most common cause of child deaths next to pneumonia. <i>Objective:</i> To assess the determinants of diarrheal disease among under -five years of children in Worabe town Silte zone, Southern Ethiopia. <i>Methodology:</i> A community based cross-sectional study was conducted in 02 kebele, Worabe town from April to June 2018. Systematic random sampling method was used to get samples. Data was collected using questionnaire developed from different literatures. Data was analyzed by online bivariate analysis and p-value less than 0.05 was used to determine association. <i>Result:</i> A total of two hundred and twenty two respondents were included in the study. The prevalence of diarrhea among under-five children in 02 kebele was 69 (30.9%). From the total 69 under-five children affected by diarrhea, 32 (46.4%) were males and 37 (53.6%) were females. There was significant association between diarrhea morbidity and age of the child (X² = 16.42 (p<0.05)), children feeding status (on exclusive breast feeding and complementary feeding) (X² = 7.9009 (p<0.05)), hand washing during preparing food for children (X² = 49.55 (p<0.001)), and solid waste disposal (X² = 21.56 (p<0.001)). <i>Conclusion and Recommendation:</i> The prevalence of diarrhea among under-five children in Worabe town was high. There was significant association between risk of having diarrhea with age of the child, exclusive breast feeding and complementary feeding, hand washing when preparing food for children, and solid waste disposal. Health Extension workers, woreda health office, kebele administrators and responsible bodies should educate communities on exclusive breast feeding, hygienic practices while preparing food and feeding children. Further research should be done using qualitative methods.

Overview of acute diarrheal disease at the dawn of the 21st century: The case of Mexico.

To provide an overview of morbidity and mortality due to acute diarrheal disease in Mexico in order to understand its magnitude, distribution, and evolution from 2000 to 2016. We carried out a longitudinal ecological study with secondary sources of information. We used data from epidemiological surveillance, health services, and vital statistics. We calculated and mapped measures of utilization of health services rates and mortality due to diarrheal diseases. Diarrhea morbidity decreased by 42.1% across the period. However, emergency department attendances increased by 50.7% in the Ministry of Health. The hospitalization rate and mortality among the general population decreased by 37.6 and 39.7%, respectively, and the infant mortality rate decreased by 72.3% among children under five years of age. Chiapas and Oaxaca had the highest mortality among the states of Mexico. Cases of diarrhea, including rotavirus, have decreased in Mexico. However, in 2016, 3.4 per 100 000 people died due to diarrhea, which could have been avoided with health promotion.

Hygiene and Sanitation Practices and the Risk of Morbidity among Children 6–23 Months of Age in Kumbungu District, Ghana

Background. Poor hygiene and sanitation (WASH) practices are characterised by the manifestation of disease and infections, notably diarrhoea and respiratory tract infections (RTIs) among children. This study aimed to assess the influence of WASH practices on the occurrence of diarrhoea and RTIs among children 6–23 months of age.Methods. An analytical cross-sectional study design was conducted in June 2017. Systematic random sampling technique was used to select 300 mothers/caregivers with children aged 6–23 months from 9 communities in the Kumbungu District. We assessed the WASH practices, socio-demographic characteristics of the households and the occurrence of diarrhoea and RTIs among the children with a semi-structured questionnaire. The Hygiene Improvement Framework observational guide was adapted for household sanitation. Backward binary multiple logistic regression was used to determine the WASH practices that significantly predicted morbidity.Results. About 53% and 55.3% of the children reportedly experienced diarrhoea and RTIs, respectively, two weeks before the survey. Caregiver handwashing with soap after defecation [OR = 0.32 (95% C.I: 0.19, 0.52)] and before feeding [OR = 0.50 (95% C.I: 0.30, 0.84)] as well as washing the child’s hands with or without soap before feeding [OR = 0.21 (95% C.I: 0.04, 1.01)] were associated with lower odds of diarrhoea morbidity. The main determinants of RTI morbidity included caregiver handwashing with or without soap after defecation [OR = 0.29 (95% C.I: 0.10, 0.81)] and washing of the child’s hands with soap before feeding [OR = 0.60 (95% C.I: 0.37, 0.99)] However, we found no association between household sanitation and diarrhoea as well as RTI among the children.Conclusion. About a half each of the children had diarrhoea and RTI 2 weeks before the survey. The results emphasise the need for urgent targeting of handwashing and waste disposal programmes to avert the high burden of diarrhoea and RTIs among children.

PENERAPAN METODE K-MEDOIDS CLUSTERING PADA PENANGANAN KASUS DIARE DI INDONESIA

Diarrhea is a condition in which a person defecates in a runny or liquid form and occurs repeatedly. Diarrhea can cause the loss of large amounts of water and substances needed by the body. Diarrhea is one of the health problems in developing countries, especially in Indonesia both in urban and rural areas. Diarrhea morbidity rates around 200-400 occurrences among 1000 residents each year. Thus in Indonesia there can be around 60 million incidents each year, most (70-80%) of these sufferers are children under five years (BALITA). Some patients (1- 2%) will fall into dehydration and if not immediately helped 50-60% of them can die. This group experiences more than one incidence of diarrhea every year. K-Medoids Algorithm Clustering is one of the algorithms used for to group data.Keywords: Data Mining, K-Medoids, Clustering, Diarrhea

HOUSEHOLD DRINKING WATER STORAGE INTERVENTION TO ASSESS ITS IMPACT ON WATER QUALITY AT MAE LA TEMPORARY SHELTER

Background: Diarrhoea cases make up nearly two-thirds of total clinic visits at Mae La temporary shelter, Thailand, 40% being under five diarrhoeal cases. The use of a safe storage container for drinking water may prevent contamination and reduce diarrhoeal disease morbidity in camp residents. The aim of this study was to evaluate the use of safe drinking water storage containers and diarrhoeal diseases in under 5 children at the Mae La temporary shelter.&#x0D; Methods: A randomized controlled trail was conducted in 400 households with at least one child under 5 years old over a period of four months. Intervention households received safe containers, while control households did not. Households were visited twice weekly during the three-month follow-up. Recent occurrence of diarrhoea in children under five was ascertained and residual chlorine levels in drinking water were measured. The results were analyzed by chi-square tests and survival analyses.&#x0D; Results: Overall, the study found a 75% reduction of under five diarrhoea in the intervention group and 3.5-times less risk than control group subjects. Key factors associated with under five diarrhoea were: study group participation, no formal education of household primary caregivers; main sources of acquired drinking water; awareness regarding tap water chlorination; length of time living in camp&#x0D; Conclusion: In conclusion, intervention group participants were found to experience a reduction in diarrhoea morbidity when compared to their control group counterparts. E. coli contamination of drinking water was very common, suggesting little or no protection from chlorination.

Household Drinking Water Storage Intervention to Assess its Impact on Water Quality at Mae La Temporary Shelter

Background: Diarrhoea cases make up nearly two-thirds of total clinic visits at Mae La temporary shelter, Thailand, 40% being under five diar­rhoeal cases. The use of a safe storage container for drinking water may prevent contamination and reduce diarrhoeal disease morbidity in camp residents. The aim of this study was to evaluate the use of safe drinking water storage containers and diarrhoeal diseases in under 5 children at the Mae La temporary shelter.&#x0D; Methods: A randomized controlled trail was conducted in 400 households with at least one child under 5 years old over a period of four months. In­tervention households received safe containers, while control households did not. Households were visited twice weekly during the three-month follow-up. Recent occurrence of diarrhoea in children under five was as­certained and residual chlorine levels in drinking water were measured. The results were analyzed by chi-square tests and survival analyses.&#x0D; Results: Overall, the study found a 75% reduction of under five diarrhoea in the intervention group and 3.5-times less risk than control group sub­jects. Key factors associated with under five diarrhoea were: study group participation, no formal education of household primary caregivers; main sources of acquired drinking water; awareness regarding tap water chlori­nation; length of time living in camp&#x0D; Conclusions: In conclusion, intervention group participants were found to experience a reduction in diarrhoea morbidity when compared to their control group counterparts. E. coli contamination of drinking water was very common, suggesting little or no protection from chlorination.

How knowledgeable and practicable are the mothers of under five children in urban slum, Tamil Nadu on: utilization of ORS, homemade fluids and feeding practices during acute diarrhoeal diseases

Background: Globally, acute diarrhoea claims around 1.5 million lives of under-five children. In India, ADD accounts for 8% of deaths in &lt;5yrs age group. Child may be pushed into an irreversible outcome as stunting because of inadequate nutrition and repeated bouts of infection during the first 1000 days of life. Oral rehydration therapy is the most effective treatment intervention which can avert about 14% of deaths in under five children.Methods: A cross sectional study was done among 270 mothers of under five children from our urban health centre service area of PSGIMSR.Results: Among 270 mothers of under five children most of them belonged to the age group of ≤25 years. Only 10.7% of the mothers were aware that infection or germs cause diarrhea, signs of dehydration were not known by 80% of mothers. Mothers’ with more than one child and mothers with education more than 8th class were emerged as the factors affecting ORS preparation.Conclusions: The knowledge on diarrhoea was low. Although awareness regarding spread of diarrhoea and ORS was adequate in this community, knowledge regarding continuation of feeding and signs of dehydration were deficient. Thus educating the mothers of under-five children regarding correct practices of home management of diarrhoea is likely to further reduce diarrhoea morbidity and mortality.

Analysis of spatial autocorrelation of diarrhea events in East Kalimantan in 2015-2017 using a local indicator of spatial autocorrelation

Diarrhea is still a public health issue in developing countries, one of which is Indonesia. This is indicated by an increase in diarrhea morbidity rates from year to year. Therefore, it was necessary to conduct research related to diarrheal diseases. Factors that influence the incidence of diarrhea in an area depend on the condition of the environment or the surrounding area. Spatial autocorrelation is the correlation of a variable with itself based on space or can be said similarity of objects in space, both in terms of distance, time or region. Local Indicator of Spatial Autocorrelation (LISA) is a method for measuring and identifying spatial autocorrelation locally. The purpose of this study was to determine whether there is spatial autocorrelation in the incidence data of diarrhea in East Kalimantan in 2015-2017 by using LISA testing and to determine the level of vulnerability to the incidence of diarrhea in East Kalimantan. The results of data analysis with α = 10% indicated that there were spatial autocorrelations in several districts/cities in East Kalimantan in 2015, 2016 and 2017. The results of the analysis also showed that Samarinda City and Mahakam Ulu District were categorized as prone to diarrhea.

Spatial pattern and determinants of diarrhoea morbidity among under-five-aged children in Lagos State, Nigeria

ABSTRACT Diarrhoeal diseases are major causes of morbidity and mortality among under-fived-aged children globally. In Nigeria, 10% of under-five deaths in 2016 were due to diarrhoea. The diseases were responsible for 9% of childhood deaths in Lagos State in 2011. This study examined the spatial pattern and sociodemographic, environmental, hygiene and behavioural factors associated with diarrhoeal morbidity in Lagos State. Data on reported cases of childhood diarrhoeal diseases in government hospitals was analysed using spatial statistical techniques. Data from 2013 Nigerian Demographic Health Survey was used to determine diarrhoeal disease risk factors through multivariate logistic regression analysis. Lagos Island recorded the highest (34.2%) number of cases, followed by Agege (16.6%) and Somolu (13.2%) local government areas (LGAs). The spatial distribution of diarrhoeal cases is random. The prevalence of diarrhoeal diseases during the two-week period before the survey was 7.5%. Factors significantly associated with diarrhoeal disease morbidity were child’s age, mother’s age, religion, paternal education and occupation, mother’s occupation, source of drinking water, floor material, mixed feeding and mothers not wanting the last child. These findings highlight the need to strengthen the provision of safe water supply. Educational programmes that emphasise treatment of drinking water, safe hygiene and sanitation practices should be implemented.

Associations between High Temperature, Heavy Rainfall, and Diarrhea among Young Children in Rural Tamil Nadu, India: A Prospective Cohort Study.

Background:The effects of weather on diarrhea could influence the health impacts of climate change. Children have the highest diarrhea incidence, especially in India, where many lack safe water and sanitation.Objectives:In a prospective cohort of 1,284 children under 5 y of age from 900 households across 25 villages in rural Tamil Nadu, India, we examined whether high temperature and heavy rainfall was associated with increased all-cause diarrhea and water contamination.Methods:Seven-day prevalence of diarrhea was assessed monthly for up to 12 visits from January 2008 to April 2009, and hydrogen sulfide () presence in drinking water, a fecal contamination indicator, was tested in a subset of households. We estimated associations between temperature and rainfall exposures and diarrhea and using binomial regressions, adjusting for potential confounders, random effects for village, and autoregressive-1 error terms for study week.Results:There were 259 cases of diarrhea. The prevalence of diarrhea during the 7 d before visits was 2.95 times higher (95% CI: 1.99, 4.39) when mean temperature in the week before the 7-d recall was in the hottest versus the coolest quartile of weekly mean temperature during 1 December 2007 to 15 April 2009. Diarrhea prevalence was 1.50 times higher when the 3 weeks before the diarrhea recall period included (vs. 0 d) with rainfall of (95% CI: 1.12, 2.02), and 2.60 times higher (95% CI: 1.55, 4.36) for heavy rain weeks following a 60-d dry period. The prevalence in household water was not associated with heavy rain prior to sample collection.Conclusions:The results suggest that, in rural Tamil Nadu, heavy rainfall may wash pathogens that accumulate during dry weather into child contact. Higher temperatures were positively associated with diarrhea 1–3 weeks later. Our findings suggest that diarrhea morbidity could worsen under climate change without interventions to reduce enteric pathogen transmission through multiple pathways. https://doi.org/10.1289/EHP3711