Diarrhoeal diseases in Soweto, South Africa, 2020: a cross-sectional community survey

Abstract

Background In South Africa, there are limited data on the burden of diarrhoea at a community level, specifically in older children and adults. This community survey estimated rates of and factors associated with diarrhoea across all ages and determined the proportion of cases presenting to healthcare facilities. Methods Households were enrolled from an existing urban health and demographic surveillance site. A household representative was interviewed to determine associated factors and occurrence of diarrhoea in the household, for all household members, in the past 2 weeks (including symptoms and health seeking behaviour). Diarrhoeal rate of any severity was calculated for < 5 years, 5–15 years and > 15 years age groups. Factors associated with diarrhoea and health seeking behaviour were investigated using binomial logistic regression. Results Diarrhoeal rate among respondents (2.5 episodes/person-year (95% CI, 1.8–3.5)) was significantly higher than for other household members (1.0 episodes/person-year (95% CI, 0.8–1.4); IRR = 2.4 (95% CI, 1.5–3.7) p < 0.001). Diarrhoeal rates were similar between age groups, however younger children (< 5 years) were more likely to present to healthcare facilities than adults (OR = 5.9 (95% CI, 1.1–31.4), p = 0.039). Oral rehydration solution was used in 44.8% of cases. Having a child between 5 and 15 years in the household was associated with diarrhoea (OR = 2.3 (95% CI, 1.3–3.9), p = 0.003) and, while 26.4% of cases sought healthcare, only 4.6% were hospitalised and only 3.4% of cases had a stool specimen collected. While the majority of cases were mild, 13.8% of cases felt they required healthcare but were unable to access it. Conclusion Diarrhoeal rate was high across all age groups in this community; however, older children and adults were less likely to present to healthcare, and are therefore underrepresented through facility-based clinical surveillance. Current diarrhoeal surveillance represents a fraction of the overall cases occurring in the community.

Social and Environmental Determinants of Diarrheal Diseases among Children Under Five Years in Epworth Township, Harare

“…This finding is higher than studies conducted elsewhere in the SADC region (6,16). A study conducted in a South African low-and middle-income township (Soweto) found a diarrheal disease prevalence of 20.9% among children under-5 years old (16). This study's prevalence was higher when compared to a study in Mozambique with a similar population that find a prevalence of 10.6%.…”

“…In this study, the prevalence of childhood diarrheal diseases was 22.5% over two weeks. This finding is higher than studies conducted elsewhere in the SADC region (6,16). A study conducted in a South African low-and middle-income township (Soweto) found a diarrheal disease prevalence of 20.9% among children under-5 years old (16).…”

Exploration of Infant Food Microbial Composition from Formal and Informal Settings Using Viable Counts and 16S rRNA Gene Amplicon Sequencing in Johannesburg, South Africa

“…Soweto, a sprawling urban settlement in Johannesburg, is South Africa's biggest township. It has a projected 1.6 million residents, occupying 355,331 households (2019 census) [7,8]. Johnstone et al [7] reported that Soweto has a diarrhoeal prevalence rate of 5.3%, with children more likely to present to the hospital compared to adults.…”

“…It has a projected 1.6 million residents, occupying 355,331 households (2019 census) [7,8]. Johnstone et al [7] reported that Soweto has a diarrhoeal prevalence rate of 5.3%, with children more likely to present to the hospital compared to adults. The majority of Soweto's population live in informal settlements [8], and between 600,000 and 1,000,000 residents live in abject poverty [9].…”

“…The aetiological agents of diarrhoea are frequently spread through the faecal-oral pathway. This is often a result of inadequate hygiene and poor sanitation, and the consumption of unclean food or drinking water coupled with inappropriate practices that make food unsafe [7]. It has been suggested that in settlements poorly supplied with water and sanitation services, households utilising resources to access improved water and sanitation avoid infection and spreading diseases like diarrhoea [10].…”