Risk Factors Associated with Recurrent Diarrheal Illnesses among Children in Kabul, Afghanistan: A Prospective Cohort Study

Abstract

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.Trial Registration www.ClinicalTrials.gov NCT00548379 https://www.clinicaltrials.gov/ct2/show/NCT00548379

Diarrheal Diseases in Under-Five Children and Associated Factors among Farta District Rural Community, Amhara Regional State, North Central Ethiopia: A Comparative Cross-Sectional Study

“…Handwashing after touching the infant's faeces was found statistically significant with diarrheal diseases. is finding is consistent with studies done in Kabul, Afghanistan, that washing and the presence of improved sanitation facilities were protective for diarrheal diseases [17]. However, this study does have some inherent limitations.…”

Validation of primer for promoting maternal self-efficacy in preventing childhood diarrhea

“…Concerning the care covered in the primer, as already pointed out, hand hygiene and of fruits and vegetables was considered by the mothers as the most important care to be followed. We highlight that mothers pointed out relevant themes, because earlier study shows influence of inadequate hygiene in the occurrence of diarrhea episodes (28) . However, many people still assign diarrhea to supernatural factors and dental eruptions, which shows a lack of knowledge about the mode of transmission, as well as the definition of the disease (29) .…”

On-plot drinking water supplies and health: A systematic review

“…Children in a peri-urban community in Peru with the worst water and sanitation conditions (no on-plot water, small water storage containers, lack of sewerage) experienced 2% higher risk of diarrhea (95% CI: 1.00-1.04, p=0.057) than children with the best conditions (on-plot water, large water storage containers, sewerage); however, risk of diarrhea was not significantly different between households with on-plot sources and households using standpipes or cisterns (hazard ratio (HR)=1.09, 95% CI: 0.60-1.98) or neighbors' water source (HR=1.21, 95% CI: 0.96-1.52) (Checkley et al, 2004). Children from households in Afghanistan lacking water on-plot were found to have higher risk of diarrhea than children from households with on-plot access in the univariate analysis, but not the multivariate analysis (HR=1.08, 95% CI: 0.95-1.23, p=0.239) (Aluisio et al, 2015). Findings from studies in Brazil and Malaysia were suggestive of an association between access to indoor on-plot water supply and diarrhea, but not significant ((p=0.08) (Fuchs and Victora, 2002) (OR=1.73, 95% CI: 0.58-5.17) (Knight et al, 1992)).…”

“…Eight of 15 less rigorous studies assessed effects of socioeconomic status in the analysis. Thirteen studies had durations of a year or longer, nine of which were rigorous (Aluisio et al, 2015;Bukenya et al, 1991;Bulkow et al, 2012;Checkley et al, 2004;Devoto et al, 2011;Molbak et al, 1997;Thomas et al, 2016;van der Hoek et al, 2001;van der Hoek et al, 2002). Common reporting omissions and sources of potential bias identified were non-systematic or nonrepresentative participant selection, unadjusted statistical analysis, and non-disclosure of funding or conflict of interest (Table 5).…”

“…Five studies investigated the health impacts of on-plot water sources other than piped connections, examining use of onplot wells (Aluisio et al, 2015;Schemann et al, 2002;Stewart et al, 1955;van der Hoek et al, 2002;van der Hoek et al, 2001). Several diarrhea studies compared health effects of on-plot water supplies with multiple water sources types, such as public standpipes, wells, springs, and rivers.…”