1921
Volume 94, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract

Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011–2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries ( < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0–5 months, those 6–23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.15-0750
2016-03-02
2019-11-18
Loading full text...

Full text loading...

/deliver/fulltext/14761645/94/3/544.html?itemId=/content/journals/10.4269/ajtmh.15-0750&mimeType=html&fmt=ahah

References

  1. Institute for Health Metrics and Evaluation, 2015. GBD Compare: Central Latin America, Diarrheal Diseases, Both Sexes, Under 5 Years. GBD 2010, Released 3/2013. Available at: http://vizhub.healthdata.org/gbd-compare/. [Google Scholar]
  2. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez M-G, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT-A, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, 3rd Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA, , 2012. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 21972223.[Crossref] [Google Scholar]
  3. Wagstaff A, Bustreo F, Bryce J, Claeson M, WHO-World Bank Child Health and Poverty Working Group; , 2004. Child health: reaching the poor. Am J Public Health 94: 726736.[Crossref] [Google Scholar]
  4. The World Bank Development Research Group, 2015. GINI Index (World Bank Estimate). Available at: http://data.worldbank.org/indicator/SI.POV.GINI. [Google Scholar]
  5. Locklear TD, Perez A, Caceres A, Mahady GB, , 2013. Women's health in Central America: the complexity of issues and the need to focus on indigenous healthcare. Curr Womens Health Rev 9: 3040.[Crossref] [Google Scholar]
  6. Santosham M, Chandran A, Fitzwater S, Fischer-Walker C, Baqui AH, Black R, , 2010. Progress and barriers for the control of diarrhoeal disease. Lancet 376: 6367.[Crossref] [Google Scholar]
  7. World Health Organization, Department of Child and Adolescent Health and Development, 2005. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Geneva, Switzerland: Department of Child and Adolescent Health and Development, World Health Organization. [Google Scholar]
  8. Munos MK, Walker CLF, Black RE, , 2010. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. Int J Epidemiol 39: i75i87.[Crossref] [Google Scholar]
  9. Santosham M, Greenough WB, , 1991. Oral rehydration therapy: a global perspective. J Pediatr 118: S44S51; discussion S52.[Crossref] [Google Scholar]
  10. Lukacik M, Thomas RL, Aranda JV, , 2008. A meta-analysis of the effects of oral zinc in the treatment of acute and persistent diarrhea. Pediatrics 121: 326336.[Crossref] [Google Scholar]
  11. Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, Khatun F, Martorell R, Ninh NX, Penny ME, Rosado JL, Roy SK, Ruel M, Sazawal S, Shankar A, , 1999. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. J Pediatr 135: 689697.[Crossref] [Google Scholar]
  12. Aggarwal R, Sentz J, Miller MA, , 2007. Role of zinc administration in prevention of childhood diarrhea and respiratory illnesses: a meta-analysis. Pediatrics 119: 11201130.[Crossref] [Google Scholar]
  13. Mokdad AH, Colson KE, Zúñiga-Brenes P, Ríos-Zertuche D, Palmisano EB, Alfaro-Porras E, Anderson BW, Borgo M, Desai S, Gagnier MC, Gillespie CW, Giron SL, Haakenstad A, Romero SL, Mateus J, McKay A, Mokdad AA, Murphy T, Naghavi P, Nelson J, Orozco M, Ranganathan D, Salvatierra B, Schaefer A, Usmanova G, Varela A, Wilson S, Wulf S, Hernandez B, Lozano R, Iriarte E, Regalia F, , 2015. Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings. Popul Health Metr 13: 3. Available at: http://www.pophealthmetrics.com/content/13/1/3. Accessed February 20, 2015.[Crossref] [Google Scholar]
  14. Fischer Walker CL, Fontaine O, Black RE, , 2013. Measuring coverage in MNCH: current indicators for measuring coverage of diarrhea treatment interventions and opportunities for improvement. PLoS Med 10: e1001385.[Crossref] [Google Scholar]
  15. Zou G, , 2004. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159: 702706.[Crossref] [Google Scholar]
  16. Oropeza Abúndez C, Instituto Nacional de Salud Pública (Mexico); , 2012. Encuesta Nacional de Salud Y Nutrición 2012: Resultados Nacionales. Primera edición. Cuernavaca, México: Instituto Nacional de Salud Pública and Secretaría de Salud. [Google Scholar]
  17. Gutiérrez G, Tapia-Conyer R, Guiscafreì H, Reyes H, Martinez H, Kumate J, , 1996. Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico. Bull World Health Organ 74: 189. [Google Scholar]
  18. Velázquez FR, Garcia-Lozano H, Rodriguez E, Cervantes Y, Gómez A, Melo M, Anaya L, Ovalle JC, Torres J, De Jesus BD, Alvarez-Lucas C, Breuer T, Muñoz O, Kuri P, , 2004. Diarrhea morbidity and mortality in Mexican children: impact of rotavirus disease. Pediatr Infect Dis J 23: S149S155.[Crossref] [Google Scholar]
  19. Becker-Dreps S, Paniagua M, Dominik R, Cao H, Shah NK, Morgan DR, Moreno G, Espinoza F, , 2011. Changes in childhood diarrhea incidence in Nicaragua following 3 years of universal infant rotavirus immunization. Pediatr Infect Dis J 30: 243247.[Crossref] [Google Scholar]
  20. Molto Y, Cortes JE, De Oliveira LH, Mike A, Solis I, Suman O, Coronado L, Patel MM, Parashar UD, Cortese MM, , 2011. Reduction of diarrhea-associated hospitalizations among children aged < 5 years in Panama following the introduction of rotavirus vaccine. Pediatr Infect Dis J 30: S16S20.[Crossref] [Google Scholar]
  21. Gorter AC, Sánchez G, Pauw J, Pérez RM, Sandiford P, Smith GD, , 1995. Childhood diarrhea in rural Nicaragua: beliefs and traditional health practices [in Spanish]. Boletin Oficina Sanit Panam Pan Am Sanit Bur 119: 377390. [Google Scholar]
  22. Arvelo W, Degollado J, Reyes L, Álvarez A, , 2013. Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas. Rev Panam Salud Publica 34: 121126. [Google Scholar]
  23. Smith GD, Gorter A, Hoppenbrouwer J, Sweep A, Perez RM, Gonzalez C, Morales P, Pauw J, Sandiford P, , 1993. The cultural construction of childhood diarrhoea in rural Nicaragua: relevance for epidemiology and health promotion. Soc Sci Med 36: 16131624.[Crossref] [Google Scholar]
  24. Homedes N, Ugalde A, , 1993. Patients' compliance with medical treatments in the third world. What do we know? Health Policy Plan 8: 291314.[Crossref] [Google Scholar]
  25. Boerma JT, Black RE, Sommerfelt AE, Rutstein SO, Bicego GT, , 1991. Accuracy and completeness of mothers' recall of diarrhoea occurrence in pre-school children in demographic and health surveys. Int J Epidemiol 20: 10731080.[Crossref] [Google Scholar]
  26. Alam N, Henry FJ, Rahaman MM, , 1989. Reporting errors in one-week diarrhoea recall surveys: experience from a prospective study in rural Bangladesh. Int J Epidemiol 18: 697700.[Crossref] [Google Scholar]
  27. Villa S, Guiscafreì H, Martinez H, Munoz O, Gutierrez G, , 1999. Seasonal diarrhoeal mortality among Mexican children. Bull World Health Organ 77: 375. [Google Scholar]
  28. Levy K, Hubbard AE, Eisenberg JN, , 2009. Seasonality of rotavirus disease in the tropics: a systematic review and meta-analysis. Int J Epidemiol 38: 14871496.[Crossref] [Google Scholar]
  29. De Oliveira LH, Danovaro-Holliday MC, Andrus JK, de Fillipis AMB, Gentsch J, Matus CR, Widdowson M, , 2009. Sentinel hospital surveillance for rotavirus in Latin American and Caribbean countries. J Infect Dis 200: S131S139.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.15-0750
Loading
/content/journals/10.4269/ajtmh.15-0750
Loading

Data & Media loading...

Supplementary PDF

  • Received : 15 Oct 2015
  • Accepted : 30 Nov 2015
  • Published online : 02 Mar 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error