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We investigated the environmental and individual-level risk factors for diarrheal disease among young children in slum areas of Dhaka, Bangladesh. A prospective cohort study was conducted among 884 children under 5 years of age. Caregiver reports were collected on sociodemographic factors and hygiene behaviors. Diarrhea surveillance data was collected monthly based on caregiver-reported diarrhea for children in the past 2 weeks during the 12-month study period. Unannounced spot checks of the household compound were performed at 1, 3, 6, 9, and 12 months after enrollment to check for the presence of feces (animal or human) and the presence of animals in the child’s sleeping space, to assess child and caregiver hands for the presence of dirt, and to collect samples of the household’s source and stored drinking water. Children with feces found on the household compound during spot checks had a significantly higher odds of diarrhea (odds ratio: 1.71; 95% confidence interval: 1.23–2.38). Children residing in households with > 100 colony forming units/100 mL Escherichia coli in source drinking water had a significantly higher odds of diarrhea (OR: 1.43; 95% CI: 1.06–1.92). The presence of feces on the household compound and source drinking water with > 100 colony forming units/100 mL E. coli were significant risk factors for diarrheal disease for children < 5 years of age in slum areas of Dhaka, Bangladesh. These findings demonstrate the urgent need for comprehensive interventions to reduce fecal contamination on the household compound to protect the health of susceptible pediatric populations.
Authors’ addresses: Tahmina Parvin, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: email@example.com. Elizabeth D. Thomas, David A. Sack, Jamie Perin, Christine Marie George, Johns Hopkins University Bloomberg School of Public Health, International Health, Baltimore, MD, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Md. Sazzadul Islam Bhuyian and Fatema Zohura, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mails: firstname.lastname@example.org and email@example.com. Ismat Minhaj Uddin, Md. Tasdik Hasan, Jahed Masud, Marzia Sultana, and Fatema-Tuz Johura, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mails: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Zillur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: email@example.com. Indrajeet Barman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: firstname.lastname@example.org. Anne Westin, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: email@example.com. Shirajum Monira, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: firstname.lastname@example.org. Shwapon Kumar Biswas, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, and Department of Medicine, Rangpur Medical College Hospital, Rangpur, Bangladsh, E-mail: email@example.com. Munirul Alam, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh, E-mail: firstname.lastname@example.org.