GBD 2016 Causes of Death Collaborators, 2017. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390: 1151–1210.
GBD Diarrhoeal Diseases Collaborators, 2017. Estimates of global, regional, and national morbidity, mortality, and aetiologies of diarrhoeal diseases: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Infect Dis 17: 909–948.
Caulfield LE , de Onis M , Blossner M , Black RE , 2004. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles. Am J Clin Nutr 80: 193–198.
George CM et al. 2018. Enteric infections in young children are associated with environmental enteropathy and impaired growth. Trop Med Int Health 23: 26–33.
Ruff HA , Dubiner K , 1987. Stability of individual differences in infants’ manipulation and exploration of objects. Percept Mot Skills 64: 1095–1101.
Black RE et al. 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371: 243–260.
Moya J , Bearer CF , Etzel RA , 2004. Children’s behavior and physiology and how it affects exposure to environmental contaminants. Pediatrics 113 (Suppl): 996–1006.
Saathoff E , Olsen A , Kvalsvig JD , Geissler PW , 2002. Geophagy and its association with geohelminth infection in rural schoolchildren from northern KwaZulu-Natal, South Africa. Trans R Soc Trop Med Hyg 96: 485–490.
Kwong LH et al. 2020. Ingestion of fecal bacteria along multiple pathways by young children in rural Bangladesh participating in a cluster-randomized trial of Water, Sanitation, and Hygiene Interventions (WASH Benefits). Environ Sci Technol 54: 13828–13838.
Julian TR et al. 2013. Fecal indicator bacteria contamination of fomites and household demand for surface disinfection products: a case study from Peru. Am J Trop Med Hyg 89: 869–872.
Pickering AJ et al. 2012. Fecal contamination and diarrheal pathogens on surfaces and in soils among Tanzanian households with and without improved sanitation. Environ Sci Technol 46: 5736–5743.
Vujcic J et al. 2014. Toys and toilets: cross-sectional study using children’s toys to evaluate environmental faecal contamination in rural Bangladeshi households with different sanitation facilities and practices. Trop Med Int Health 19: 528–536.
George CM et al. 202. Child mouthing of feces and fomites and animal contact are associated with diarrhea and impaired growth among young children in the democratic republic of the congo: a prospective cohort study. J Pediatr 228: 110–116.
George CM et al. 2015. Geophagy is associated with environmental enteropathy and stunting in children in rural Bangladesh. Am J Trop Med Hyg 92: 1117–1124.
Morita T et al. 2017. Mouthing of soil contaminated objects is associated with environmental enteropathy in young children. Trop Med Int Health 22: 670–678.
Parvin T et al. 2020. Prospective cohort study of child mouthing of faeces and fomites in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 25: 976–984.
Perin J et al. 2016. Geophagy is associated with growth faltering in children in rural Bangladesh. J Pediatr 178: 34–39, e1.
Alemayehu B , Ayele BT , Kloos H , Ambelu A , 2020. Individual and community-level risk factors in under-five children diarrhea among agro-ecological zones in southwestern Ethiopia. Int J Hyg Environ Health 224: 113447.
Bushen OY et al. 2004. Diarrhea and reduced levels of antiretroviral drugs: improvement with glutamine or alanyl-glutamine in a randomized controlled trial in northeast Brazil. Nephrol Dial Transplant 38: 1764–1770.
Checkley W et al. 2004. Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet 363: 112–118.
D’Souza RM , 1997. Housing and environmental factors and their effects on the health of children in the slums of Karachi, Pakistan. J Biosoc Sci 29: 271–281.
Gebru T , Taha M , Kassahun W , 2014. Risk factors of diarrhoeal disease in under-five children among health extension model and non-model families in Sheko district rural community, southwest Ethiopia: comparative cross-sectional study. BMC Public Health 14: 395.
George CM et al. 2014. Risk factors for diarrhea in children under five years of age residing in peri-urban communities in Cochabamba, Bolivia. Am J Trop Med Hyg 91: 1190–1196.
Getachew A , Tadie A , Hiwot MG, Guadu T, Haile D, Teklay GC, Gizaw Z, Alemayehu M, 2018. Environmental factors of diarrhea prevalence among under five children in rural area of North Gondar zone, Ethiopia. Ital J Pediatr 44: 95.
Ghosh S , Sengupta PG , Mondal SK , Banu MK , Gupta DN , Sircar BK , 1997. Risk behavioural practices of rural mothers as determinants of childhood diarrhoea. J Commun Dis 29: 7–14.
Kosek M et al. 2008. Epidemiology of highly endemic multiply antibiotic-resistant shigellosis in children in the Peruvian Amazon. Pediatrics 122: e541–e549.
Maponga BA , Chirundu D , Gombe NT , Tshimanga M , Shambira G , Takundwa L , 2013. Risk factors for contracting watery diarrhoea in Kadoma City, Zimbabwe, 2011: a case control study. BMC Infect Dis 13: 567.
Mulatya DM , Ochieng C , 2020.Disease burden and risk factors of diarrhoea in children under five years: evidence from Kenya's demographic health survey 2014. Int J Infect Dis 93: 359–366.
Omona S , Malinga GM , Opoke R , Openy G , Opiro R , 2020. Prevalence of diarrhoea and associated risk factors among children under five years old in Pader District, northern Uganda. BMC Infect Dis 20: 37.
Shrestha A , Six J , Dahal D , Marks S , Meierhofer R , 2020. Association of nutrition, water, sanitation and hygiene practices with children’s nutritional status, intestinal parasitic infections and diarrhoea in rural Nepal: a cross-sectional study. BMC Public Health 20: 1241.
Thiam S et al. 2017. Prevalence of diarrhoea and risk factors among children under five years old in Mbour, Senegal: a cross-sectional study. Infect Dis Poverty 6: 109.
Tornheim JA , Morland KB , Landrigan PJ , Cifuentes E , 2009. Water privatization, water source, and pediatric diarrhea in Bolivia: epidemiologic analysis of a social experiment. Int J Occup Environ Health 15: 241–248.
Workie GY , Akalu TY , Baraki AG , 2019. Environmental factors affecting childhood diarrheal disease among under-five children in Jamma district, South Wello zone, Northeast Ethiopia. BMC Infect Dis 19: 804.
Luby SP et al. 2015. Microbiological contamination of drinking water associated with subsequent child diarrhea. Am J Trop Med Hyg 93: 904–911.
Ercumen A , Arnold BF , Naser AM , Unicomb L , Colford JM Jr , Luby SP , 2017. Potential sources of bias in the use of Escherichia coli to measure waterborne diarrhoea risk in low-income settings. Trop Med Int Health 22: 2–11.
Adane M , Mengistie B , Kloos H , Medhin G , Mulat W , 2017. Sanitation facilities, hygienic conditions, and prevalence of acute diarrhea among under-five children in slums of Addis Ababa, Ethiopia: baseline survey of a longitudinal study. PLoS One 12: e0182783.
Wasihun AG et al. 2018. Risk factors for diarrhoea and malnutrition among children under the age of 5 years in the Tigray Region of northern Ethiopia. PLoS One 13: e0207743.
Kapwata T , Mathee A , le Roux WJ , Wright CY , 2018. Diarrhoeal disease in relation to possible household risk factors in South African villages. Int J Environ Res Public Health 15: 1665.
Baker KK , O’Reilly CE , Levine MM , Kotloff KL , Nataro JP , 2016. Sanitation and hygiene-specific risk factors for moderate-to-severe diarrhea in young children in the Global Enteric Multicenter Study, 2007–2011: case-control study. PLoS Med 13: e1002010.
George CM et al. 2016. Randomized controlled trial of hospital-based hygiene and water treatment intervention (CHoBI7) to reduce cholera. Emerg Infect Dis 22: 233.
George CM et al. 2019. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 19: 1–18.
Thomas ED et al. 2020. Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program). BMC Public Health 20: 1–19.
George CM et al. 2020. Effects of a water, sanitation, and hygiene mobile health program on diarrhea and child growth in Bangladesh: a cluster-randomized controlled trial of the cholera hospital-based intervention for 7 days (CHoBI7) mobile health program. Clin Infect Dis (Epub ahead of print).
Monira S et al. 2020. Child mouthing of soil and presence of animals in child sleeping spaces are associated with growth faltering among young children in Dhaka, Bangladesh (CHoBI7 Program). Trop Med Int Health 25: 1016–1023.
Zohura F et al. 2020. Effect of a water, sanitation and hygiene program on handwashing with soap among household members of diarrhoea patients in healthcare facilities in Bangladesh: a cluster‐randomised controlled trial of the CHoBI7 mobile health program. Trop Med Int Health 25: 1008–1015.
Masud J et al. 2020. Diarrhoeal disease knowledge among diarrhoea patient housholds: findings from the randomised controlled trial of the Cholera‐Hospital‐Based‐Intervention‐for‐7‐days (CHoBI7) mobile health program. Trop Med Int Health 25: 996–1007.
Islam Bhuyian MS et al. 2020. Process evaluation for the delivery of a water, sanitation and hygiene mobile health program: findings from the randomised controlled trial of the CHoBI7 mobile health program. Trop Med Int Health 25: 985–995.
Biswas SK et al. 2021. Formative research for the design of a baby water, sanitation, and hygiene mobile health program in Bangladesh (CHoBI7 Mobile Health Program). Am J Trop Med Hyg 104: 357–371.
WHO, 2017. Diarrhoeal Disease Fact Sheet. Available at: https://www.who.int/en/news-room/fact-sheets/detail/diarrhoeal-disease. Accessed February 2020.
George CM et al. 2016. Sustained uptake of a hospital-based handwashing with soap and water treatment intervention (Cholera-Hospital-Based Intervention for 7 Days [CHoBI7]): a randomized controlled trial. Am J Trop Med Hyg 94: 428–436.
Islam MS et al. 2001. Microbiological analysis of tube-well water in a rural area of Bangladesh. Appl Environ Microbiol 67: 3328–3330.
WHO, 2011. Guidelines for Drinking Water Quality. Geneva, Switzerland: WHO.
Halder AK , Tronchet C , Akhter S , Bhuiya A , Johnston R , Luby SP , 2010. Observed hand cleanliness and other measures of handwashing behavior in rural Bangladesh. BMC Public Health 10: 545.
Lipsitz SR , Kim K , Zhao L , 1994. Analysis of repeated categorical data using generalized estimating equations. Stat Med 13: 1149–1163.
Knee J , Sumner T , Adriano Z , Berendes D , 2018.Risk factors for childhood enteric infection in urban Maputo, Mozambique: a cross-sectional study. PLoS Negl Trop Dis 12: e0006956.
Conan A et al. 2017. Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: a matched case-control study. PLoS Negl Trop Dis 11: e0005795.
Randremanana RV et al. 2016. Etiologies, risk factors and impact of severe diarrhea in the under-fives in Moramanga and Antananarivo, Madagascar. PLoS One 11: e0158862.
Black RE , Morris SS , Bryce J , 2003. Where and why are 10 million children dying every year? Lancet 361: 2226–2234.
Makoni FS , Ndamba J , Mbati PA , Manase G , 2004. Impact of waste disposal on health of a poor urban community in Zimbambwe. East Afr Med J 81: 422–426.
Moraes LR , Cancio JA , Cairncross S , Huttly S , 2003. Impact of drainage and sewerage on diarrhoea in poor urban areas in Salvador, Brazil. Trans R Soc Trop Med Hyg 97: 153–158.
Oyemade A , Omokhodion FO , Olawuyi JF , Sridhar MK , Olaseha IO , 1998. Environmental and personal hygiene practices: risk factors for diarrhoea among children of Nigerian market women. J Diarrhoeal Dis Res 16: 241–247.
Lauer JM et al. 2018. Unsafe drinking water is associated with environmental enteric dysfunction and poor growth outcomes in young children in rural southwestern Uganda. Am J Trop Med Hyg 99: 1606–1612.
Jensen PK , Jayasinghe G , van der Hoek W , Cairncross S , Dalsgaard A , 2004. Is there an association between bacteriological drinking water quality and childhood diarrhoea in developing countries? Trop Med Int Health 9: 1210–1215.
Pickering AJ et al. 2019. Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Glob Health 7: e1247–e1256.
Arnold BF et al. 2013. Optimal recall period for caregiver-reported illness in risk factor and intervention studies: a multicountry study. Am J Epidemiol 177: 361–370.
Prendergast AJ et al. 2019. Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene. Lancet Planet Health 3: e336–e337.
Pickering AJ et al. 2019. The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhoea. Lancet Glob Health 7: e1139–e1146.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||373||234||3|
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: firstname.lastname@example.org. 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: email@example.com, firstname.lastname@example.org, email@example.com, and firstname.lastname@example.org. Md. Sazzadul Islam Bhuyian and Fatema Zohura, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mails: email@example.com and firstname.lastname@example.org. 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: email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, and email@example.com. Zillur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: firstname.lastname@example.org. Indrajeet Barman, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: email@example.com. Anne Westin, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mail: firstname.lastname@example.org. Shirajum Monira, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Infectious Disease Division, Dhaka, Bangladesh, E-mail: email@example.com. 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: firstname.lastname@example.org. Munirul Alam, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh, E-mail: email@example.com.