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Clinical, Sociodemographic and Environmental Risk Factors for Acute Bacterial Diarrhea among Adults and Children over Five Years in Bangladesh

Sabiha NasrinInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Stephanie C. GarbernDepartment of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island;

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Monique GaineyDepartment of Emergency Medicine, Rhode Island Hospital, Providence, Rhode Island;

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Samika KanekarBrown University, Providence, Rhode Island;

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Mahmuda MonjoryInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Dilruba AhmedInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Kexin QuDepartment of Biostatistics, Brown University School of Public Health, Providence, Rhode Island;

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Tzu-Chun ChuCenter for Statistical Sciences, Brown University, Providence, Rhode Island;

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Christopher H. SchmidDepartment of Biostatistics, Brown University School of Public Health, Providence, Rhode Island;

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Eric J. NelsonDepartments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida

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Tahmeed AhmedInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Nur H. AlamInternational Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh;

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Adam C. LevineDepartment of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island;

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ABSTRACT.

In 2016, diarrheal disease was the eighth leading cause of mortality globally accounting for over 1.6 million deaths with the majority of deaths in adults and children over 5 years. This study aims to investigate the clinical, sociodemographic, and environmental risk factors associated with common bacterial acute diarrhea among adults and children over 5. Data were collected from March 2019 to March 2020 in patients over 5 years presenting with acute gastroenteritis at icddr,b. Stool samples were collected from each patient for culture and polymerase chain reaction (PCR) testing. Bivariate associations between independent variables and stool-testing indicating bacterial etiology were calculated. This analysis included 2,133 diarrheal patients of whom a bacterial enteropathogen was identified in 1,537 (72%). Detection of bacteria was associated with: younger age (OR 0.92; 95% CI: 0.88–0.96), lower mean arterial pressure (OR 0.84; 95% CI: 0.79–0.89), heart rate (OR 1.06; 95% CI: 1.01–1.10), percentage dehydration (OR 1.33; 95% CI: 1.13–1.55), respiration rate (OR 1.23; 95% CI: 1.04–1.46), lower mid-upper arm circumference (OR 0.97; 95% CI: 0.94–0.99), confused/lethargic mental status (OR 1.85; 95% CI: 1.11–3.25), rice watery stool (OR 1.92; 95% CI: 1.54–2.41), and vomiting more than three times in the past 24 hours (OR 1.30; 95% CI: 1.06–1.58). Higher monthly income (OR 0.92; 95% CI: 0.86–0.98), > 8 years of education (OR 0.79; 95% CI: 0.63–1.00), and having more than five people living at home (OR 0.80; 95% CI: 0.66–0.98) were associated with lower odds of bacterial diarrhea. These findings may help guide the development of predictive tools to aid in identifying patients with bacterial diarrhea for timely and appropriate use of antibiotics.

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Author Notes

Address correspondence to Sabiha Nasrin, Nutrition and Clinical Services Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani. Mohakhali, Dhaka 1212, Bangladesh. E-mail: sabiha.nasrin@icddrb.org

Financial support: Funding was provided through a grant received from the National Institutes of Health (NIH) National Institute for Diabetes and Diarrhoeal and Kidney Diseases (NIDDK) (Federal Identifier: DK116163) (https://www.niddk.nih.gov/). The funders had no role in the study design, data collection, or reporting processes. TC is supported by Institutional Development Award Number U54GM115677 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR).

Authors’ addresses: Sabiha Nasrin, Mahmuda Monjory, Dilruba Ahmed, Tahmeed Ahmed, and Nur H. Alam, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh, E-mails: sabiha.nasrin@icddrb.org, monjory_r@yahoo.com, dahmed@icddrb.org, tahmeed@icddrb.org, and nhalam@icddrb.org. Stephanie C. Garbern and Adam C. Levine, Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, RI, E-mails: stephanie_garbern@brown.edu and adam_levine@brown.edu. Monique Gainey, Rhode Island Hospital, Providence, RI, E-mail: gaineym@bu.edu. Samika Kanekar, Brown University, Providence, RI, E-mail: samika_kanekar@brown.edu. Kexin Qu and Christopher H. Schmid, Department of Biostatistics, School of Public Health, Brown University, Providence, RI, E-mails: kexin_qu@brown.edu and christopher_schmid@brown.edu. Tzu-Chun Chu, Center for Statistical Sciences, Brown University, Providence, RI, E-mail: tzu-chun_chu@brown.edu. Eric J. Nelson, Emerging Pathogens Institute, University of Florida, Gainesville, FL, E-mail: eric.nelson@ufl.edu.

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