Population-Based Study of a Widespread Outbreak of Diarrhea Associated with Increased Mortality and Malnutrition in Botswana, January–March, 2006

Ondrej Mach Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Ondrej Mach in
Current site
Google Scholar
PubMed
Close
,
Lydia Lu Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Lydia Lu in
Current site
Google Scholar
PubMed
Close
,
Tracy Creek Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Tracy Creek in
Current site
Google Scholar
PubMed
Close
,
Anna Bowen Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Anna Bowen in
Current site
Google Scholar
PubMed
Close
,
Wences Arvelo Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Wences Arvelo in
Current site
Google Scholar
PubMed
Close
,
Molly Smit Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Molly Smit in
Current site
Google Scholar
PubMed
Close
,
Japhter Masunge Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Japhter Masunge in
Current site
Google Scholar
PubMed
Close
,
Muireann Brennan Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Muireann Brennan in
Current site
Google Scholar
PubMed
Close
, and
Thomas Handzel Centers for Disease Control and Prevention, Atlanta, Georgia; BOTUSA Project, Gaborone, Botswana; Botswana Ministry of Health, Gaborone, Botswana

Search for other papers by Thomas Handzel in
Current site
Google Scholar
PubMed
Close
Restricted access

In early 2006, coinciding with heavy rains, Botswana health facilities reported increases in diarrhea, mortality, and acute malnutrition among young children. Data on diarrhea, human immunodeficiency virus, feeding, mortality, and water/sanitation were collected by random cluster survey. Anthropometric data were measured and drinking water samples were tested. Of 537 surveyed children less than five years of age, one-third experienced ≥ 1 episode of diarrhea. Prevalence of acute malnutrition was 7.9%, and the mortality rate for children less than five years of age was 2.6/10,000/day during the outbreak. Significant risk factors for diarrhea included an age less than two years; breastfeeding was protective. Diarrhea lasting for more than 14 days and failure to thrive were risk factors for acute malnutrition. Prevalence of acute malnutrition was higher than previously documented and the mortality rate in children less than five years of age during the outbreak was above the international threshold for emergency action with an estimated 547 excess deaths. This survey highlights the need for safe infant feeding and effective treatment of malnutrition and diarrhea in young children.

  • 1

    UNDP, 2005. Human Development Index. Geneva: World Health Organization.

  • 2

    Boonstra E, Lindbaek M, Fidzani B, Bruusgaard D, 2001. Cattle eradication and malnutrition in under five’s: a natural experiment in Botswana. Public Health Nutr 4 :877–882.

    • Search Google Scholar
    • Export Citation
  • 3

    Ismail S, 1991. Nutritional surveillance: experience from developing countries. Proc Nutr Soc 50 :673–679.

  • 4

    Grivetti LE, 1978. Nutritional success in a semi-arid land: examination of Tswana agro-pastoralists of the eastern Kalahari, Botswana. Am J Clin Nutr 31 :1204–1220.

    • Search Google Scholar
    • Export Citation
  • 5

    UNDP, 2003. Human Development Report 2003. New York: Oxford University Press.

  • 6

    Lemeshow S, Robinson D, 1985. Surveys to measure programme coverage and impact: a review of the methodology used by the expanded programme on immunization. World Health Stat Q 38 :65–75.

    • Search Google Scholar
    • Export Citation
  • 7

    Hoshaw-Woodard S, 2001. Description and Comparison of the Methods of Cluster Sampling and Lot Quality Assurance Sampling to Assess Immunization Coverage. Geneva: World Health Organization.

  • 8

    World Health Organization, 2005. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Fourth edition. Geneva: World Health Organization.

  • 9

    World Health Organization, 1995. Physical Status: The Use and Interpretation of Anthropometry. Geneva: World Health Organization.

  • 10

    American Public Health Association, American Water Works Association, Water Pollution Control Federation, 1980. Standard Methods for the Examination of Water and Wastewater. 15th edition. Washington, DC: American Public Health Association.

  • 11

    Olson B, Clark D, Milner B, Stewart M, Wolfe R, 1991. Total coliform detection in drinking water: comparison of membrane filtration with Colilert and Coliquick. Appl Environ Microbiol 57 :1535–1539.

    • Search Google Scholar
    • Export Citation
  • 12

    Alam NHF, Rahaman MM, 1989. Reporting errors in one-week diarrhoea recall surveys: experience from a prospective study in rural Bangladesh. Int J Epidemiol 18 :697–700.

    • Search Google Scholar
    • Export Citation
  • 13

    Ramakrishnan RVT, Koya PK, Kamaraj P, 1999. Influence of recall period on estimates of diarrhoea morbidity in infants in rural Tamilnadu. Indian J Public Health 43 :136–139.

    • Search Google Scholar
    • Export Citation
  • 14

    Genser B, Strina A, Teles CA, Prado MS, Barreto ML, 2006. Risk factors for childhood diarrhea incidence: dynamic analysis of a longitudinal study. Epidemiology 17 :658–667.

    • Search Google Scholar
    • Export Citation
  • 15

    Molbak K, Aaby P, Hojlyng N, da Silva AP, 1994. Risk factors for Cryptosporidium diarrhea in early childhood: a case-control study from Guinea-Bissau, West Africa. Am J Epidemiol 139 :734–740.

    • Search Google Scholar
    • Export Citation
  • 16

    Rose JB, 1997. Environmental ecology of Cryptosporidium and public health implications. Annu Rev Public Health 18 :135–161.

  • 17

    Thomson MC, Mason SJ, Phindela T, Connor SJ, 2005. Use of rainfall and sea surface temperature monitoring for malaria early warning in Botswana. Am J Trop Med Hyg 73 :214–221.

    • Search Google Scholar
    • Export Citation
  • 18

    Schmitt CV, 2006. Africa Weather Hazards Assessment February 2–8, 2006. Famine Early Warning System Network.

  • 19

    Leshomo K, 2006. Diarrhea Epidemic Leads to Threat of Severe Malnutrition in Botswana. New Yok: UNICEF.

  • 20

    Southern African Development Community Food Agricultural and Natural Resources Directorate, 2006. Agromet-Update: 2005/2006 Agricultural Season. Food Security Early Warning System.

  • 21

    Dop MC, 2002. Breastfeeding in Africa: will positive trends be challenged by the AIDS epidemic? [in French]. Sante 12 :64–72.

  • 22

    UNICEF, 2000. Botswana Multiple Indicator Survey. New York: The United Nations Children’s Fund.

  • 23

    Gracey M, 1996. Diarrhea and malnutrition: a challenge for pediatricians. J Pediatr Gastroenterol Nutr 22 :6–16.

  • 24

    The Sphere Project, 2004. Humanitarian Charter and Minimum Standards in Disaster Response. Geneva: Oxfam Publishing.

Past two years Past Year Past 30 Days
Abstract Views 21 21 4
Full Text Views 300 78 2
PDF Downloads 140 26 3
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save