Boschi-Pinto C, Velebit L, Shibuya K, 2008. Estimating child mortality due to diarrhoea in developing countries. Bull World Health Organ 86: 710–717.
Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, Molbak K, Valentiner-Branth P, Lanata CF, Black RE, 2008. Multi-country analysis of the effects of diarrhoea on childhood stunting. Int J Epidemiol 37: 816–830.
Lorntz B, Soares AM, Moore SR, Pinkerton R, Gansneder B, Bovbjerg VE, Guyatt H, Lima AM, Guerrant RL, 2006. Early childhood diarrhea predicts impaired school performance. Pediatr Infect Dis J 25: 513–520.
Plate DK, Strassmann BI, Wilson ML, 2004. Water sources are associated with childhood diarrhoea prevalence in rural east-central Mali. Trop Med Int Health 9: 416–425.
Pande S, Keyzer MA, Arouna A, Sonneveld BG, 2008. Addressing diarrhea prevalence in the West African Middle Belt: social and geographic dimensions in a case study for Benin. Int J Health Geogr 7: 17.
Ryland SR, 1998. Childhood morbidity and treatment patterns. Demographic and Health Surveys Comparative Studies. Calverton, MD: Macro International Inc.
Esrey SA, 1996. Water, waste, and well-being: a multicountry study. Am J Epidemiol 143: 608–623.
Robins-Browne RM, 1984. Seasonal and racial incidence of infantile gastroenteritis in South Africa. Am J Epidemiol 119: 350–355.
Mahmud A, Jalil F, Karlberg J, Lindblad BS, 1993. Early child health in Lahore, Pakistan: VII. Diarrhoea. Acta Paediatr Suppl 82 (Suppl 390): 79–85.
Velazquez FR, Garcia-Lozano H, Rodriguez E, Cervantes Y, Gomez A, Melo M, Anaya L, Ovalle JC, Torres J, Diaz De Jesus B, Alvarez-Lucas C, Breuer T, Munoz O, Kuri P, 2004. Diarrhea morbidity and mortality in Mexican children: impact of rotavirus disease. Pediatr Infect Dis J 23: S149–S155.
Huttly SR, Hoque BA, Aziz KM, Hasan KZ, Patwary MY, Rahaman MM, Feachem RG, 1989. Persistent diarrhoea in a rural area of Bangladesh: a community-based longitudinal study. Int J Epidemiol 18: 964–969.
Blum D, Feachem RG, 1983. Measuring the impact of water supply and sanitation investments on diarrhoeal diseases: problems of methodology. Int J Epidemiol 12: 357–365.
Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM, 2004. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA 291: 2547–2554.
Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer W, Keswick B, Hoekstra RM, 2006. Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Trop Med Int Health 11: 479–489.
Luby SP, Agboatwalla M, Bowen A, Kenah E, Sharker Y, Hoekstra RM, 2009. Difficulties in maintaining improved handwashing behavior, Karachi, Pakistan. Am J Trop Med Hyg 81: 140–145.
Planning and Development Corporation and Pakistan Environmental Planning and Architecture Consultant, 1990. Karachi Development Plan 2000. Karachi, Pakistan: Karchi Developmental Association.
Morris SS, Cousens SN, Kirkwood BR, Arthur P, Ross DA, 1996. Is prevalence of diarrhea a better predictor of subsequent mortality and weight gain than diarrhea incidence? Am J Epidemiol 144: 582–588.
Fleiss JL, Levin B, Paik MC, 2003. Statistical Methods for Rates and Proportions. New York: Wiley-Interscience.
Levy K, Hubbard AE, Nelson KL, Eisenberg JN, 2009. Drivers of water quality variability in northern coastal Ecuador. Environ Sci Technol 43: 1788–1797.
Forsberg BC, van Ginneken JK, Nagelkerke NJ, 1993. Cross-sectional household surveys of diarrhoeal diseases–a comparison of data from the Control of Diarrhoeal Diseases and Demographic and Health Surveys programmes. Int J Epidemiol 22: 1137–1145.
Pinfold JV, Horan NJ, Mara DD, 1991. Seasonal effects on the reported incidence of acute diarrhoeal disease in northeast Thailand. Int J Epidemiol 20: 777–786.
Hashizume M, Armstrong B, Hajat S, Wagatsuma Y, Faruque AS, Hayashi T, Sack DA, 2007. Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups. Int J Epidemiol 36: 1030–1037.
Briscoe J, 1978. The role of water supply in improving health in poor countries (with special reference to Bangla Desh). Am J Clin Nutr 31: 2100–2113.
Sheth M, Obrah M, 2004. Diarrhea prevention through food safety education. Indian J Pediatr 71: 879–882.
Elsanousi S, Abdelrahman S, Elshiekh I, Elhadi M, Mohamadani A, Habour A, Elamin SE, Elnoury A, Ahmed EA, Hunter PR, 2009. A study of the use and impacts of LifeStraw in a settlement camp in southern Gezira, Sudan. J Water Health 7: 478–483.
Kolesar R, Kleinau E, Torres MP, Gill C, Cruz V, Post M, Johnson E, Cordero F, Gavin J, 2004. Combining Hygiene Behavior Change with Water and Sanitation: Monitoring Progress in Hato Mayor, Dominican Republic. Washington, DC: Environmental Health Project, 38.
Moll DM, McElroy RH, Sabogal R, Corrales LF, Gelting RJ, 2007. Health impact of water and sanitation infrastructure reconstruction programmes in eight Central American communities affected by Hurricane Mitch. J Water Health 5: 51–65.
Keusch GT, Fontaine O, Bhargava A, Boschi-Pinto C, Bhutta ZA, Gotuzzo E, Rivera JA, Chow J, Shahid-Salles SA, Laxminarayan R, 2006. Diarrheal diseases. Disease Control Priorities in Developing Countries. New York: Oxford University Press, 371–388.
Kosek M, Bern C, Guerrant RL, 2003. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ 81: 197–204.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||364||134||1|
Diarrhea burden is often estimated using cross-sectional surveys. We measured variability in diarrhea prevalence among children < 5 years of age living in squatter settlements in central Karachi, Pakistan. We pooled data from non-intervention control households from studies conducted from 2002 through 2006. The prevalence of diarrhea varied on average by 29% from one week to the next, by 37% from one month to the next, and during peak diarrhea season by 32% from one year to the next. During 24 months when the same nine neighborhoods were under surveillance, each month the prevalence of diarrhea varied by at least an order of magnitude from the lowest to the highest prevalence neighborhood, and each neighborhood recorded the highest diarrhea prevalence during at least one month. Cross-sectional surveys are unreliable measures of diarrhea prevalence.
Financial support: This work was supported by the Procter & Gamble Company and the U.S. Centers for Disease Control and Prevention.
Authors' addresses: Stephen Luby, Centre for Communicable Diseases, ICDDR,B: International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, and Global Disease Detection and Emergency Response Division, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: firstname.lastname@example.org. Mubina Agboatwalla, Health Oriented Preventive Education, Karachi, Pakistan, E-mail: email@example.com. Robert M. Hoekstra, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: firstname.lastname@example.org.