title: Family latrines and paediatric shigellosis in rural Bangladesh: benefit or risk?
abstract: BACKGROUND
  The potential benefits of installing excreta disposal facilities on the burden of paediatric diarrhoea in less-developed settings remain controversial. We conducted a longitudinal study to evaluate whether family latrines are associated with interruption of the transmission of shigellosis to younger children in rural Bangladesh.
  
  
  METHODS
  We prospectively studied 1529 children under 5 years of age exposed to index cases of Shigella dysentery. In all 219 children with culture-proven shigellosis detected during 1 month of follow-up were compared with 1310 control children who did not develop shigellosis or Shigella-negative dysentery.
  
  
  RESULTS
  Overall, the presence of a family latrine appeared to be associated with a higher, not a lower, risk of paediatric shigellosis (adjusted odds ratio (ORa) = 1.37, 95% confidence interval (CI): 0.99-1.89). While use of a pit or sanitary latrine revealed no evidence of a protective association (ORa = 0.96, 95% CI: 0.43-2.15), use of a hanging latrine in which faeces were discharged directly onto the ground or into a body of water was associated with a notable increase of risk (ORa = 1.42, 95% CI: 1.02-1.98, P < 0.05).
  
  
  CONCLUSIONS
  While cautioning that installation of sanitary latrines may not be sufficient to reduce the burden of paediatric shigellosis in less-developed settings, these data suggest that eliminating unsanitary latrines constitutes a potentially important intervention in its own right in these settings.
authors.affiliation: International Center for Diarrhoeal Disease Research, Bangladesh, Dhaka.
authors.forename: F
authors.initials: F
authors.lastname: Ahmed
authors.forename: J D
authors.initials: JD
authors.lastname: Clemens
authors.forename: M R
authors.initials: MR
authors.lastname: Rao
authors.forename: A K
authors.initials: AK
authors.lastname: Banik
mesh_terms: D000367:Age Factors; D001459:Bangladesh / Q000453:epidemiology; D001942:Breast Feeding; D016022:Case-Control Studies; D002675:Child, Preschool; D016001:Confidence Intervals; D003906:Developing Countries; D004405:Dysentery, Bacillary / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D005192:Family Health; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011159:Population Surveillance; D012307:Risk Factors; D012423:Rural Health; D014038:Toilet Facilities / Q000145:classification / Q000592:standards