Association between child-care and acute diarrhea: a study in Portuguese children.
OBJECTIVE
To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care.


METHODS
From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The Chi2 and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR) and their respective 95% confidence intervals (95% CI), crude and adjusted by unconditional logistic regression.


RESULTS
Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]).


CONCLUSIONS
Group care increases the risk of acute diarrhea whatsoever the specific setting.
Servição de Higiene e Epidemiologia, Faculdade de Medicina do Porto, Porto, Portugal. hbarros@med.up.pt
Henrique
H
Barros
Nuno
N
Lunet
D000208:Acute Disease; D002654:Child Care; D002656:Child Day Care Centers; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology*; D006801:Humans; D011174:Portugal / Q000453:epidemiology; D012307:Risk Factors; D012959:Socioeconomic Factors