title: Pathogen-specific risk factors and protective factors for acute diarrheal illness in children aged 12-59 months in São Paulo, Brazil.
abstract: Diarrheal diseases are a leading cause of childhood morbidity and mortality in Latin America. Most studies have focused on infants but not on older children. We enrolled 505 children (age, 12-59 months) with diarrhea and age-matched controls in a case-control study in Sao Paulo, Brazil. Independent risk factors for diarrhea included another household member with diarrhea (matched odds ratio [mOR], 8.1; attributable fraction [AF], 0.17; P<.001) and consumption of homemade juice (mOR, 1.8; AF, 0.10; P=.01); protective factors included boiling of the baby bottle or nipple (mOR, 0.60; AF, 0.19; P=.026), childcare at home (mOR, 0.58; AF, 0.12; P=.004), and piped sewage (mOR, 0.58; AF, 0.05; P=.047). Hand washing by the caretaker after helping the child defecate protected against Shigella infection (mOR, 0.35; P<.05). Preparation of rice, beans, or soup in the morning and serving it to children after noon were associated with enterotoxigenic Escherichia coli infection (mOR, 8.0; P<.05). In these poor households, 28% of cases of diarrhea in 1-4-year-old children was attributable to easily modifiable exposures.
authors.affiliation: Foodborne and Diarrheal Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jsobel@cdc.gov
authors.forename: J
authors.initials: J
authors.lastname: Sobel
authors.forename: T A T
authors.initials: TA
authors.lastname: Gomes
authors.forename: R T S
authors.initials: RT
authors.lastname: Ramos
authors.forename: M
authors.initials: M
authors.lastname: Hoekstra
authors.forename: D
authors.initials: D
authors.lastname: Rodrigue
authors.forename: V
authors.initials: V
authors.lastname: Rassi
authors.forename: P M
authors.initials: PM
authors.lastname: Griffin
mesh_terms: D000258:Adenovirus Infections, Human / Q000453:epidemiology / Q000517:prevention & control; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002169:Campylobacter Infections / Q000453:epidemiology / Q000517:prevention & control; D016022:Case-Control Studies; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000821:virology; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000821:virology; D004405:Dysentery, Bacillary / Q000453:epidemiology / Q000517:prevention & control; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000517:prevention & control; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D012400:Rotavirus Infections / Q000453:epidemiology / Q000517:prevention & control; D017678:Sex Distribution; D012760:Shigella / Q000302:isolation & purification / Q000472:pathogenicity; D013045:Species Specificity