title: Risk factors for shigellosis in Thailand.
abstract: OBJECTIVE
  To assess the potential risk factors for shigellosis including housefly density.
  
  
  METHODS
  A matched case-control study to investigate potential risk factors for shigellosis was conducted in a semi-urban area, Kaengkhoi District, Saraburi Province, central Thailand. Shigella cases were ascertained from a two-year population-based surveillance study detecting diarrhea and shigellosis in the area. The study evaluated a wide range of exposures, which were assessed by odds ratios (OR) adjusted for proxy markers of socioeconomic status: family income, and type of residence, using conditional logistic regression analysis.
  
  
  RESULTS
  Hygiene behaviors such as regular hand washing (p<0.05), a clean environment surrounding the household (p<0.001), and the availability of water to flush the toilet (p=0.08) were associated with a reduced risk for shigellosis in the multivariate model. In contrast factors indicating a lower than average socioeconomic status, such as having to rent instead of owning one's housing (p<0.001) and a low family income (p<0.01) were associated with an increased risk for shigellosis. For children, breastfeeding showed a strong protective effect in reducing the risk of shigellosis (p<0.01). Prior to adjustment for environmental factors, fly density in the kitchen area was associated with an increased risk of shigellosis (p<0.01).
  
  
  CONCLUSIONS
  We found a correlation between socioeconomic status and the risk for shigellosis. To reduce shigellosis in this setting, we recommend interventions focused on three aspects: improved water supply and sanitation (especially latrines and garbage disposal) including fly control, health education on hand washing, and the promotion of breastfeeding.
authors.affiliation: Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand. pchompook@gmail.com
authors.forename: Pornthip
authors.initials: P
authors.lastname: Chompook
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.forename: Jeremy G
authors.initials: JG
authors.lastname: Wheeler
authors.forename: Lorenz
authors.initials: L
authors.lastname: von Seidlein
authors.forename: John
authors.initials: J
authors.lastname: Clemens
authors.forename: Wanpen
authors.initials: W
authors.lastname: Chaicumpa
mesh_terms: D000818:Animals; D001942:Breast Feeding; D016022:Case-Control Studies; D004175:Diptera; D004405:Dysentery, Bacillary / Q000517:prevention & control*; D006225:Hand; D006798:Housing; D006801:Humans; D006920:Hygiene; D011156:Population Density; D011159:Population Surveillance; D011203:Poverty; D012307:Risk Factors; D012499:Sanitation; D013785:Thailand / Q000453:epidemiology; D014881:Water Supply / Q000592:standards