title: Factors determining vulnerability to diarrhoea during and after severe floods in Bangladesh.
abstract: This paper identifies groups vulnerable to the effect of flooding on hospital visits due to diarrhoea during and after a flood event in 1998 in Dhaka, Bangladesh. The number of observed cases of cholera and non-cholera diarrhoea per week was compared to expected normal numbers during the flood and post-flood periods, obtained as the season-specific average over the two preceding and subsequent years using Poisson generalised linear models. The expected number of diarrhoea cases was estimated in separate models for each category of potential modifying factors: sex, age, socio-economic status and hygiene and sanitation practices. During the flood, the number of cholera and non-cholera diarrhoea cases was almost six and two times higher than expected, respectively. In the post-flood period, the risk of non-cholera diarrhoea was significantly higher for those with lower educational level, living in a household with a nonconcrete roof, drinking tube-well water (vs. tap water), using a distant water source and unsanitary toilets. The risk for cholera was significantly higher for those drinking tube-well water and those using unsanitary toilets. This study confirms that low socio-economic groups and poor hygiene and sanitation groups were most vulnerable to flood-related diarrhoea.
authors.affiliation: Research Center for Tropical Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-12-4, Nagasaki City, Nagasaki 852-8523, Japan. hashizum@nagasaki-u.ac.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hashizume
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Wagatsuma
authors.forename: Abu S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Taiichi
authors.initials: T
authors.lastname: Hayashi
authors.forename: Paul R
authors.initials: PR
authors.lastname: Hunter
authors.forename: Ben
authors.initials: B
authors.lastname: Armstrong
authors.forename: David A
authors.initials: DA
authors.lastname: Sack
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002771:Cholera / Q000453:epidemiology*; D003967:Diarrhea / Q000453:epidemiology*; D005260:Female; D055868:Floods; D006801:Humans; D008297:Male; D018570:Risk Assessment; D035862:Vulnerable Populations; D014871:Water Microbiology; D055815:Young Adult