title: Child dysentery in the Limpopo Valley: a cohort study of water, sanitation and hygiene risk factors.
abstract: The objective of this cohort study was to assess risk factors for child dysentery and watery diarrhoea. The study participants consisted of 254 children aged 12-24 months in rural South Africa and Zimbabwe in households where drinking water was collected from communal sources. The main outcome measure was the most severe diarrhoea episode: dysentery, watery diarrhoea or none. For dysentery, drinking water from sources other than standpipes had a relative risk ratio of 3.8 (95% CI 1.5-9.8). Poor source water quality, as indicated by Escherichia coli counts of 10 or more cfu 100 ml(-1), increased risk by 2.9 (1.5-5.7). There were no other significant risk factors for dysentery and none for watery diarrhoea. In this study, endemic dysentery is associated only with faecal contamination of source water. Sources other than standpipes, including improved groundwater, are of greater risk. Remediation of water quality by treatment at source or in the household will be required to achieve access to safe drinking water in accordance with the 7th Millennium Development Goal.
authors.affiliation: Water and Health Research Centre, University of Bristol, Bristol, BS8 1UB, UK. stephen.gundry@bristol.ac.uk
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Gundry
authors.forename: James A
authors.initials: JA
authors.lastname: Wright
authors.forename: Ronán M
authors.initials: RM
authors.lastname: Conroy
authors.forename: Martella Du
authors.initials: MD
authors.lastname: Preez
authors.forename: Bettina
authors.initials: B
authors.lastname: Genthe
authors.forename: Sibonginkosi
authors.initials: S
authors.lastname: Moyo
authors.forename: Charles
authors.initials: C
authors.lastname: Mutisi
authors.forename: Natasha
authors.initials: N
authors.lastname: Potgieter
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004403:Dysentery / Q000453:epidemiology* / Q000517:prevention & control; D004926:Escherichia coli; D005260:Female; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D012499:Sanitation / Q000706:statistics & numerical data*; D013019:South Africa / Q000453:epidemiology; D014871:Water Microbiology; D014881:Water Supply / Q000706:statistics & numerical data*; D015030:Zimbabwe / Q000453:epidemiology