title: Bowel habits and toilet training in rural and urban dwelling children in a developing country.
abstract: OBJECTIVE
  To determine the bowel habits and toilet training of developmentally normal children ages 5 to 8 years in rural and urban areas of the province of Sindh, Pakistan.
  
  
  METHODS
  We conducted a descriptive cross-sectional study, conducted at households of rural (District Khairpur) and urban (Karachi) areas of Sindh, Pakistan, which enrolled 1000 children between 5 and 8 years of age, (half from rural and half from urban areas). A questionnaire regarding age, ethnicity, and sex was completed by two separate investigators from each setting. Recall information was elicited about bowel habits for the previous 2 weeks and the frequency and quality of stools, size of stools, and dietary habit for the previous 24 hours. A constipation score that was based on modified Rome III criteria was developed for each child.
  
  
  RESULTS
  Functional constipation was reported 1.6 times more in the rural than the urban population (P < .001). Toilet training was initiated and completed earlier in the urban (18.6 ± 6.8 and 46 ± 12.5 months) than the rural children (28.6 ± 6.1 and 56.5 ± 6.7 months) (P < .001). The daily calorie, macronutrient, fiber, and water intake was higher in the urban population (P < .001). Functional constipation was significantly (P = .016) negatively correlated (r = -0.076) with the fiber intake.
  
  
  CONCLUSIONS
  Functional constipation was found more frequently in the rural area. Toilet training was initiated and completed significantly earlier in the urban population.
authors.affiliation: Department of Pediatrics, Dow University of Health Sciences, Karachi, Pakistan. sigma_98@hotmail.com
authors.forename: Sina
authors.initials: S
authors.lastname: Aziz
authors.forename: Hafiz Abdul
authors.initials: HA
authors.lastname: Moiz Fakih
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Lorenzo
mesh_terms: D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D003430:Cross-Sectional Studies; D003672:Defecation; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan; D012424:Rural Population; D011795:Surveys and Questionnaires; D014039:Toilet Training; D014505:Urban Population