title: Multilevel analysis of childhood nonviral gastroenteritis associated with environmental risk factors in Quebec, 1999-2006.
abstract: Childhood nonviral gastroenteritis is a priority for various public health authorities. Given that waterborne transmission is sometimes incriminated during investigation of gastroenteritis outbreaks, the authors hypothesized that watershed characteristics may influence the occurrence of this disease and could contribute additional insights for better prevention and control. The study described here aimed to investigate watershed characteristics in relation to nonviral gastroenteritis and specifically three bacterial and parasitic forms of childhood gastroenteritis to assess their relative importance in the province of Quebec, Canada. Information on children aged 0-4 years with bacterial or parasitic enteric infections reported through ongoing surveillance between 1999 and 2006 in the province of Quebec was collected. Factors measured at the municipal and watershed levels were analyzed using multilevel models with a Poisson distribution and log link function. Childhood nonviral gastroenteritis, giardiasis, and campylobacteriosis were positively associated with small ruminants and cattle density. Childhood salmonellosis was positively associated with cattle density. Also, childhood campylobacteriosis incidence was positively associated with larger watershed agricultural surface. In addition to local agroenvironmental factors, this analysis revealed an important watershed effect.
authors.affiliation: Institut national de santé publique du Quebec Centre de recherche du CHU de Québec Département de médecine sociale et préventive, Université Laval.
authors.forename: Henri
authors.initials: H
authors.lastname: Kaboré
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lebel
authors.forename: Patrick
authors.initials: P
authors.lastname: Levallois
authors.forename: Pascal
authors.initials: P
authors.lastname: Michel
authors.forename: Pierre
authors.initials: P
authors.lastname: Payment
authors.forename: Pierre
authors.initials: P
authors.lastname: Déry
authors.forename: Germain
authors.initials: G
authors.lastname: Lebel
mesh_terms: D000818:Animals; D001424:Bacterial Infections / Q000150:complications / Q000635:transmission; D002675:Child, Preschool; D004196:Disease Outbreaks; D004781:Environmental Exposure / Q000009:adverse effects*; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D058751:Livestock / Q000382:microbiology / Q000469:parasitology; D055361:Multilevel Analysis; D010272:Parasitic Diseases / Q000150:complications / Q000635:transmission; D016012:Poisson Distribution; D011156:Population Density; D011159:Population Surveillance; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D014871:Water Microbiology; D062066:Water Resources / Q000032:analysis; D015047:Zoonoses / Q000382:microbiology / Q000469:parasitology / Q000635:transmission*