Urban-rural differentials in overweight and obese individuals with diarrhea in bangladesh.
OBJECTIVE
The study aimed to determine urban and rural differences in overweight and obesity (OO) with diarrhea regarding subjects' sociodemographic, clinical characteristics, etiology, and antimicrobial susceptibility.


METHODS
Relevant information from 2000 to 2011 were extracted from the data archive of the Diarrheal Disease Surveillance System of urban Dhaka (1248, 4.5%) and rural Matlab (615, 3.4%) hospitals of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).


RESULTS
The proportion of OO significantly increased in both urban (3-7%; chi-square for trend p < 0.001) and rural (1-6%; p < 0.001) areas over the study period. In multivariate modeling, monthly income more than US$100 (odds ratio [OR] = 54.44, 95% confidence interval [CI], 25.37-116.82, p < 0.001), high wealth quintile (OR = 18.23, 95% CI, 8.63-38.49, p < 0.001), access to sanitary toilet (OR = 3.07. 95% CI. 1.76-5.26. p < 0.001), boiled drinking water (OR = 2.77, 95% CI, 1.09-7.05, p = 0.032), antimicrobial use before hospitalization (OR = 4.99, 95% CI, 2.85-8.74, p < 0.001), fever (OR = 0.14, 95% CI, 0.37, 0.50, p < 0.001), watery stools (OR = 5.59, 95% CI, 2.11-14.80, p < 0.001), dehydrating diarrhea (OR = 5.17, 95% CI, 2.54-10.52, p < 0.001), intravenous saline infusion after hospitalization (OR = 2.65, 95% CI, 1.28-5.49, p = 0.009), and Salmonella infection (OR = 0.20, 95% CI, 0.50-0.83, p = 0.027) remained significantly associated with urban OO individuals. At least 88% of Shigella isolates were susceptible to ciprofloxacin in both urban and rural areas; for mecillinum it was 90%. Ciprofloxacin had the least detected resistance for Vibrio cholerae (0%) and trimethoprim-sulfamethoxazole (TMP-SMX) showed the greatest resistance (Dhaka 86%; Matlab 98%). Susceptibility for Salmonella showed ampicillin (95%), chloramphenecol (100%), ciprofloxacin (95%), ceftraxone (93%), TMP-SMX (95%) at both sites.


CONCLUSIONS
Urban OO with diarrheal illnesses was significantly different from that in rural areas, including antimicrobial susceptibility.
a International Centre for Diarrheal Disease Research , Dhaka , BANGLADESH.
Sumon Kumar
SK
Das
Mohammod Jobayer
MJ
Chisti
Mohammad Abdul
MA
Malek
Lana
L
Vanderlee
Mohammed Abdus
MA
Salam
Tahmeed
T
Ahmed
Pradip Kumar
PK
Bardhan
Abu Syed Golam
AS
Faruque
Abdullah
A
Al Mamun
D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology*; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
D000890:Anti-Infective Agents
Bangladesh; diarrhea; obesity; overweight; rural; urban