title: The impact of household hygiene on the risk of bacterial diarrhea among Egyptian children in rural areas, 2004-2007.
abstract: BACKGROUND
  The present study, conducted between January 2004 and April 2007, explored the impact of household hygiene on the risk of bacterial diarrhea, using data from a prospective birth cohort of 348 infants in five villages in the Nile Delta in Egypt.
  
  
  METHODS
  Neonates were enrolled at birth and followed up until 24 months of age. Children were visited twice a week to survey them for acute diarrhea. A detailed observational household hygiene survey was completed in-house every six months. Adjusted relative risk (aRR) of developing bacterial diarrhea was calculated for exposure to different hygiene variables and examined for specific bacterial pathogens.
  
  
  RESULTS
  Exclusive breastfeeding reduced the risk of bacterial diarrhea by 70%, while bacterial diarrhea cases were 2.6 times higher in the warm season. Risk of Campylobacter diarrhea increased with the absence of barriers to keep birds and animals out of the eating area, the presence of garbage containers and a bathing facility within the compound, and the presence of feces on the floor of the bathing facility. Use of municipal water for drinking and cooking was associated with a lower risk of Campylobacter diarrhea. Risk of enterotoxigenic Escherichia coli diarrhea increased with uncovered garbage containers and the presence of liquid materials in the garbage containers, but decreased with the use of tap water in the washing facility.
  
  
  CONCLUSIONS
  The results highlight some potential targets for interventions, such as expanding municipal water supply to all houses and comprehensive mass-media awareness programs to change hygiene-promoting behaviors and practices.
authors.affiliation: US Naval Medical Research Unit No. 3, Bacteriology and Parasitology Diseases Research Program, Cairo, Egypt. adel.mansour.eg@med.navy.mil.
authors.forename: Khaled E
authors.initials: KE
authors.lastname: Hassan
authors.forename: Adel
authors.initials: A
authors.lastname: Mansour
authors.forename: Hind
authors.initials: H
authors.lastname: Shaheen
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amine
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
authors.forename: Sylvia Y N
authors.initials: SY
authors.lastname: Young
authors.forename: Peter
authors.initials: P
authors.lastname: Sebeny
authors.forename: Samuel
authors.initials: S
authors.lastname: Levin
mesh_terms: D000818:Animals; D001424:Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002675:Child, Preschool; D015331:Cohort Studies; D003625:Data Collection; D003967:Diarrhea / Q000453:epidemiology* / Q000517:prevention & control*; D004534:Egypt / Q000453:epidemiology; D004755:Enterobacteriaceae / Q000145:classification / Q000302:isolation & purification; D005191:Family Characteristics; D005192:Family Health; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006920:Hygiene; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012424:Rural Population