title: Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults.
abstract: Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with children (<5 years) residing in two semi-urban slums and three villages were visited weekly for 12-18 months to monitor gastrointestinal morbidity. Households were surveyed at baseline to obtain information on environmental and behavioural factors relevant to diarrhoea. There were 258 diarrhoeal episodes during the follow-up period, resulting in an overall incidence rate of 0·12 episodes/person-year. Incidence and longitudinal prevalence rates of diarrhoea were twofold higher in the slums compared to rural communities (P < 0·0002). Regardless of study site, diarrhoeal incidence was highest in infants (<1 year) at 1·07 episodes/person-year, and decreased gradually with increasing age. Increasing diarrhoeal rates were associated with presence of children (<5 years), domesticated animals and low socioeconomic status. In rural communities, open-field defecation was associated with diarrhoea in young children. This study demonstrates the contribution of site-specific environmental and behavioural factors in influencing endemic rates of urban and rural diarrhoea in a region with highly contaminated drinking water.
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: D
authors.initials: D
authors.lastname: Kattula
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: M R
authors.initials: MR
authors.lastname: Francis
authors.affiliation: Department of Civil and Environmental Engineering,Tufts University School of Engineering,Medford,MA,USA.
authors.forename: A
authors.initials: A
authors.lastname: Kulinkina
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: R
authors.initials: R
authors.lastname: Sarkar
authors.affiliation: Department of Community Health,Christian Medical College,Vellore,India.
authors.forename: V R
authors.initials: VR
authors.lastname: Mohan
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: S
authors.initials: S
authors.lastname: Babji
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: H D
authors.initials: HD
authors.lastname: Ward
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: G
authors.initials: G
authors.lastname: Kang
authors.affiliation: Department of Community Health,Christian Medical College,Vellore,India.
authors.forename: V
authors.initials: V
authors.lastname: Balraj
authors.affiliation: Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
authors.forename: E N
authors.initials: EN
authors.lastname: Naumova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology*; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D015995:Prevalence; D012424:Rural Population; D014505:Urban Population; D055815:Young Adult
keywords: Diarrhoea; incidence rate; risk factors; rural; urban