title: Risk factors for hospital admission of Brazilian children with non-rotavirus diarrhoea: a case control-study.
abstract: BACKGROUND
  Rotavirus has been the leading cause of severe cases of acute diarrhoea (AD) among children worldwide; however, in the same areas, a large reduction in AD related to rotavirus has been observed after the introduction of the rotavirus vaccine. In Brazil, where there is a high rotavirus vaccine coverage, AD caused by pathogens other than rotavirus is still a frequent cause of outpatient visits and hospitalisations among children under 5 years.
  
  
  METHODS
  A hospital-based case-control study enrolled children aged 4 to 24 months admitted to 10 hospitals from all five Brazilian Regions. Cases (n=1178) were children admitted with diarrhoea who tested negative for rotavirus in a stool sample. Controls (n=2515) were children admitted without diarrhoea, frequency matched to cases by sex and age group. We estimated odds ratios using logistic regression, in a hierarchical approach according to a previously defined conceptual framework. Population-attributable fractions (PAF) were estimated for each variable, each block and for all significant variables in the latter model adjusted.
  
  
  RESULTS
  The factors studied accounted for 41% of the non-rotavirus AD hospital admissions and the main risk factors included lack of adequate excreta disposal (PAF=12%), untreated drinking water (PAF=11%) and a history of previous hospitalization due to AD (PAF=21%). Low socio-economic conditions, no public water supply, crowding and low weight-for-age made smaller contributions.
  
  
  CONCLUSIONS
  These findings further our knowledge of risk factors associated with severe AD in the post-rotavirus vaccination era. We recommend further increase in coverage of basic sanitation, improvements in water quality and further expansion of primary healthcare coverage to reduce the occurrence of non-rotavirus severe diarrhoea and subsequent hospitalization of Brazilian children.
authors.affiliation: Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela Salvador, CEP 40110-040, Salvador, Bahia, Brazil my.ichihara@gmail.com.
authors.forename: Maria Yury T
authors.initials: MY
authors.lastname: Ichihara
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rodrigues
authors.affiliation: State University of Feira de Santana, Bahia, Brazil Gonçalo Muniz Research Center, FIOCRUZ, Salvador, Bahia, Brazil.
authors.forename: Carlos A S T
authors.initials: CA
authors.lastname: Santos
authors.affiliation: Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela Salvador, CEP 40110-040, Salvador, Bahia, Brazil.
authors.forename: Maria da Glória L C
authors.initials: Mda G
authors.lastname: Teixeira
authors.affiliation: Institute of Collective Health, Federal University of Bahia, Rua Basílio da Gama, s/n, Campus Universitário do Canela Salvador, CEP 40110-040, Salvador, Bahia, Brazil Gonçalo Muniz Research Center, FIOCRUZ, Salvador, Bahia, Brazil.
authors.forename: Mauricio L
authors.initials: ML
authors.lastname: Barreto
mesh_terms: D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012499:Sanitation / Q000592:standards; D014611:Vaccination; D014881:Water Supply / Q000592:standards
keywords: Child hospitalization; Diarrhoea; Non-rotavirus diarrhea; Risk factors for diarrhea