title: Child diarrhoea and nutritional status in rural Rwanda: a cross-sectional study to explore contributing environmental and demographic factors.
abstract: OBJECTIVE
  To explore associations of environmental and demographic factors with diarrhoea and nutritional status among children in Rusizi district, Rwanda.
  
  
  METHODS
  We obtained cross-sectional data from 8847 households in May-August 2013 from a baseline survey conducted for an evaluation of an integrated health intervention. We collected data on diarrhoea, water quality, and environmental and demographic factors from households with children <5, and anthropometry from children <2. We conducted log-binomial regression using diarrhoea, stunting and wasting as dependent variables.
  
  
  RESULTS
  Among children <5, 8.7% reported diarrhoea in the previous 7 days. Among children <2, stunting prevalence was 34.9% and wasting prevalence was 2.1%. Drinking water treatment (any method) was inversely associated with caregiver-reported diarrhoea in the previous 7 days (PR = 0.79, 95% CI: 0.68-0.91). Improved source of drinking water (PR = 0.80, 95% CI: 0.73-0.87), appropriate treatment of drinking water (PR = 0.88, 95% CI: 0.80-0.96), improved sanitation facility (PR = 0.90, 95% CI: 0.82-0.97), and complete structure (having walls, floor and roof) of the sanitation facility (PR = 0.65, 95% CI: 0.50-0.84) were inversely associated with stunting. None of the exposure variables were associated with wasting. A microbiological indicator of water quality was not associated with diarrhoea or stunting.
  
  
  CONCLUSIONS
  Our findings suggest that in Rusizi district, appropriate treatment of drinking water may be an important factor in diarrhoea in children <5, while improved source and appropriate treatment of drinking water as well as improved type and structure of sanitation facility may be important for linear growth in children <2. We did not detect an association with water quality.
authors.affiliation: Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA.
authors.forename: Sheela S
authors.initials: SS
authors.lastname: Sinharoy
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Wolf-Peter
authors.initials: WP
authors.lastname: Schmidt
authors.affiliation: Innovations for Poverty Action, New Haven, CT, USA.
authors.forename: Kris
authors.initials: K
authors.lastname: Cox
authors.affiliation: Innovations for Poverty Action, New Haven, CT, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Clemence
authors.affiliation: Innovations for Poverty Action, New Haven, CT, USA.
authors.forename: Leodomir
authors.initials: L
authors.lastname: Mfura
authors.affiliation: Innovations for Poverty Action, New Haven, CT, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Wendt
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Boisson
authors.affiliation: McCourt School of Public Policy, Georgetown University, Washington, DC, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Crossett
authors.affiliation: Robert F. Wagner Graduate School of Public Service, New York University, New York, NY, USA.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Grépin
authors.affiliation: McCourt School of Public Policy, Georgetown University, Washington, DC, USA.
authors.forename: William
authors.initials: W
authors.lastname: Jack
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Jeanine
authors.initials: J
authors.lastname: Condo
authors.affiliation: McCourt School of Public Policy, Georgetown University, Washington, DC, USA.
authors.forename: James
authors.initials: J
authors.lastname: Habyarimana
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clasen
keywords: Agua potable; agua de para consumo; atrofia; diarrea; diarrhoea; diarrhée; drinking water; eau potable; nutrición; nutrition; retard de croissance; saneamiento; sanitaire; sanitation; stunting