title: Rainfall variation and child health: effect of rainfall on diarrhea among under 5 children in Rwanda, 2010.
abstract: Diarrhea among children under 5 years of age has long been a major public health concern. Previous studies have suggested an association between rainfall and diarrhea. Here, we examined the association between Rwandan rainfall patterns and childhood diarrhea and the impact of household sanitation variables on this relationship.
  
  
  
  We derived a series of rain-related variables in Rwanda based on daily rainfall measurements and hydrological models built from daily precipitation measurements collected between 2009 and 2011. Using these data and the 2010 Rwanda Demographic and Health Survey database, we measured the association between total monthly rainfall, monthly rainfall intensity, runoff water and anomalous rainfall and the occurrence of diarrhea in children under 5 years of age.
  
  
  
  Among the 8601 children under 5 years of age included in the survey, 13.2 % reported having diarrhea within the 2 weeks prior to the survey. We found that higher levels of runoff were protective against diarrhea compared to low levels among children who lived in households with unimproved toilet facilities (OR = 0.54, 95 % CI: [0.34, 0.87] for moderate runoff and OR = 0.50, 95 % CI: [0.29, 0.86] for high runoff) but had no impact among children in household with improved toilets.
  
  
  
  Our finding that children in households with unimproved toilets were less likely to report diarrhea during periods of high runoff highlights the vulnerabilities of those living without adequate sanitation to the negative health impacts of environmental events.
authors: University of Rwanda School of Public Health, Kigali, Rwanda. amukabutera@nursph.org.
authors: Assumpta
authors: A
authors: Mukabutera
authors: University of Rwanda School of Public Health, Kigali, Rwanda.|Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
authors: Dana
authors: D
authors: Thomson
authors: Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.|Epidemiology Departments, Harvard School of Public Health, Boston, USA.
authors: Megan
authors: M
authors: Murray
authors: University of Rwanda School of Public Health, Kigali, Rwanda.|Rwanda Biomedical Center (RBC), Kigali, Rwanda.
authors: Paulin
authors: P
authors: Basinga
authors: University of Rwanda School of Public Health, Kigali, Rwanda.
authors: Laetitia
authors: L
authors: Nyirazinyoye
authors: Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.
authors: Sidney
authors: S
authors: Atwood
authors: Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
authors: Kevin P
authors: KP
authors: Savage
authors: Rwanda Meteorological Agency, Kigali, Rwanda.
authors: Aimable
authors: A
authors: Ngirimana
authors: Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.|Partners In Health, Kigali, Rwanda.
authors: Bethany L
authors: BL
authors: Hedt-Gauthier
mesh_terms: D000328:Adult; D000067576:Child Health; D002675:Child, Preschool; D003710:Demography; D003967:Diarrhea / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D011634:Public Health; D011891:Rain; D012432:Rwanda / Q000453:epidemiology; D012499:Sanitation; D014038:Toilet Facilities / Q000592:standards; D014867:Water
chemical_list: D014867:Water
keywords: Climate change; DHS; Diarrhea; Rainfall; Runoff; Rwanda