Bartlett A V, Hurtado E, Schroeder D G, Mendez H
Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland.
Acta Paediatr Suppl. 1992 Sep;381:66-71. doi: 10.1111/j.1651-2227.1992.tb12374.x.
We examined the association between water and hygiene-related behaviors and persistent diarrhea (duration > or = 14 days) among children under age three years in an indigenous rural Guatemalan community. Behavior indicators were specific aspects of the appearance of the mother, study child, other children and household that could be observed using a spot observation technique. Thirty-four percent of children had one or more episodes of persistent diarrhea during the year of study. Bivariate analyses found that a higher proportion of observations in which the anti-hygienic condition was observed was significantly associated with persistent diarrhea for 11 of 26 behavior indicators; these 11 indicators were also strongly correlated with each other. In individual logistic regression models, which included overall rate of diarrhea and other child characteristics associated with persistent diarrhea, six behavior indicators maintained significant association with persistent diarrhea: presence of toy on the ground, presence of baby bottle on the ground, the hands of the mother being dirty, presence of a fecally soiled diaper on the ground in the household compound, presence of feces in the yard, and the study child wearing a fecally soiled diaper. Three additional indicators closely approached significant association with persistent diarrhea. Excluding the three soiled diaper indicators, which might be the result rather than the cause of diarrhea, we found the six other behavior indicators to demonstrate a significant dose-response effect in increasing risk of persistent diarrhea. These findings suggest that behaviors which promote increased exposure of young children to enteric pathogens increase risk of persistent diarrhea.
我们研究了危地马拉农村一个原住民社区中三岁以下儿童的饮水和卫生相关行为与持续性腹泻（持续时间≥14天）之间的关联。行为指标是母亲、研究对象儿童、其他儿童及家庭环境外观的特定方面，可通过现场观察技术进行观察。在研究年度内，34%的儿童出现过一次或多次持续性腹泻。双变量分析发现，在26项行为指标中有11项显示，观察到存在反卫生状况的比例较高与持续性腹泻显著相关；这11项指标之间也存在很强的相关性。在包含腹泻总发生率及与持续性腹泻相关的其他儿童特征的个体逻辑回归模型中，有6项行为指标与持续性腹泻保持显著关联：地上有玩具、地上有奶瓶、母亲的手脏、家庭院落地面上有粪便污染的尿布、院子里有粪便以及研究对象儿童穿着粪便污染的尿布。另外还有3项指标与持续性腹泻的关联接近显著水平。排除3项尿布污染指标（这可能是腹泻的结果而非原因）后，我们发现其他6项行为指标在增加持续性腹泻风险方面呈现出显著的剂量反应效应。这些发现表明，那些促使幼儿更多接触肠道病原体的行为会增加持续性腹泻的风险。
