Chompook Pornthip, Todd Jim, Wheeler Jeremy G, von Seidlein Lorenz, Clemens John, Chaicumpa Wanpen
Bureau of General Communicable Diseases, Department of Disease Control, Ministry of Public Health, Thailand.
Int J Infect Dis. 2006 Nov;10(6):425-33. doi: 10.1016/j.ijid.2006.05.011. Epub 2006 Sep 25.
To assess the potential risk factors for shigellosis including housefly density.
A matched case-control study to investigate potential risk factors for shigellosis was conducted in a semi-urban area, Kaengkhoi District, Saraburi Province, central Thailand. Shigella cases were ascertained from a two-year population-based surveillance study detecting diarrhea and shigellosis in the area. The study evaluated a wide range of exposures, which were assessed by odds ratios (OR) adjusted for proxy markers of socioeconomic status: family income, and type of residence, using conditional logistic regression analysis.
Hygiene behaviors such as regular hand washing (p<0.05), a clean environment surrounding the household (p<0.001), and the availability of water to flush the toilet (p=0.08) were associated with a reduced risk for shigellosis in the multivariate model. In contrast factors indicating a lower than average socioeconomic status, such as having to rent instead of owning one's housing (p<0.001) and a low family income (p<0.01) were associated with an increased risk for shigellosis. For children, breastfeeding showed a strong protective effect in reducing the risk of shigellosis (p<0.01). Prior to adjustment for environmental factors, fly density in the kitchen area was associated with an increased risk of shigellosis (p<0.01).
We found a correlation between socioeconomic status and the risk for shigellosis. To reduce shigellosis in this setting, we recommend interventions focused on three aspects: improved water supply and sanitation (especially latrines and garbage disposal) including fly control, health education on hand washing, and the promotion of breastfeeding.
评估包括家蝇密度在内的志贺氏菌病潜在风险因素。
在泰国中部沙拉武里府挽磨通区的一个半城市地区开展了一项配对病例对照研究，以调查志贺氏菌病的潜在风险因素。志贺氏菌病例来自一项为期两年的基于人群的监测研究，该研究在该地区检测腹泻和志贺氏菌病。该研究评估了广泛的暴露因素，通过对社会经济地位的替代指标（家庭收入和居住类型）进行调整后的比值比（OR），采用条件逻辑回归分析进行评估。
在多变量模型中，诸如经常洗手（p<0.05）、家庭周围环境清洁（p<0.001）以及有冲水马桶用水（p=0.08）等卫生行为与志贺氏菌病风险降低相关。相比之下，表明社会经济地位低于平均水平的因素，如必须租房而非自有住房（p<0.001）和家庭收入低（p<0.01）与志贺氏菌病风险增加相关。对于儿童，母乳喂养在降低志贺氏菌病风险方面显示出强大的保护作用（p<0.01）。在调整环境因素之前，厨房区域的苍蝇密度与志贺氏菌病风险增加相关（p<0.01）。
我们发现社会经济地位与志贺氏菌病风险之间存在关联。为了在这种情况下减少志贺氏菌病，我们建议干预措施集中在三个方面：改善供水和卫生条件（特别是厕所和垃圾处理）包括控制苍蝇、关于洗手的健康教育以及促进母乳喂养。
