Department of Epidemiology, University of Washington, Seattle, Washington, USA.
PLoS One. 2013;8(1):e54395. doi: 10.1371/journal.pone.0054395. Epub 2013 Jan 18.
Children under five bear the largest cholera burden. We therefore sought to identify modifiable risk factors among Bangladeshi children.
METHODOLOGY/PRINCIPAL FINDINGS: We used multivariate Poisson regression to assess risk factors for severe cholera among diarrheal patients presenting at hospitals in Matlab (rural) and Dhaka (urban), Bangladesh. Risk increased with age. Compared to those under one, rural and urban four-year-olds had adjusted risk ratios (aRR) of 4.17 (95% confidence interval (CI) 2.43-7.15) and 6.32 (95% CI: 4.63-8.63), respectively. Breastfeeding halved the risk in both rural (aRR = 0.49, 95% CI: 0.35-0.67) and urban (aRR = 0.51, 95% CI: 0.41-0.62) settings. Rural children's risk decreased with maternal education (P-trend: <0.001) and increased among those with a family member with diarrhea in the past week (aRR = 1.61, 95% CI: 1.22-2.14) and those with prior vitamin A supplementation (aRR = 1.65, 95% CI: 1.12-2.43). Urban children whose mothers daily (aRR = 0.41, 95% CI: 0.21-0.79) or occasionally (aRR = 0.55, 95% CI: 0.36-0.84) read a newspaper experienced reduced risk. Urban children from households with incomes between 34-84 USD/month had a 30% increased risk compared to those from households with incomes >84 USD/month.
CONCLUSION/SIGNIFICANCE: Increasing age, lower socioeconomic status, and lack of breastfeeding are key correlates of increased risk for cholera hospitalization among those under five in rural and urban Bangladesh. In addition, having a family member with diarrhea in the past week was associated with increased risk among rural children. Continued attention should be directed to the promotion of breastfeeding. Further research is needed to elucidate the relationship between maternal education and cholera risk. Renewed research regarding the use of chemoprophylaxis among family members of cholera cases may be warranted in rural endemic settings.
五岁以下儿童承受着最大的霍乱负担。因此，我们试图确定孟加拉国儿童中可改变的风险因素。
方法/主要发现：我们使用多变量泊松回归评估了在孟加拉国 Matlab（农村）和达卡（城市）医院就诊的腹泻患者中严重霍乱的风险因素。风险随年龄增长而增加。与一岁以下的儿童相比，农村和城市的四岁儿童的调整后风险比（aRR）分别为 4.17（95%置信区间（CI）2.43-7.15）和 6.32（95%CI：4.63-8.63）。在农村（aRR = 0.49，95%CI：0.35-0.67）和城市（aRR = 0.51，95%CI：0.41-0.62）环境中，母乳喂养使风险降低了一半。农村儿童的风险随母亲教育程度的提高而降低（P-趋势：<0.001），与过去一周有家庭成员腹泻（aRR = 1.61，95%CI：1.22-2.14）和有维生素 A 补充史的儿童（aRR = 1.65，95%CI：1.12-2.43）的风险增加。母亲每天（aRR = 0.41，95%CI：0.21-0.79）或偶尔（aRR = 0.55，95%CI：0.36-0.84）看报纸的城市儿童风险降低。家庭月收入在 34-84 美元/月的城市儿童患霍乱住院的风险比家庭月收入超过 84 美元/月的儿童高 30%。
结论/意义：在孟加拉国农村和城市地区，年龄增长、社会经济地位较低以及缺乏母乳喂养是五岁以下儿童霍乱住院风险增加的关键因素。此外，过去一周有家庭成员腹泻与农村儿童风险增加有关。应继续关注促进母乳喂养。需要进一步研究以阐明母亲教育与霍乱风险之间的关系。在农村流行地区，可能需要重新研究对霍乱病例家庭成员使用化学预防的问题。
