Colombara Danny V, Faruque Abu S G, Cowgill Karen D, Mayer Jonathan D
Department of Epidemiology, University of Washington, Seattle, WA, USA.
BMC Infect Dis. 2014 Aug 15;14:440. doi: 10.1186/1471-2334-14-440.
Cholera and shigellosis are endemic on the Indian subcontinent. Our objective was to identify cholera-specific risk factors distinct from shigellosis risk factors.
We conducted a case-case study among hospitalized diarrheal patients, comparing those with cholera and shigellosis in International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospitals in Matlab (rural) and Dhaka (urban) between January 1, 2000 and December 31, 2008.
Multivariable Poisson regression models revealed that having more than nine years of education, compared to no education, was associated with a 39% (adjusted Risk Ratio [aRR] = 0.61, 95% confidence interval [CI]: 0.40-0.93) decreased risk for cholera hospitalization in Matlab and a 16% (aRR = 0.84, 95% CI: 0.75-0.94) decreased risk in Dhaka. Having a family member with diarrhea in the past seven days increased cholera hospitalization risk by 17% (aRR = 1.17, 95% CI: 1.09-1.26) in Matlab.
Further studies are needed to elucidate the pathway through which education impacts cholera risk in order to create targeted interventions in cholera-endemic areas. Interventions seeking to reduce transmission and facilitate hygienic practices among family members of index cases with diarrhea should be considered, especially in rural cholera endemic settings.
霍乱和志贺氏菌病在印度次大陆呈地方流行性。我们的目标是确定有别于志贺氏菌病风险因素的霍乱特异性风险因素。
我们在住院腹泻患者中开展了一项病例对照研究，比较了2000年1月1日至2008年12月31日期间在孟加拉国腹泻疾病国际研究中心（icddr，b）位于马特莱（农村）和达卡（城市）的医院中患霍乱和志贺氏菌病的患者。
多变量泊松回归模型显示，与未受过教育相比，接受过九年以上教育的人在马特莱因霍乱住院的风险降低了39%（调整风险比[aRR]=0.61，95%置信区间[CI]：0.40 - 0.93），在达卡降低了16%（aRR = 0.84，95% CI：0.75 - 0.94）。在马特莱，过去七天内有家庭成员患腹泻会使霍乱住院风险增加17%（aRR = 1.17，95% CI：1.09 - 1.26）。
需要进一步研究以阐明教育影响霍乱风险的途径，以便在霍乱流行地区制定有针对性的干预措施。应考虑采取干预措施以减少传播并促进腹泻指数病例家庭成员的卫生习惯，尤其是在农村霍乱流行地区。
