Kattula D, Francis M R, Kulinkina A, Sarkar R, Mohan V R, Babji S, Ward H D, Kang G, Balraj V, Naumova E N
Division Gastrointestinal Sciences,Christian Medical College,Vellore,India.
Department of Civil and Environmental Engineering,Tufts University School of Engineering,Medford,MA,USA.
Epidemiol Infect. 2015 Oct;143(14):3036-47. doi: 10.1017/S0950268814003562. Epub 2015 Feb 18.
Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with children (<5 years) residing in two semi-urban slums and three villages were visited weekly for 12-18 months to monitor gastrointestinal morbidity. Households were surveyed at baseline to obtain information on environmental and behavioural factors relevant to diarrhoea. There were 258 diarrhoeal episodes during the follow-up period, resulting in an overall incidence rate of 0·12 episodes/person-year. Incidence and longitudinal prevalence rates of diarrhoea were twofold higher in the slums compared to rural communities (P < 0·0002). Regardless of study site, diarrhoeal incidence was highest in infants (<1 year) at 1·07 episodes/person-year, and decreased gradually with increasing age. Increasing diarrhoeal rates were associated with presence of children (<5 years), domesticated animals and low socioeconomic status. In rural communities, open-field defecation was associated with diarrhoea in young children. This study demonstrates the contribution of site-specific environmental and behavioural factors in influencing endemic rates of urban and rural diarrhoea in a region with highly contaminated drinking water.
腹泻病是发展中国家发病和死亡的主要原因。这项纵向研究旨在确定印度南部泰米尔纳德邦韦洛尔市城市贫民窟和村庄饮用水高度污染情况下肠道感染的可控环境驱动因素。对居住在两个半城市贫民窟和三个村庄的300户有5岁以下儿童的家庭进行了为期12 - 18个月的每周一次走访，以监测胃肠道发病情况。在基线时对家庭进行调查，以获取与腹泻相关的环境和行为因素信息。随访期间共发生258次腹泻发作，总体发病率为0·12次/人年。贫民窟的腹泻发病率和纵向患病率比农村社区高出两倍（P < 0·0002）。无论研究地点如何，腹泻发病率在1岁以下婴儿中最高，为1·07次/人年，并随年龄增长逐渐下降。腹泻率上升与5岁以下儿童、家畜的存在以及社会经济地位低有关。在农村社区，在露天排便与幼儿腹泻有关。这项研究表明，在饮用水高度污染的地区，特定地点的环境和行为因素对影响城乡腹泻流行率有作用。
