Colombara Danny V, Hernández Bernardo, McNellan Claire R, Desai Sima S, Gagnier Marielle C, Haakenstad Annie, Johanns Casey, Palmisano Erin B, Ríos-Zertuche Diego, Schaefer Alexandra, Zúñiga-Brenes Paola, Zyznieuski Nicholas, Iriarte Emma, Mokdad Ali H
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington; Salud Mesoamérica Initiative, Inter-American Development Bank, Panamá, Panamá
Am J Trop Med Hyg. 2016 Mar;94(3):544-52. doi: 10.4269/ajtmh.15-0750. Epub 2016 Jan 19.
Care practices and risk factors for diarrhea among impoverished communities across Mesoamerica are unknown. Using Salud Mesoamérica Initiative baseline data, collected 2011-2013, we assessed the prevalence of diarrhea, adherence to evidence-based treatment guidelines, and potential diarrhea correlates in poor and indigenous communities across Mesoamerica. This study surveyed 14,500 children under 5 years of age in poor areas of El Salvador, Guatemala, Mexico (Chiapas State), Nicaragua, and Panama. We compared diarrhea prevalence and treatment modalities using χ(2) tests and used multivariable Poisson regression models to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for potential correlates of diarrhea. The 2-week point prevalence of diarrhea was 13% overall, with significant differences between countries (P < 0.05). Approximately one-third of diarrheal children were given oral rehydration solution and less than 3% were given zinc. Approximately 18% were given much less to drink than usual or nothing to drink at all. Antimotility medication was given to 17% of diarrheal children, while antibiotics were inappropriately given to 36%. In a multivariable regression model, compared with children 0-5 months, those 6-23 months had a 49% increased risk for diarrhea (aRR = 1.49, 95% CI = 1.15, 1.95). Our results call for programs to examine and remedy low adherence to evidence-based treatment guidelines.
中美洲贫困社区腹泻的护理措施和风险因素尚不清楚。利用2011 - 2013年收集的中美洲健康倡议基线数据，我们评估了中美洲贫困和土著社区腹泻的患病率、对循证治疗指南的遵循情况以及腹泻的潜在相关因素。本研究对萨尔瓦多、危地马拉、墨西哥（恰帕斯州）、尼加拉瓜和巴拿马贫困地区的14500名5岁以下儿童进行了调查。我们使用χ²检验比较腹泻患病率和治疗方式，并使用多变量泊松回归模型计算腹泻潜在相关因素的调整风险比（aRRs）和95%置信区间（CIs）。腹泻的两周点患病率总体为13%，各国之间存在显著差异（P < 0.05）。约三分之一的腹泻儿童接受了口服补液盐，不到3%的儿童服用了锌。约18%的儿童饮水比平时少得多或根本不饮水。17%的腹泻儿童服用了止泻药，36%的儿童不恰当地使用了抗生素。在多变量回归模型中，与0 - 5个月的儿童相比，6 - 23个月的儿童腹泻风险增加49%（aRR = 1.49，95% CI = 1.15，1.95）。我们的研究结果呼吁开展相关项目，以检查和纠正对循证治疗指南的低遵循情况。
