Saha Amit, Hayen Andrew, Ali Mohammad, Rosewell Alexander, Clemens John D, Raina MacIntyre C, Qadri Firdausi
School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
School of Public Health and Community Medicine, UNSW Australia, NSW, Australia; Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Australia.
Vaccine. 2017 Sep 5;35(37):5043-5049. doi: 10.1016/j.vaccine.2017.07.021. Epub 2017 Jul 29.
Cholera remains a threat globally, and socioeconomic factors play an important role in transmission of the disease. We assessed socioeconomic risk factors for cholera in vaccinated and non-vaccinated communities to understand whether the socioeconomic risk factors differ by transmission patterns for cholera.
We used data from a cluster randomized control trial conducted in Dhaka, Bangladesh. There were 90 geographic clusters; 30 in each of the three arms of the study: vaccine (VAC), vaccine plus behavioural change (VBC), and non-intervention. The data were analysed for the three populations: (1) vaccinees in the vaccinated communities (VAC and VBC arms), (2) non-vaccinated individuals in the vaccinated communities and (3) all individuals in the non-vaccinated communities (non-intervention arm). A generalized estimating equation with logit link function was used to evaluate the risk factors for cholera among these different populations adjusting for household level correlation in the data.
A total of 528 cholera and 226 cholera with severe dehydration (CSD) in 268,896 persons were observed during the two-year follow-up. For population 1, the cholera risk was not associated with any socioeconomic factors; however CSD was less likely to occur among individuals living in a household having ≤4 members (aOR=0.55, 95% CI=0.32-0.96). Among population 2, younger participants and individuals reporting diarrhoea during registration were more likely to have cholera. Females and individuals reporting diarrhoea during registration were at increased risk of CSD. Among population 3, individuals living in a household without a concrete floor, in an area with high population density, closer to the study hospital, or not treating drinking water were at significantly higher risk for both cholera and CSD.
The profile of socioeconomic factors associated with cholera varies by individuals' vaccination status as well as the transmission setting. In a vaccinated community where transmission would be expected to be lower, socioeconomic factors may not increase the risk of the disease.
霍乱在全球范围内仍然是一个威胁，社会经济因素在该疾病的传播中起着重要作用。我们评估了接种疫苗和未接种疫苗社区中霍乱的社会经济风险因素，以了解社会经济风险因素是否因霍乱传播模式而异。
我们使用了在孟加拉国达卡进行的一项整群随机对照试验的数据。有90个地理集群；研究的三个组各有30个：疫苗组（VAC）、疫苗加行为改变组（VBC）和非干预组。对三类人群的数据进行了分析：（1）接种疫苗社区中的接种者（VAC组和VBC组），（2）接种疫苗社区中的未接种者，以及（3）未接种疫苗社区中的所有个体（非干预组）。使用具有logit链接函数的广义估计方程来评估这些不同人群中霍乱的风险因素，并对数据中的家庭层面相关性进行调整。
在两年的随访期间，在268,896人中共观察到528例霍乱和226例伴有严重脱水的霍乱（CSD）。对于第一类人群，霍乱风险与任何社会经济因素均无关联；然而，生活在家庭成员≤4人的家庭中的个体发生CSD的可能性较小（调整后比值比[aOR]=0.55，95%置信区间[CI]=0.32-0.96）。在第二类人群中，较年轻的参与者和在登记时报告有腹泻的个体更有可能患霍乱。女性和在登记时报告有腹泻的个体发生CSD的风险增加。在第三类人群中，生活在没有水泥地面的家庭、人口密度高的地区、离研究医院较近或未处理饮用水的个体患霍乱和CSD的风险显著更高。
与霍乱相关的社会经济因素状况因个体的疫苗接种状况以及传播环境而异。在预期传播率较低的接种疫苗社区中，社会经济因素可能不会增加患病风险。
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