Harvard Medical School, Boston, Massachusetts, United States of America.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS Negl Trop Dis. 2021 Oct 22;15(10):e0009726. doi: 10.1371/journal.pntd.0009726. eCollection 2021 Oct.
Diarrheal illness is a major cause of morbidity and mortality among children in Haiti, and the impact of diarrheal illness was compounded by a cholera outbreak between 2010 and 2019. Our understanding of risk factors for diarrhea among children during this outbreak is limited. We conducted a secondary analysis of data collected as part of a cholera vaccine effectiveness study to identify factors associated with medically attended diarrhea among children in central Haiti from October of 2012 through November of 2016. We identified 47 children aged one to five years old who presented to medical clinics with acute, watery diarrhea, and 166 matched controls who did not have diarrhea, and we performed conditional logistic regression to identify factors associated with diarrhea. Discontinuing exclusive breastfeeding within one month of birth was associated with increased risk of diarrhea (RR 6.9, 95% CI 1.46-32.64), and diarrhea was inversely associated with reported history of supplementation with vitamin A (RR 0.05, 95% CI 0.004-0.56) and zinc (reported among 0% of cases vs. 17% of controls). Because of the concordance in supplementation patterns, it was not possible to attribute the association to vitamin A or zinc independently. While having a respondent who correctly identified ≥3 means of avoiding cholera was associated with reduced risk of diarrhea (RR 0.43, 95% CI 0.19-1.01), reported household sanitation practices and knowledge of cholera were not consistently associated with risk of diarrhea. These findings support ongoing efforts to reduce barriers to breastfeeding and promote pediatric supplementation with vitamin A and zinc in Haiti. Given the reduced efficacy of current oral cholera vaccines (OCV) among children, the results reinforce the importance of breastfeeding and micronutrient supplementation in preventing all-cause pediatric diarrheal illness generally and during cholera outbreaks.
腹泻病是海地儿童发病和死亡的主要原因，2010 年至 2019 年期间霍乱的爆发使腹泻病的影响更加严重。我们对此次暴发期间儿童腹泻的危险因素了解有限。我们对作为霍乱疫苗效力研究的一部分收集的数据进行了二次分析，以确定 2012 年 10 月至 2016 年 11 月期间海地中部因急性水样腹泻就诊的儿童中与医疗相关腹泻相关的因素。我们确定了 47 名 1 至 5 岁的儿童，他们因急性水样腹泻就诊于诊所，166 名匹配的对照儿童没有腹泻，并进行了条件逻辑回归分析以确定与腹泻相关的因素。出生后一个月内停止纯母乳喂养与腹泻风险增加相关（RR6.9，95%CI1.46-32.64），腹泻与维生素 A（RR0.05，95%CI0.004-0.56）和锌（RR0.05，95%CI0.004-0.56）补充史呈负相关。由于补充模式的一致性，无法将该关联归因于维生素 A 或锌。虽然有一名受访者正确识别了≥3 种避免霍乱的方法与腹泻风险降低相关（RR0.43，95%CI0.19-1.01），但家庭卫生实践和对霍乱的了解与腹泻风险没有一致关联。这些发现支持海地减少母乳喂养障碍和促进儿童补充维生素 A 和锌的持续努力。鉴于目前的口服霍乱疫苗（OCV）对儿童的疗效降低，这些结果强调了母乳喂养和微量营养素补充在预防一般儿科腹泻病和霍乱暴发期间腹泻病的重要性。
