[Water supply, excrement disposal and diarrheal diseases in rural zones of Ivory Coast].

This study was designed to determine the incidence of diarrhea over a 15 day period in children below 4 years living in villages in a rural area of Côte d'Ivoire and to identify possible correlation with water supply and excrement disposal. In this exhaustive cross-sectional household survey, each person caring for a child between the ages of 0 and 4 years was interviewed at home using an open, pretested survey with questions concerning diarrhea, water supply, and excrement disposal. Responses were authenticated by on-site observations made by surveyors. The study population included 1151 care providers and 1260 children between 0 and 4 years of age. Diarrhea had occurred in 27.7% of children within the 15 days prior to questioning, i.e. an annual incidence rate of 3.1 episodes per child after seasonal correction. Age was a risk factor for diarrhea since the incidence of diarrhea was inversely proportional to age. The number of episodes increases up to 6 months, stabilizes at a maximum of 37 to 38% until 36 months, and then gradually decreases to 6% between 53 and 59 months. Diarrhea was more common in children whose care provider was illiterate, the relative risk being 1.22. There was also a correlation between occurrence of diarrhea and age of the care provider since older providers were more likely to be illiterate. Use of a technique to prevent water from splashing out during transport was correlated with diarrhea. Children whose care providers used leaves or plastic covers to prevent splashing during transport had more episodes of diarrhea (30%) than the those whose care providers did not use these techniques (23%). The place where stool pots were emptied was also related to diarrhea. Disposal behavior was strongly correlated with literacy of the care provider, with the site of disposal being relevant only if the provider was illiterate. In view of these findings, we conclude that educating women, teaching child care providers about healthy eating habits in children as young as 5 months, and informing families about proper water storage and excrement disposal would reduce the incidence of diarrheal disease in village children.