Skip to main content Accessibility help

Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh

  • F. FERDOUS (a1) (a2), S. AHMED (a1), F. D. FARZANA (a1), J. DAS (a1), M. A. MALEK (a1), S. K. DAS (a1) (a3), M. A. SALAM (a1) and A. S. G. FARUQUE (a1)...


The objective of our analysis was to describe the aetiology, clinical features, and socio-demographic background of adults with diarrhoea attending different urban and rural diarrhoeal disease hospitals in Bangladesh. Between January 2010 and December 2011, a total of 5054 adult diarrhoeal patients aged ⩾20 years were enrolled into the Diarrhoeal Disease Surveillance Systems at four different hospitals (two rural and two urban) of Bangladesh. Middle-aged [adjusted odds ratio (aOR) 0·28, 95% confidence interval (CI) 0·23–0·35, P < 0·001] and elderly (aOR 0·15, 95% CI 0·11–0·20, P < 0·001) patients were more likely to present to rural diarrhoeal disease facilities than urban ones. Vibrio cholerae was the most commonly isolated pathogen (16%) of the four pathogens tested followed by rotavirus (5%), enterotoxigenic Escherichia coli (ETEC) (4%), and Shigella (4%). Of these pathogens, V. cholerae (19% vs. 11%, P < 0·001), ETEC (9% vs. 4%, P < 0·001), and rotavirus (5% vs. 3%, P = 0·013) were more commonly detected from patients presenting to urban hospitals than rural hospitals, but Shigella was more frequently isolated from patients presenting to rural hospitals than urban hospitals (7% vs. 2%, P < 0·001). The isolation rate of Shigella was higher in the elderly than in younger adults (8% vs. 3%, P < 0·001). Some or severe dehydration was higher in urban adults than rural adults (P < 0·001). Our findings indicate that despite economic and other progress made, conditions facilitating transmission of V. cholerae and Shigella prevail in adults with diarrhoea in Bangladesh and further efforts are needed to control these infections.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh
      Available formats


Corresponding author

* Author for correspondence: Dr S. K. Das, Assistant Scientist, Centre for Nutrition and Food Security (CNFS), icddr,b, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh. (Email:


Hide All
1. Kotloff, KL, et al. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 2013.
2. Faruque, AS, et al. Diarrhoea in elderly people: aetiology, and clinical characteristics. Scandinavian Journal of Infectious Diseases 2004; 36: 204208.
3. Bryce, J, et al. WHO estimates of the causes of death in children. Lancet 2005; 365: 11471152.
4. Kosek, M, et al. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bulletin of the World Health Organization 2003; 81: 197204.
5. Parashar, UD, et al. The global burden of diarrhoeal disease in children. Bulletin of the World Health Organization 2003; 81: 236.
6. Guerrant, RL, et al. Magnitude and impact of diarrheal diseases. Archives of Medical Research 2002; 33: 351355.
7. Aggett, P, et al. Zinc and human health. Nutrition Reviews 1995; 53: S1622.
8. Farthing, MJ Diarrhoea: a significant worldwide problem. International Journal of Antimicrobial Agents 2000; 14: 6569.
9. Liu, L, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012; 379: 21512161.
10. Chowdhury, F, et al. Impact of rapid urbanization on the rates of infection by Vibrio cholerae O1 and enterotoxigenic Escherichia coli in Dhaka, Bangladesh. PLoS Neglected Tropical Diseases 2011; 5: e999.
11. Fang, ZY, et al. Investigation of an outbreak of adult diarrhea rotavirus in China. International Journal of Infectious Diseases 1989; 160: 948953.
12. Kirk, MD, et al. Gastroenteritis and food-borne disease in elderly people living in long-term care. Clinical Infectious Diseases 2010; 50: 397404.
13. de Magny, GC, et al. Cholera outbreak in Senegal in 2005: was climate a factor? PLoS ONE 2012; 7: e44577.
14. Edwards, BH Salmonella and Shigella species. Clinical Laboratory Medicine 1999; 19: 469487.
15. Sanekata, T, et al. Human group B rotavirus infections cause severe diarrhea in children and adults in Bangladesh. Journal of Clinical Microbiology 2003; 41: 21872190.
16. WHO. Manual for Laboratory Investigations of Acute Enteric Infections. Programme for control of diarrhoeal disease. Geneva: World Health Organization, 1987.
17. Ferdous, F, et al. Aetiology and clinical features of dysentery in children aged <5 years in rural Bangladesh <5 years in rural Bangladesh. Epidemiology and Infection 2014; 142: 9098.
18. Alam, NH, et al. Treatment of infectious diarrhea in children. Paediatric Drugs 2003; 5: 151–65.
19. WHO. Treatment of Diarrhoea: a Manual for Physicians and Other Senior Health Workers. Geneva: World Health Organization, 1990.
20. Oyeyemi, AL, et al. Relationship of physical activity to cardiovascular risk factors in an urban population of Nigerian adults. Archives of Public Health 2013; 71: 6.
21. Rahman, M, et al. Genetic characterization of a novel, naturally occurring recombinant human G6P[6] rotavirus. Journal of Clinical Microbiology 2003; 41: 20882095.
22. Qadri, F, et al. Enterotoxigenic Escherichia coli and Vibrio cholerae diarrhea, Bangladesh, 2004. Emerging Infectious Diseases 2005; 11: 11041107.
23. Talukder, KA, et al. Altering trends in the dominance of Shigella flexneri serotypes and emergence of serologically atypical S. flexneri strains in Dhaka, Bangladesh. Journal of Clinical Microbiology 2001; 39: 37573759.
24. Tanaka, G, et al. Deaths from rotavirus disease in Bangladeshi children: estimates from hospital-based surveillance. Pediatric Infectious Disease Journal 2007; 26: 10141018.
25. Das, SK, et al. Changing emergence of Shigella sero-groups in Bangladesh: observation from four different diarrheal disease hospitals. PLoS ONE 2013; 8: e62029.
26. Ogden, CL, et al. Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief 2012; 82: 18.
27. Das, SK, et al. Lipoprotein status among urban populations in Bangladesh. Atherosclerosis 2012; 223: 454457.
28. ME, H, et al. Rural to Urban migration and household living conditions in Bangladesh. Dhaka University Journal of Science 2012; 60: 253257.
29. Perveen, I, et al. Prevalence and health-care seeking pattern of patients with functional diarrhoea in an urban community of Bangladesh. Mymensingh Medical Journal 2010; 19: 8588.
30. Mandal, S, et al. Cholera: a great global concern. Asian Pacific Journal of Tropical Medicine 2011; 4: 573580.
31. Lee, LA, et al. Hyperendemic shigellosis in the United States: a review of surveillance data for 1967–1988. International Journal of Infectious Diseases 1991; 164: 894900.
32. Drewnowski, A, et al. Impact of aging on eating behaviors, food choices, nutrition, and health status. Journal of Nutrition Health and Aging 2001; 5: 7579.
33. Ahmed, F, et al. Family latrines and paediatric shigellosis in rural Bangladesh: benefit or risk? International Journal of Epidemiology 1994; 23: 856862.
34. Boyce, JM, et al. Patterns of Shigella infection in families in rural Bangladesh. American Journal of Tropical Medicine and Hygiene 1982; 31: 1015–20.
35. Twamley, K, et al. UK-born ethnic minority women and their experiences of feeding their newborn infant. Midwifery 2011; 27: 595602.
36. von Seidlein, L, et al. A multicentre study of Shigella diarrhoea in six Asian countries: disease burden, clinical manifestations, and microbiology. PLoS Medicine 2006; 3: e353.
37. Sansonetti, PJ, et al. Rupture of the intestinal epithelial barrier and mucosal invasion by Shigella flexneri. Clinical Infectious Diseases 1999; 28: 466475.
38. Slotwiner-Nie, PK, et al. Infectious diarrhea in the elderly. Gastroenterology Clinics of North America 2001; 30: 625635.
39. Sahlen, KG, et al. Health coaching to promote healthier lifestyle among older people at moderate risk for cardiovascular diseases, diabetes and depression: a study protocol for a randomized controlled trial in Sweden. BMC Public Health 2013; 13: 199.
40. Khatun, F, et al. Changing species distribution and antimicrobial susceptibility pattern of Shigella over a 29-year period (1980–2008). Epidemiology and Infection 2011; 139: 446452.
41. Khan, AI, et al. Analysis of fecal leukocytes and erythrocytes in Shigella infections in urban Bangladesh. Southeast Asian Journal of Tropical Medicine and Public Health 2006; 37: 747754.
42. Bennish, ML, et al. Mortality due to shigellosis: community and hospital data. Reviews of infectious diseases 1991; 13 (Suppl. 4): S245251.
43. Selianskaia, NA, et al. In vitro induction of transmissive resistance to tetracycline, chloramphenicol and ampicillin chloramphenicol in Vibrio cholera non-O1/non-O139 serogroups isolated within 1990–2005 [in Russian]. Antibiotiki i Khimioterapiia 2012; 56: 1621.
44. Bhattacharya, D, et al. Antimicrobial resistance in Shigella – rapid increase & widening of spectrum in Andaman Islands, India. Indian Journal of Medical Research 2012; 135: 365370.
45. Shah, SQ, et al. Prevalence of antibiotic resistance genes in the bacterial flora of integrated fish farming environments of Pakistan and Tanzania. Environmental Science and Technology 2012; 46: 86728679.
46. Hasan, B, et al. Antimicrobial drug-resistant Escherichia coli in wild birds and free-range poultry, Bangladesh. Emerging Infectious Diseases 2012; 18: 20552058.
47. Hasan, B, et al. High prevalence of antibiotic resistance in pathogenic Escherichia coli from large- and small-scale poultry farms in Bangladesh. Avian Diseases 2012; 55: 689692.
48. Rahman, M, et al. Extended-spectrum beta-lactamase-mediated third-generation cephalosporin resistance in Shigella isolates in Bangladesh. Journal of Antimicrobial Chemotherapy 2004; 54: 846847.
49. Qadri, F, et al. Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. Clinical Microbiology Reviews 2005; 18: 465483.
50. Merson, MH, et al. Disease due to enterotoxigenic Escherichia coli in Bangladeshi adults: clinical aspects and a controlled trial of tetracycline. International Journal of Infectious Diseases 1980; 141: 702711.
51. Clemens, J, et al. Development of pathogenicity-driven definitions of outcomes for a field trial of a killed oral vaccine against enterotoxigenic Escherichia coli in Egypt: application of an evidence-based method. International Journal of Infectious Diseases 2004; 189: 22992307.
52. Kotloff, KL, et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bulletin of the World Health Organization 1999; 77: 651666.
53. Levine, MM, et al. Immunity to enterotoxigenic Escherichia coli. Infect Immun 1979; 23: 729736.
54. Rahman, M, et al. Molecular detection of noroviruses in hospitalized patients in Bangladesh. European Journal of Clinical Microbiology and Infectious Diseases 2010; 29: 937945.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed