Skip to main content Accessibility help
×
Home

Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults

  • D. KATTULA (a1), M. R. FRANCIS (a1), A. KULINKINA (a2), R. SARKAR (a1), V. R. MOHAN (a3), S. BABJI (a1), H. D. WARD (a1) (a4), G. KANG (a1) (a4), V. BALRAJ (a3) and E. N. NAUMOVA (a1) (a2)...

Summary

Diarrhoeal diseases are major causes of morbidity and mortality in developing countries. This longitudinal study aimed to identify controllable environmental drivers of intestinal infections amidst a highly contaminated drinking water supply in urban slums and villages of Vellore, Tamil Nadu in southern India. Three hundred households with children (<5 years) residing in two semi-urban slums and three villages were visited weekly for 12–18 months to monitor gastrointestinal morbidity. Households were surveyed at baseline to obtain information on environmental and behavioural factors relevant to diarrhoea. There were 258 diarrhoeal episodes during the follow-up period, resulting in an overall incidence rate of 0·12 episodes/person-year. Incidence and longitudinal prevalence rates of diarrhoea were twofold higher in the slums compared to rural communities (P < 0·0002). Regardless of study site, diarrhoeal incidence was highest in infants (<1 year) at 1·07 episodes/person-year, and decreased gradually with increasing age. Increasing diarrhoeal rates were associated with presence of children (<5 years), domesticated animals and low socioeconomic status. In rural communities, open-field defecation was associated with diarrhoea in young children. This study demonstrates the contribution of site-specific environmental and behavioural factors in influencing endemic rates of urban and rural diarrhoea in a region with highly contaminated drinking water.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org 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 @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ 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.

      Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults
      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.

      Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults
      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.

      Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults
      Available formats
      ×

Copyright

Corresponding author

* Author for correspondence: E. N. Naumova, Ph.D., Associate Dean for Research, Professor, Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Avenue, Medford, MA 02155, USA. (Email: Elena.Naumova@tufts.edu)

References

Hide All
1. Kosek, M, Bern, C, Guerrant, RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bulletin of the World Health Organization 2003; 81: 197204.
2. Walker, CL, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013; 381: 14051416.
3. Fischer Walker, CL, et al. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health 2012; 12: 220.
4. Bassani, DG, et al. Causes of neonatal and child mortality in India: a nationally representative mortality survey. Lancet 2010; 376: 18531860.
5. Black, RE, et al. Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010; 375: 19691987.
6. WHO. Meeting the MDG Drinking Water and Sanitation target: the urban and rural challenge of the decade. Geneva and New York: WHO/United Nations Children's Fund, 2006.
7. Indian Institute of Population Survey (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005–06: India. Volume 1. Mumbai: IIPS, 2007.
8. Gopal, S, et al. Study of water supply & sanitation practices in India using geographic information systems: some design & other considerations in a village setting. Indian Journal of Medical Research 2009; 129: 233241.
9. Bora, D, et al. V. cholerae 01 outbreak in remote villages of Shimla district, Himachal Pradesh, 1994. Journal of Communicable Diseses 1997; 29: 121125.
10. Sarkar, R, et al. Epidemiological investigation of an outbreak of acute diarrhoeal disease using geographic information systems. Transactions of the Royal Society of Tropical Medicine and Hygiene 2007; 101: 587593.
11. Kelly, P, et al. Environmental and Behavioral Risk Factors for Diarrheal Diseases in Childhood: A Survey in Two Towns in Morocco. Washington D.C.: Bureau for Global Programs, USAID, 1999.
12. Shivoga, WA, Moturi, WN. Geophagia as a risk factor for diarrhoea. Journal of Infection in Developing Countries 2009; 3: 9498.
13. Madhiwalla, N. Healthcare in urban slums in India. National Medical Journal of India 2007; 20: 113114.
14. Melo, MC, et al. Incidence of diarrhea in children living in urban slums in Salvador, Brazil. Brazilian Journal of Infectious Diseases 2008; 12: 8993.
15. McPike, J, Luke, N. Rethinking the urban advantage: differences in child diarrhea across rural, urban non-slum and urban slum locations in India. Population Association of America 2012 Annual Meeting. San Francisco: Population Association of America, 2012.
16. UNICEF. The State of the World's Children, 2012: Children in an Urban World. New York: United Nations Children's Fund, 2012.
17. Banda, K, et al. Water handling, sanitation and defecation practices in rural southern India: a knowledge, attitudes and practices study. Transactions of the Royal Society of Tropical Medicine and Hygiene 2007; 101: 11241130.
18. Government of India. Report of the Pronab Sen Committee on Slum Statistics/Census. New Delhi: Ministry of Housing and Urban Poverty Alleviation, Government of India, 2010.
19. Brick, T, et al. Water contamination in urban south India: household storage practices and their implications for water safety and enteric infections. International Journal of Hygiene and Environmental Health 2004; 207: 473480.
20. Firth, J, et al. Point-of-use interventions to decrease contamination of drinking water: a randomized, controlled pilot study on efficacy, effectiveness, and acceptability of closed containers, Moringa oleifera, and in-home chlorination in rural South India. American Journal of Tropical Medicine and Hygiene 2010; 82: 759765.
21. Rose, A, et al. Solar disinfection of water for diarrhoeal prevention in southern India. Archives of Disease in Childhood 2006; 91: 139141.
22. Kang, G, et al. Epidemiological and laboratory investigations of outbreaks of diarrhoea in rural South India: implications for control of disease. Epidemiology and Infection 2001; 127: 107112.
23. Pai, M, et al. An epidemic of diarrhoea in south India caused by enteroaggregative Escherichia coli. Indian Journal of Medical Research 1997; 106: 712.
24. Ramakrishna, BS, et al. Isolation of Vibrio cholerae O139 from the drinking water supply during an epidemic of cholera. Tropical Medicine and International Health 1996; 1: 854858.
25. Sowmyanarayanan, TV, et al. Investigation of a hepatitis A outbreak in children in an urban slum in Vellore, Tamil Nadu, using geographic information systems. Indian Journal of Medical Research 2008; 128: 3237.
26. WHO. The Treatment of Diarrhoea: A Manual for Physicians and other Senior Health Workers. Geneva: World Health Organization, 2005.
27. Morris, SS, et al. Is prevalence of diarrhea a better predictor of subsequent mortality and weight gain than diarrhea incidence? American Journal of Epidemiology 1996; 144: 582588.
28. Kumar, N, et al. Kuppuswamy's socioeconomic status scale-updating for 2007. Indian Journal of Pediatrics 2007; 74: 11311132.
29. WHO. Global Water Supply and Sanitation Assessment 2000 Report. Geneva: World Health Organization, 2000.
30. Gladstone, BP, et al. Burden of illness in the first 3 years of life in an Indian slum. Journal of Tropical Pediatrics 2010; 56: 221226.
31. Feikin, DR, et al. Evaluation of the optimal recall period for disease symptoms in home-based morbidity surveillance in rural and urban Kenya. International Journal of Epidemiology 2010; 39: 450458.
32. Ramakrishnan, R, et al. Influence of recall period on estimates of diarrhoea morbidity in infants in rural Tamilnadu. Indian Journal of Public Health 1999; 43: 136139.
33. Byass, P, Hanlon, PW. Daily morbidity records: recall and reliability. International Journal of Epidemiology 1994; 23: 757763.
34. Perry, S, et al. Household transmission of gastroenteritis. Emerging Infectious Diseases 2005; 11: 10931096.
35. Hung, BV, The most common causes of and risk factors for diarrhea among children less than five years of age admitted to Dong Anh Hospital, Hanoi, Northern Vietnam (dissertation). Oslo, Norway: University of Oslo, 2006.
36. Werber, D, et al. Preventing household transmission of Shiga toxin-producing Escherichia coli O157 infection: promptly separating siblings might be the key. Clinical Infectious Diseases 2008; 46: 11891196.
37. Bachrach, LR, Gardner, JM. Caregiver knowledge, attitudes, and practices regarding childhood diarrhea and dehydration in Kingston, Jamaica. Revista Panamericana de Salud Pública 2002; 12: 3744.
38. El-Gilany, AH, Hammad, S. Epidemiology of diarrhoeal diseases among children under age 5 years in Dakahlia, Egypt. Eastern Mediterranean Health Journal 2005; 11: 762775.
39. Saha, CK. Dynamics of risk determinants regarding diarrhea affected slum children in urban Dhaka: a dysfunctional health care system. Current Research Journal of Social Sciences 2012; 4: 304313.
40. Engleberg, NC, et al. Epidemiology of diarrhea due to rotavirus on an Indian reservation: risk factors in the home environment. Journal of Infectious Diseases 1982; 145: 894898.
41. Khalili, B, et al. Risk factors for hospitalization of children with diarrhea in Shahrekord, Iran Iranian Journal of Clinical Infectious Diseases 2006; 1: 131136.
42. Ziegelbauer, K, et al. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. PLoS Medicine 2012; 9: e1001162.
43. Lamberti, LM, et al. Breastfeeding and the risk for diarrhea morbidity and mortality. BMC Public Health 2011; 11: S15.
44. Gladstone, BP, et al. Infant morbidity in an Indian slum birth cohort. Archives of Disease in Childhood 2008; 93: 479484.
45. Sarkar, R, et al. Burden of childhood diseases and malnutrition in a semi-urban slum in southern India. BMC Public Health 2013; 13: 87.

Keywords

Type Description Title
WORD
Supplementary materials

Kattula supplementary material
Kattula supplementary material 1

 Word (150 KB)
150 KB

Environmental predictors of diarrhoeal infection for rural and urban communities in south India in children and adults

  • D. KATTULA (a1), M. R. FRANCIS (a1), A. KULINKINA (a2), R. SARKAR (a1), V. R. MOHAN (a3), S. BABJI (a1), H. D. WARD (a1) (a4), G. KANG (a1) (a4), V. BALRAJ (a3) and E. N. NAUMOVA (a1) (a2)...

Metrics

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