News article

Risk factors associated with diarrhoea in young children

Posted:  Monday, August 01, 2016

Importance of proper sanitation in preventing diarrhoea in young children

Moderate-to-severe diarrhoea (MSD) is common in children exposed to poor sanitation and hygiene. MSD is defined as the passage of 3 or more loose stools within 24 hours along with signs of moderate-to-severe dehydration, dysentery, or hospitalization. Children defecating in an open area or using shared toilet facilities are at risk of developing MSD. A new study published in the journal PLoS Medicine assessed the access to sanitation and hygiene across Global Enteric Multicentre Study (GEMS) locations.

A matched case-control study was conducted among children less than 5 years old at seven locations in sub-Saharan Africa and South Asia. The study enrolled 8592 children with MSD as cases and 12,390 children without any symptoms of diarrhoea as controls. Information regarding maternal education, household size, water sources, facilities for the disposal of human faecal waste, hand washing, etc. were collected. Hygiene practices of children and availability of latrines and toilet facilities of the households were directly observed and the details were recorded.

Households in the majority of the study locations had access to sanitation facilities. However, in rural Kenya, most households did not have access to any facility. Children sharing sanitation facilities with other households were at a greater risk of developing MSD in Kenya, Mali, Bangladesh, Mozambique, and Pakistan. Defecating in open areas was also associated with MSD in Kenyan children. Designating a separate hand wash area near home and washing hands with soap or ash had a protective effect against MSD, in Mozambique and India.

The study findings demonstrated that sharing sanitation facilities with 2 or more households increased the risk of MSD in children. Promoting the use of private sanitation facility, proper maintenance of shared facilities to ensure safety and privacy, and soap and water for handwashing may reduce the risk of MSD in children. The majority of the households in the study locations had access to sanitation facilities. This limited the comparison of the risks associated with shared sanitation facilities. Details on how the sanitation facility was shared; maintenance of the shared facility; and distance between sanitation facility and washing area or household were lacking. Further research is needed to explore the behaviours related to sanitation, exposures, and conditions that predispose to MSD in developing countries.

News source - Baker KK, O’Reilly CE, Levine MM, Kotloff KL, Nataro JP, Ayers TL, Farag TH, Nasrin D, Blackwelder WC, Wu Y, Alonso PL. Sanitation and hygiene-specific risk factors for moderate-to-severe diarrhoea in young children in the global enteric multicenter study, 2007–2011: case-control study. PLoS Med. 2016 May 3; 13(5):e1002010.c