Burden of Self-Reported Acute Gastrointestinal Illness in Cuba

Article excerpt

ABSTRACT

Acute gastrointestinal illness is an important public-health issue worldwide. Burden-of-illness studies have not previously been conducted in Cuba. The objective of the study was to determine the magnitude, distribution, and burden of self-reported acute gastrointestinal illness in Cuba. A retrospective, cross-sectional survey was conducted in three sentinel sites during June-July 2005 (rainy season) and during November 2005-January 2006 (dry season). Households were randomly selected from a list maintained by the medical offices in each site. One individual per household was selected to complete a questionnaire in a face-to-face interview. The case definition was three or more bouts of loose stools in a 24-hour period within the last 30 days. In total, 97.3% of 6,576 interviews were completed. The overall prevalence of acute gastrointestinal illness was 10.6%. The risk of acute gastrointestinal illness was higher during the rainy season (odds ratio [OR]=3.85, 95% confidence interval [CI] 3.18-4.66) in children (OR=3.12, 95% CI 2.24-4.36) and teens (OR=2.27, 95% CI 1.51-3.41) compared to people aged 25-54 years, in males (OR=1.24, 95% CI 1.04-1.47), and in the municipality of Santiago de Cuba (OR=1.33, 95% CI 1.11-1.61). Of 680 cases, 17.1-38.1% visited a physician, depending on sentinel site. Of the cases who visited a physician, 33.3-53.9% were requested to submit a stool sample, and of those, 72.7-100.0% complied. Of the cases who sought medical care, 16.7-61.5% and 0-31.6% were treated with antidiarrhoeals and antibiotics respectively. Acute gastrointestinal illness represented a substantial burden of health compared to developed countries. Targeting the identified risk factors when allocating resources for education, food safety, and infrastructure might lower the morbidity associated with acute gastrointestinal illness.

Key words: Cross-sectional studies; Developing countries; Diarrhoea; Epidemiology; Public health; Retros-pective studies; Risk factors; Seasonal variation; Sentinel sites; Cuba

INTRODUCTION

Acute gastrointestinal illness is an important public-health issue worldwide. In developed countries, estimates of monthly prevalence range from 4.5% to 11% (1-9). Although illness is typically mild and self-limiting, acute gastrointestinal illness imposes a substantial economic burden to the population and healthcare system (3-5,9). Diarrhoea is one of the primary causes of morbidity and mortality among children aged less than five years in the developing world; globally, it is estimated that there are 3.2 episodes of diarrhoea per child-year and 4.9 deaths per 1,000 children per year due to diarrhoeal illness (10).

The Pan American Health Organization (PAHO) supports health needs and initiatives within the Americas, with a focus on the Latin American and Caribbean countries. Within an initiative sponsored by the World Health Organization (WHO), the PAHO and the Centre for Food-borne, Environmental and Zoonotic Infectious Diseases of the Public Health Agency of Canada worked jointly with the Cuban Ministry of Health to develop a study aimed at understanding the burden of illness associated with gastrointestinal diseases in Cuba and how it compares with other countries.

Our objective was to determine the temporal and demographic distribution and burden of self-reported acute gastrointestinal illness in Cuba. It is anticipated that this information will assist the Ministry of Health in assigning resources for education and food safety.

MATERIALS AND METHODS

Study design

A cross-sectional survey was conducted within three purposively-selected sentinel sites in Cuba (Fig.). The main municipality within provinces representing differences in urban-rural mix, from different regions of the country, and the differences in their predefined risk rating for acute gastrointestinal illness were selected. The sentinel sites were: (a) municipality of Cienfuegos (CF; provincial capital, 333 sq km, population-164,180) within the province of Cienfuegos, (b) municipality of Santiago de Cuba (SC; provincial capital, 1,024 sq km, population-494,915) within the province of Santiago de Cuba, and (c) municipality of Centro Habana (CH; 4 sq km, population-157,539) within the province of Ciudad de La Habana (11). …