Academic journal article Journal of Health Population and Nutrition

Aetiology of Diarrhoea in a Birth Cohort of Children Aged 0-2 Year(s) in Rural Mirzapur, Bangladesh

Academic journal article Journal of Health Population and Nutrition

Aetiology of Diarrhoea in a Birth Cohort of Children Aged 0-2 Year(s) in Rural Mirzapur, Bangladesh

Article excerpt


Acute diarrhoea is one of the leading causes of morbidity and mortality in children in most developing areas of the world. Despite the use of oral rehydration therapy, deaths due to diarrhoea in children aged less than five years are still estimated to be about two million per year (1). Besides mortality, the long-term effects of diarrhoeal illness on childhood health are extremely serious and include malnutrition and growth faltering (2). Further attention to the causes of diarrhoea is important to develop preventive measures.

Aetiology of diarrhoea is variable according to geographic and climatic conditions, host factors, and socioeconomic situations. It is important to establish the causative agents of diarrhoea across different settings and populations. Determination of enteric agents may contribute to improved surveillance systems, including early recognition of epidemics and their modes of spread, guide vaccine development and administration policies, and influence appropriate outcome measures for intervention studies.

In the 1980s, studies of aetiologies of diarrhoeal diseases in children of developing countries, such as Bangladesh, were able to detect an enteropathogen in about half of stool specimens taken from ill subjects (3). Recent advances in microbiological techniques have greatly increased the rate of isolation of enteric pathogens, including newer ones. The enhanced laboratory capacity, coupled with its application in the context of a longitudinal study, permits a more complete picture of the epidemiology of diarrhoeal infections. The objective of the present study was to investigate the aetiological roles of a vast array of pathogens, including ones discovered relatively recently, in the context of a rural community-based birth-cohort study.


Study site and subjects

The study site encompassed 10 villages in Mirzapur, a rural area, located approximately 60 km from Dhaka, the capital city of Bangladesh. Detailed characteristics of the villages and village inhabitants are given elsewhere (4).

During July 1993-August 1993, a door-to-door census, conducted by community health workers (CHWs), identified pregnant women or those who had the potential to become pregnant and deliver their babies. The pregnant women were invited to participate in the surveillance project. Informed consent for inclusion of their children in the project was obtained from mothers or caretakers. All study children were assured of healthcare by a paediatrician either in the home or at the Kumudini Hospital for the duration of their enrollment in the study. The Ethical Review Committee of ICDDR,B: Centre for Health and Population Research approved the study protocol, and the Johns Hopkins Committee on Human Research approved the data analysis plan.

Study participants

In total, 252 children made up the cohort, of whom 244 completed the full two-year follow-up, and 179,789 child-days of observation was made.

About 40% of the study children lived in households of more than six people, and the median monthly household income for all households was about Taka 3,000 or US$ 60. Keeping animals around the living area was common. For over 80% of the households, disposal of faeces took place in open space rather than in closed pits or sanitary latrines. Since only 30% of the households claimed ownership of a tubewell, 81% of them practised storing water for later use. Although Bangladeshi mothers generally practise partial breastfeeding for a prolonged period, exclusive breastfeeding of the infant beyond three months of age was practised by 37% of mothers in the study. More detailed data are presented elsewhere (4).

Illness and microbiology surveillance

The field team comprised a study physician and 12 local, trained female CHWs who had had previous exposure to household morbidity surveillance for diarrhoea (5). …

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