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Cited by 92Child Nutrition and Water AccessViral gastroenteritis research and epidemiologyPoverty, Education, and Child Welfare

Risk Factors for Childhood Diarrhea Incidence: Dynamic Analysis of a Longitudinal Study

Genser, Bernd, Strina, Agostino, Teles, Carlos A., Prado, Matildes S., Barreto, Mauricio L.·2006·Epidemiology
DOI 10.1097/01.ede.0000239728.75215.86
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Abstract

BACKGROUND: Several longitudinal studies have investigated factors associated with childhood diarrhea in developing countries. However, most studies have neglected important dynamic features of the longitudinal design and hierarchical interrelationships among the potential risk factors. METHODS: We conducted a longitudinal study of 902 children, age 0 to 36 months at baseline, in a large urban center in northeastern Brazil. Diarrhea data were collected by following children from October 2000 until January 2002 with biweekly home visits. We used a dynamic time-to-event analysis to account for several longitudinal features. We applied an effect-decomposition strategy to quantify direct and indirect effects of risk factors grouped in different blocks. RESULTS: Child's age and an autoregressive effect of past diarrhea episodes explained some of the decline of diarrhea incidence observed throughout the study (from more than 14 episodes to 2 episodes per child-year), a phenomenon already observed but not explained in other longitudinal diarrhea studies. We identified the following major diarrhea determinants: low socioeconomic status, poor sanitation conditions, presence of intestinal parasites, and absence of prenatal examination. The effect of socioeconomic status was mediated mostly by living and sanitation conditions. CONCLUSION: Our study shows important advantages of applying a dynamic analysis approach to longitudinal observational studies of diarrhea or other acute diseases and highlights the complex interrelationships of diarrhea determinants. Our results confirm the importance of sanitation as a major determinant of child health in urban settings of developing countries.

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Crossref · 10.1097/01.ede.0000239728.75215.86

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  • There was no difference between the amount of recall decay in severe and non-severe illness in children <5 years of age.

    “Higher incidence was documented in days 0–6 than days 7–13 before home visit in children <5 years of age for both non-severe illness (RR 2.08; 95% CI 1.93–2.25) and severe illness (RR 2.04; 95% CI 1.82–2.28), although there was no difference between the amount of recall decay in severe and non-severe illness (Table 2).”

    From Evaluation of the optimal recall period for disease symptoms in home-based morbidity surveillance in rural and urban Kenya (2010) · cites this paper as [17]

  • Of 23 studies with information about sex and diarrhoea incidence, seven showed significantly more cases in boys than in girls.

    “We identified 23 studies with information about sex with respect to the incidence of diarrhoea,20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 seven24, 29, 30, 31, 36, 37, 39 of which showed significantly more cases in boys than in girls.”

    From Global burden of childhood pneumonia and diarrhoea (2013) · cites this paper as [22]

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Authors
Genser, B., Strina, A., Teles, C. A., Prado, M. S., & Barreto, M. L.
Affiliations
Universidade Federal da Bahia (BR)
Corresponding author
Genser, Bernd
ORCID
Venue
Epidemiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-11
Volume
17
Issue
6
Pages
658-667
ISSN
1044-3983 (ISSN-L)
DOI
10.1097/01.ede.0000239728.75215.86
OpenAlex
W2007059443
Cited by
92
References
49
Citations by year
2026: 3 · 2025: 2 · 2024: 8 · 2023: 1 · 2022: 6 · 2021: 2 · 2020: 1 · 2019: 5 · 2018: 5 · 2017: 8 · 2016: 5 · 2015: 6 · 2014: 3 · 2013: 7 · 2012: 5
FWCI
2.64
Type
journal article
Language
en
Open access
closed
Locations
  • Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
  • Social Sciences › Safety Research › Poverty, Education, and Child Welfare
Keywords
childhood diarrhea, risk factors, socioeconomic status, sanitation, intestinal parasites, prenatal care, effect decomposition, mediation analysis, autoregressive effects, urban children, child health
MeSH terms
Brazil, Child, Preschool, Diarrhea, Infantile, Female, Humans, Infant, Infant, Newborn, Longitudinal Studies, Male, Risk Factors, Sanitation, Social Class, Urban Population, Incidence

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