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      Factors associated with diarrheal disease in the rural Caribbean region of Colombia

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          ABSTRACT

          OBJECTIVE:

          To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia.

          METHOD:

          A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs.

          RESULTS:

          Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07–0.85), children under five years old (PR = 4.05; 95%CI 1.70–9.68), water from deep wells (PR = 16.90; 95%CI 2.45–116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27–103.29), toilets availability (PRA = 0.23; 95%CI 0.06–0.96), and swine presence (PR = 0.20; 95%CI 0.05–0.74) were significantly associated with the occurrence of diarrheal disease.

          CONCLUSION:

          Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.

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          Most cited references 23

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          Human diarrhea infections associated with domestic animal husbandry: a systematic review and meta-analysis.

          Domestic animal husbandry, a common practice globally, can lead to zoonotic transmission of enteric pathogens. However, this risk has received little attention to date. This systematic review and meta-analysis examines the evidence for an association between domestic exposure to food-producing animals and cases of human diarrhea and specific enteric infections. We performed a systematic review of available literature to examine domestic livestock and poultry as risk factors for diarrhea and applied pre-determined quality criteria. Where possible, we carried out meta-analysis of specific animal-pathogen pairs. We found consistent evidence of a positive association between exposure to domestic food-producing animals and diarrheal illness across a range of animal exposures and enteric pathogens. Out of 29 studies included in the review, 20 (69.0%) reported a positive association between domestic animal exposure and diarrhea. Domestic exposure to poultry revealed a substantial association with human campylobacteriosis (OR 2.73, 95% CI 1.90-3.93). Our results suggest that domestic poultry and livestock exposures are associated with diarrheal illness in humans. Failure to ascertain the microbial cause of disease may mask this effect. Exposure to domestic animals should be considered a risk factor for human diarrheal illness and additional studies may identify potential mitigation strategies to address this risk.
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            Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.

            Many studies have reported the results of interventions to reduce illness through improvements in drinking water, sanitation facilities, and hygiene practices in less developed countries. There has, however, been no formal systematic review and meta-analysis comparing the evidence of the relative effectiveness of these interventions. We developed a comprehensive search strategy designed to identify all peer-reviewed articles, in any language, that presented water, sanitation, or hygiene interventions. We examined only those articles with specific measurement of diarrhoea morbidity as a health outcome in non-outbreak conditions. We screened the titles and, where necessary, the abstracts of 2120 publications. 46 studies were judged to contain relevant evidence and were reviewed in detail. Data were extracted from these studies and pooled by meta-analysis to provide summary estimates of the effectiveness of each type of intervention. All of the interventions studied were found to reduce significantly the risks of diarrhoeal illness. Most of the interventions had a similar degree of impact on diarrhoeal illness, with the relative risk estimates from the overall meta-analyses ranging between 0.63 and 0.75. The results generally agree with those from previous reviews, but water quality interventions (point-of-use water treatment) were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus. There is some evidence of publication bias in the findings from the hygiene and water treatment interventions.
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              Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma

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                Author and article information

                Journal
                Rev Saude Publica
                Rev Saude Publica
                rsp
                Revista de Saúde Pública
                Faculdade de Saúde Pública da Universidade de São Paulo
                0034-8910
                1518-8787
                24 September 2020
                2020
                : 54
                Affiliations
                [I ] orgnameUniversidad de los Andes orgdiv1Centro de Investigaciones en Ingeniería Ambiental orgdiv2Departamento de Ingeniería Civil y Ambiental Bogotá DC Colombia originalUniversidad de los Andes. Centro de Investigaciones en Ingeniería Ambiental. Departamento de Ingeniería Civil y Ambiental. Bogotá, DC, Colombia
                [II ] orgnameUniversidade de São Paulo orgdiv1Laboratório de Gestão Ambiental, Inovação e Sustentabilidade São Paulo SP Brasil originalUniversidade de São Paulo. Laboratório de Gestão Ambiental, Inovação e Sustentabilidade. São Paulo, SP, Brasil
                [III ] orgnameUniversidade de São Paulo orgdiv1Faculdade de Saúde Pública orgdiv2Laboratório de Inferência Causal em Epidemiologia São Paulo SP Brasil originalUniversidade de São Paulo. Faculdade de Saúde Pública. Laboratório de Inferência Causal em Epidemiologia. São Paulo, SP, Brasil
                [I ] Bogotá DC Colombia originalUniversidad de los Andes. Centro de Investigaciones en Ingeniería Ambiental. Departamento de Ingeniería Civil y Ambiental. Bogotá, DC, Colombia
                [II ] São Paulo SP Brasil originalUniversidade de São Paulo. Laboratório de Gestão Ambiental, Inovação e Sustentabilidade. São Paulo, SP, Brasil
                [III ] São Paulo SP Brasil originalUniversidade de São Paulo. Faculdade de Saúde Pública. Laboratório de Inferência Causal em Epidemiologia. São Paulo, SP, Brasil
                Author notes
                Correspondence: Maria Angelica Galezzo, Facultad de Ingeniería Departamento de Ingeniería Civil y Ambiental Calle 19A 1 82, Edificio Mario Laserna, Oficina 733 111711 Bogotá, Colombia. E-mail: ma.galezzo@ 123456uniandes.edu.co

                Authors' Contribution:

                MAGM wrote the research proposal, carried out the field experiment, analyzed the data, interpreted the results and wrote the manuscript. FADQ oriented the statistics analysis and data interpretation. MSRS reviewed the research proposal and, along with FADQ and WMRD contributed to the writing of the manuscript. All authors read, critically reviewed, and approved the final version of the manuscript.

                Conflict of Interest:

                The authors declare no conflict ofinterest.

                Correspondencia: Maria Angelica Galezzo, Facultad de Ingeniería Departamento de Ingeniería Civil y Ambiental Calle 19A 1 82, Edificio Mario Laserna, Oficina 733 111711 Bogotá, Colombia. E-mail: ma.galezzo@ 123456uniandes.edu.co

                Contribución de los Autores:

                MAGM escribió la propuesta de investigación, llevó a cabo el trabajo de campo, analizó los datos, interpretó los resultados y redactó el manuscrito inicial. FADQ orientó el análisis estadístico y la interpretación de los datos, MSRS revisó la propuesta de investigación y junto con FADQ y WMRG comentaron y contribuyeron a la redacción del manuscrito. Todos los autores leyeron, revisaron críticamente y aprobaron la versión final del manuscrito.

                Conflicto de Intereses:

                Los autores declaran que no hay conflictos de intereses.

                Article
                00268
                10.11606/s1518-8787.2020054002054
                7524207
                33027343

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 4, Tables: 6, Equations: 0, References: 30
                Categories
                Original Article

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