Vol. 21, No. 4 Printed in Great Britain
International Journal of Epidemiology © International Epidemiological Association 1992
Risk Factors for the Transmission of Diarrhoea in Children: A CaseControl Study in Rural Malaysia SABINA M KNIGHT. WAHEB TOODAYAN. WAKINYJAN C CAIQUE. WIN KYI, ANTHONY BARNES AND PATRICIA DESMARCHELIER
In 1985, Briscoe et at.1 recommended using casecontrol studies as an alternative to longitudinal studies for investigating risk factors for diarrhoea, specifically those related to water supply and sanitation. Cousens et a/.2-3 in 1988 provided specific guidelines for the design of case-control studies on risk factors for diarrhoea. This study was undertaken in Tumpat, a rural district in the state of Kelantan, Malaysia. Kelantan is the poorest state in Malaysia in terms of per capita income and public health facilities such as safe water supply and sanitation.4 In Kelantan in 1987 diarrhoea was ranked seventh as a cause of death among children aged 1-4 years and eleventh for children under 1 year.5 Diarrhoea ranked third after respiratory infections and skin infections as a cause of presentation at outpatient services in Tumpat in 1988.* Over the last decade the reported incidence of diarrhoea in Kelantan increased while that of immunizible diseases generally decreased.5 Konare et al.7 found an incidence of diarrhoea of 1.38 episodes/year per child (800/month Level 2: MS 500-800/month Level 3: MS 250-499/month Level 4: MS < 250/month
6 11 47 34
4 20 37 37
Years of education of main caregiver 0-2 3-5 6-9 10 +
30 10 38 20
20 11 47 20
Birth order of child First Second Third or fourth Fifth or sixth Seventh or more
12 12 30 25 19
22 18 19 22 7
Number of people living in house 0-4 5-7 8-9 10 +
13 44 25 16
19 45 22 12
Health centre of recruitment 1 2 3 4 5
20 8 27 23 20
17 24 15 25 17
Variable
P value*
0.26
0.32
0.31
0.%
0.03
* P values relate to the % for differences between OR derived from conditional logistic regression analysis, adjusted for other confounders.
Downloaded from http://ije.oxfordjournals.org/ at Cornell University Library on November 16, 2014
tional latrine (defined by proximity to the house and method of removal of faeces, i.e. pour or flush latrines or situation of latrine above a moving body of water); presence/absence of a container of washing water in latrine (used for anal and hand cleansing); accessibility of washing water source (inside or outside of house compound); type of well (concrete or bare earth, with or without a headwall, whether a cover was present, and proximity to septic system or sullage pools); method of retrieval of well water (pipe or bucket); the type of drinking water storage container (narrow or wide necked); whether any stored cooked food was seen uncovered in the kitchen; presence or absence of animals inside the house and presence or absence of animal faeces in yard. Samples of both source and drinking water were tested for water quality using a membrane filter method9 (MFM), which provided a count of faecal coliforms/100 ml of water.
815
DIARRHOEA TRANSMISSION IN MALAYSIA
The mother was the main caregiver for 92 case and 91 control children. Table 2 lists the major risk factors identified for diarrhoea. These and negative Findings are presented below.
TABLE 2 Major risk factors for diarrhoea: odds ratios (OR) from conditional logistic regression (CLR)1 (with P valueb) and matched pair analysis (MPA); with percentage of exposed controls as estimate of population prevalence of exposure to risk factor
P
OR (MPA)
Controls exposed V,
0.02
International Journal of Epidemiology © International Epidemiological Association 1992
Risk Factors for the Transmission of Diarrhoea in Children: A CaseControl Study in Rural Malaysia SABINA M KNIGHT. WAHEB TOODAYAN. WAKINYJAN C CAIQUE. WIN KYI, ANTHONY BARNES AND PATRICIA DESMARCHELIER
In 1985, Briscoe et at.1 recommended using casecontrol studies as an alternative to longitudinal studies for investigating risk factors for diarrhoea, specifically those related to water supply and sanitation. Cousens et a/.2-3 in 1988 provided specific guidelines for the design of case-control studies on risk factors for diarrhoea. This study was undertaken in Tumpat, a rural district in the state of Kelantan, Malaysia. Kelantan is the poorest state in Malaysia in terms of per capita income and public health facilities such as safe water supply and sanitation.4 In Kelantan in 1987 diarrhoea was ranked seventh as a cause of death among children aged 1-4 years and eleventh for children under 1 year.5 Diarrhoea ranked third after respiratory infections and skin infections as a cause of presentation at outpatient services in Tumpat in 1988.* Over the last decade the reported incidence of diarrhoea in Kelantan increased while that of immunizible diseases generally decreased.5 Konare et al.7 found an incidence of diarrhoea of 1.38 episodes/year per child (800/month Level 2: MS 500-800/month Level 3: MS 250-499/month Level 4: MS < 250/month
6 11 47 34
4 20 37 37
Years of education of main caregiver 0-2 3-5 6-9 10 +
30 10 38 20
20 11 47 20
Birth order of child First Second Third or fourth Fifth or sixth Seventh or more
12 12 30 25 19
22 18 19 22 7
Number of people living in house 0-4 5-7 8-9 10 +
13 44 25 16
19 45 22 12
Health centre of recruitment 1 2 3 4 5
20 8 27 23 20
17 24 15 25 17
Variable
P value*
0.26
0.32
0.31
0.%
0.03
* P values relate to the % for differences between OR derived from conditional logistic regression analysis, adjusted for other confounders.
Downloaded from http://ije.oxfordjournals.org/ at Cornell University Library on November 16, 2014
tional latrine (defined by proximity to the house and method of removal of faeces, i.e. pour or flush latrines or situation of latrine above a moving body of water); presence/absence of a container of washing water in latrine (used for anal and hand cleansing); accessibility of washing water source (inside or outside of house compound); type of well (concrete or bare earth, with or without a headwall, whether a cover was present, and proximity to septic system or sullage pools); method of retrieval of well water (pipe or bucket); the type of drinking water storage container (narrow or wide necked); whether any stored cooked food was seen uncovered in the kitchen; presence or absence of animals inside the house and presence or absence of animal faeces in yard. Samples of both source and drinking water were tested for water quality using a membrane filter method9 (MFM), which provided a count of faecal coliforms/100 ml of water.
815
DIARRHOEA TRANSMISSION IN MALAYSIA
The mother was the main caregiver for 92 case and 91 control children. Table 2 lists the major risk factors identified for diarrhoea. These and negative Findings are presented below.
TABLE 2 Major risk factors for diarrhoea: odds ratios (OR) from conditional logistic regression (CLR)1 (with P valueb) and matched pair analysis (MPA); with percentage of exposed controls as estimate of population prevalence of exposure to risk factor
P
OR (MPA)
Controls exposed V,
0.02
