Open Access Research article

Risk factors for diarrhea hospitalization in Bangladesh, 2000–2008: a case-case study of cholera and shigellosis

Danny V Colombara1*, Abu SG Faruque2, Karen D Cowgill34 and Jonathan D Mayer1

  • * Corresponding author: Danny V Colombara dvc2@uw.edu

Author Affiliations

1 Department of Epidemiology, University of Washington, Seattle, WA, USA

2 International Centre for Diarrheal Disease Research, Dhaka, Bangladesh

3 Department of Global Health, University of Washington, Seattle, WA, USA

4 Seattle University College of Nursing, Seattle, WA, USA

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BMC Infectious Diseases 2014, 14:440  doi:10.1186/1471-2334-14-440

Published: 15 August 2014

Abstract

Background

Cholera and shigellosis are endemic on the Indian subcontinent. Our objective was to identify cholera-specific risk factors distinct from shigellosis risk factors.

Methods

We conducted a case-case study among hospitalized diarrheal patients, comparing those with cholera and shigellosis in International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) hospitals in Matlab (rural) and Dhaka (urban) between January 1, 2000 and December 31, 2008.

Results

Multivariable Poisson regression models revealed that having more than nine years of education, compared to no education, was associated with a 39% (adjusted Risk Ratio [aRR] = 0.61, 95% confidence interval [CI]: 0.40-0.93) decreased risk for cholera hospitalization in Matlab and a 16% (aRR = 0.84, 95% CI: 0.75-0.94) decreased risk in Dhaka. Having a family member with diarrhea in the past seven days increased cholera hospitalization risk by 17% (aRR = 1.17, 95% CI: 1.09-1.26) in Matlab.

Conclusions

Further studies are needed to elucidate the pathway through which education impacts cholera risk in order to create targeted interventions in cholera-endemic areas. Interventions seeking to reduce transmission and facilitate hygienic practices among family members of index cases with diarrhea should be considered, especially in rural cholera endemic settings.

Keywords:
Cholera; Shigellosis; Epidemiology; Bangladesh