Factors associated with diarrhea in children under five years old in the state of Pernambuco, according to surveys conducted in 1997 and 2006

Vasconcelos, Maria Josemere de Oliveira Borba; Rissin, Anete; Figueiroa, José Natal; Lira, Pedro Israel Cabral de; Batista Filho, Malaquias

doi:10.11606/S1518-8787.2018052016094

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Original Article • Rev. Saúde Pública 52 • 2018 • https://doi.org/10.11606/S1518-8787.2018052016094 copy

Factors associated with diarrhea in children under five years old in the state of Pernambuco, according to surveys conducted in 1997 and 2006

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Describe and compare variations of the factors associated with the prevalence of diarrhea in children under five years old in the state of Pernambuco.

METHODS

We used the databases of two population-based surveys from the years 1997 and 2006, with 2,078 and 1,650 children, respectively, evaluated in 18 municipalities of Pernambuco (Metropolitan Region of Recife, urban and rural interior). The variables, allocated at hierarchical levels, were analyzed using prevalence and Poisson regression ratios.

RESULTS

Only four variables were independently associated and were included in the final hierarchical model: geographical area, number of people per room, maternal age and the age of the child. In 1997: urban interior = 1.33 (95%CI 1.06–1.66), rural interior = 1.22 (95%CI 0.97–1.53) and in 2006: urban interior = 1.87 (95%CI 1.31–2.66), rural interior = 2.07 (95%CI 1.50–2.85); number of persons per room (1997): 1 to less than 2 = 1.29 (95%CI 0.98–1.68), two or more = 1.47 (95%CI 1.11–1.95) and in 2006: 1 to less than 2 = 0.86 (95%CI 0.68–1.09), two or more = 1.29 (95%CI 0.94–1.75); maternal age (1997): 10 to 19 years = 1.48 (95%CI 1.05–2.08), 20 to 24 years = 1.23 (95%CI 0.94–1.60), 25 to 34 years = 1.01 (95%CI 0.78–1.30) and in 2006: 10 to 19 years old = 1.70 (95%CI 1.08–2.66), 20 to 24 years old = 1.64 (95%CI 1.16–2.32), 25 to 34 years = 1.20 (95%CI 0.89–1.62); and age of the child (1997): 0–11 months = 1.57 (95%CI 1.27–1.94), 12–23 months = 1.73 (95%CI 1.41–2.12) and in 2006: 0–11 months = 1.04 (95%CI 0.76–1.41), 12–23 months = 1.77 (95%CI 1.41–2.23).

CONCLUSIONS

There was a great variability of the conditioners of diarrhea in children between the two periods analyzed. At the public policy level, despite changes in terms of people, time sequences, and geographic spaces, diarrhea remains on an important scale in the ranking of government power.

DESCRIPTORS
Child, Preschool; Diarrhea, Infantile, epidemiology; Diarrhea, epidemiology; Prevalence; Risk Factors; Socioeconomic Factors; Time Series Studies

Variable			1997				2006
			Sample	Diarrhea	PR (95%CI)	p	Sample	Diarrhea	PR (95%CI)	p
			N	n (%)	PR (95%CI)	p	N	n (%)	PR (95%CI)	p
Distal level
Group A
	Geographical area
		Metropolitan region	734	124 (16.9)	1.0	0.043	427	45 (10.5)	1.0	< 0.001
		Urban interior	685	154 (22.5)	1.33 (1.06–1.66)		416	81 (19.5)	1.87 (1.31–2.66)
		Rural interior	651	131 (20.1)	1.22 (0.97–1.53)		789	169 (21.4)	2.07 (1.50–2.85)
Intermediate level
Group B
	Water supply
		General network	1,359	260 (19.1)	1.0	0.243	918	148 (16.1)	1.0	0.018
		Other	711	149 (21.0)	1.12 (0.93–1.35)		714	147 (20.6)	1.29 (1.04–1.60)
	Sanitary sewage
		Public network	554	95 (17.1)	1.0	0.004	547	83 (15.2)	1.0	0.045
		Septic tank covers	724	130 (18.0)	1.05 (0.82–1.35)		519	93 (17.9)	1.18 (0.90–1.56)
		Other	792	184 (23.2)	1.40 (1.11–1.76)		563	119 (21.1)	1.39 (1.07–1.81)
	Drinkable water treatment
		General network	1,207	209 (17.3)	1.0	< 0.001	823	104 (12.6)	1.0	< 0.001
		Other	863	200 (23.2)	1.34 (1.12–1.61)		809	191 (23.6)	1.78 (1.35–2.35)
	Waste destination
		Public waste collection	1,046	177 (16.9)	1.0	< 0.001	945	151 (16.0)	1.0	0.008
		Others	1,024	232 (22.7)	1.37 (1.14–1.65)		687	144 (21.0)	1.33 (1.08–1.65)
	Type of floor
		Ceramics/Cement	1,780	343 (19.3)	1.0	0.183	1,544	277 (17.9)	1.0	0.537
		Others	290	66 (22.8)	1.18 (0.92–1.51)		88	18 (20.4)	1.14 (0.75–1.74)
	Type of wall
		Masonry/Brick	1,771	347 (19.6)	1.0	0.544	1,525	273 (17.9)	1.0	0.550
		Other	299	62 (20.7)	1.08 (0.84–1.39)		107	22 (20.6)	1.14 (0.75–1.72)
	No. of people per room
		< 1	429	63 (14.7)	1.0	0.004	653	113 (17.3)	1.0	0.015
		1–2	1,014	200 (19.7)	1.34 (1.03–1.75)		780	132 (16.9)	0.96 (0.76–1.21)
		≥ 2	627	146 (23.3)	1.59 (1.21–2.10)		199	50 (25.1)	1.45 (1.08–1.95)
	No. of people per bedroom
		< 2	364	54 (14.8)	1.0	0.022	334	52 (15.6)	1.0	0.405
		2–3	675	131 (19.4)	1.31 (0.97–1.75)		599	108 (18.0)	1.15 (0.85–1.57)
		≥ 3	1,031	224 (21.7)	1.46 (1.11–1.92)		699	135 (19.3)	1.23 (0.91–1.65)
Group C
	Refrigerator possession
		Yes	1,138	178 (15.6)	1.0	< 0.001	1,105	179 (16.2)	1.0	0.007
		No	932	231 (24.8)	1.58 (1.32–1.90)		527	116 (22.0)	1.35 (1.09–1.68)
	Visit by the health agent
		Yes	680	151 (22.2)	1.0	0.081	1,353	248 (18.3)	1.0	0.672
		No	1,377	256 (18.6)	0.85 (0.70–1.02)		276	47 (17.0)	0.94 (0.71–1.24)
	Family income per capita (MW)
		< 0.50	1,253	285 (22.7)	1.50 (1.22–1.83)	< 0.001	1,366	267 (19.5)	2.18 (1.44–3.32)	< 0.001
		≥ 0.50	798	122 (15.3)	1.0		233	21 (9.0)	1.0
Group D
	Maternal age (years)
		10–19	170	47 (27.6)	1.58 (1.12–2.23)	0.002	100	24 (24.0)	1.64 (1.06–2.52)	0.009
		20–24	568	131 (23.1)	1.31 (1.00–1.72)		363	83 (22.9)	1.57 (1.15–2.14)
		25–34	922	159 (17.2)	0.97 (0.75–1.26)		795	134 (16.9)	1.15 (0.86–1.55)
		≥ 35	408	72 (17.6)	1.0		371	54 (14.6)	1.0
	Mother's work condition
		Is employed	610	98 (16.1)	1.0	0.010	132	24 (18.2)	1.0	0.923
		Is unemployed	1,456	310 (21.3)	1.32 (1.07–1.64)		1,496	270 (18.0)	0.98 (0.67–1.43)
	Maternal education (years)
		< 4	863	205 (23.8)	2.05 (1.57–2.67)	< 0.001	524	110 (21.0)	1.47 (1.11–1.94)	0.028
		4–7	644	138 (2.14)	1.85 (1.40–2.44)		623	117 (18.8)	1.31 (0.99–1.74)
		≥ 8	547	63 (11.5)	1.0		474	67 (14.1)	1.0
Proximal level
Group E
	Child's age (months)
		0–11	458	114 (24.9)	1.63 (1.32–2.01)	< 0.001	305	52 (17.0)	1.14 (0.85–1.53)	< 0.001
		12–23	413	112 (27.1)	1.77 (1.45–2.17)		356	100 (28.1)	1.92 (1.54–2.41)
		24–59	1,199	183 (1.53)	1.0		971	143 (14.7)	1.0
	Gender
		Male	1,028	206 (20.0)	1.03 (0.87–1.23)	0.725	841	161 (19.1)	1.13 (0.92–1.40)	0.251
		Female	1,042	203 (19.5)	1.0		791	134 (16.9)	1.0
	Weight at birth (gram)
		< 2.500	150	36 (24.0)	1.14 (0.83–1.56)	0.682	138	20 (14.5)	0.80 (0.52–1.22)	0.503
		2.500–2.999	373	74 (19.8)	0.98 (0.77–1.23)		294	57 (19.4)	1.06 (0.81–1.39)
		≥ 3,000	1,377	282 (20.5)	1.0		1,148	207 (18.0)	1.0
	Height for age
		Very low/Low	238	64 (26.9)	1.38 (1.09–1.75)	0.007	138	31 (22.5)	1.24 (0.89–1.73)	0.195
		Adequate	1,757	335 (19.1)	1.0		1,445	257 (17.8)	1.0
	Weight for height
		Accentuated thinness/Thinness	36	6 (16.7)	0.92 (0.47–1.81)	0.007	25	4 (16.0)	0.84 (0.36–2.00)	0.303
		Eutrophy	1,473	268 (18.2)	1.0		1,092	207 (19.0)	1.0
		Risk of overweight/Overweight/Obesity	512	127 (24.8)	1.35 (1.12–1.62)		467	75 (16.1)	0.82 (0.64–1.06)
	Weight for age
		Very low/Low	100	23 (23.0)	1.19 (0.81–1.74)	0.380	51	14 (27.5)	1.48 (0.92–2.38)	0.103
		Adequate/High	1,933	381 (19.7)	1.0		1,540	275 (17.9)	1.0
	Breastfeeding
		Is/was breastfed	1,840	363 (19.7)	1.0	0.886	1,542	279 (18.1)	1.0	0.903
		Never breastfed	215	42 (19.5)	0.98 (0.73–1.32)		81	15 (18.5)	1.03 (0.64–1.65)

Variable			1997				2006
			Sample	Diarrhea	PR (95%CI)^a a Razões de prevalências ajustadas.	p	Sample	Diarrhea	PR (95%CI)^a a Razões de prevalências ajustadas.	p
			N	n (%)	PR (95%CI)^a a Razões de prevalências ajustadas.	p	N	n (%)	PR (95%CI)^a a Razões de prevalências ajustadas.	p
Distal level
Group A
	Geographical area
		Metropolitan region	734	124 (16.9)	1.0	0.043	427	45 (10.5)	1.0	< 0.001
		Urban interior	685	154 (22.5)	1.33 (1.06–1.66)		416	81 (19.5)	1.87 (1.31–2.66)
		Rural interior	651	131 (20.1)	1.22 (0.97–1.53)		789	169 (21.4)	2.07 (1.50–2.85)
Intermediate level
Group B
	Waste destination
		Public waste collection	1,046	177 (16.9)	1.0	< 0.001^b b Ajustados para a variável do nível A.	-	-	-	-
		Others	1,024	232 (22.7)	1.50 (1.19–1.88)		-	-	-	-
	No. of people per room
		< 1	429	63 (14.7)	1.0	0.026^b b Ajustados para a variável do nível A.	653	113 (17.3)	1.0
		1–2	1,014	200 (19.7)	1.29 (0.98–1.68)		780	132 (16.9)	0.86 (0.68–1.09)	0.028
		≥ 2	627	146 (23.3)	1.47 (1.11–1.95)		199	50 (25.1)	1.29 (0.94–1.75)
	Water supply
		General network	-	-	-	-	918	148 (16.1)	1.0	0.028
		Others	-	-	-	-	714	147 (20.6)	0.67 (0.47–0.96)
	Drinkable water treatment
		Boiled/Filtered/Chlorinated Mineral	-	-	-	-	823	104 (12.6)	1.0	< 0.001
		Strained/Untreated/Other	-	-	-	-	809	191 (23.6)	1.77 (1.35–2.32)
Distal level
Group C
	Refrigerator possession
		Yes	1,138	178 (15.6)	1.0	0.001^c c Ajustado para as variáveis dos níveis A e B.	-	-	-	-
		No	932	231 (24.8)	1.45 (1.16–1.80)		-	-	-	-
	Per capita income
		< 0.50	-	-	-	-	1,366	267 (19.5)	1.67 (1.06–2.61)	0.026
		≥ 0.50	-	-	-	-	233	21 (9.0)	1.0
Group D
	Maternal age (years)
		10–19	169	47 (27.8)	1.48 (1.05–2.08)	0.037^d d Ajustados para as variáveis dos níveis A, B e C.	98	24 (24.5)	1.70 (1.08–2.66)	0.014^d d Ajustados para as variáveis dos níveis A, B e C.
		20–24	561	129 (23.0)	1.23 (0.94–1.60)		344	78 (22.7)	1.64 (1.16–2.32)
		25–34	919	158 (17.2)	1.01 (0.78–1.30)		780	131 (16.8)	1.20 (0.89–1.62)
		≥ 35	403	72 (17.9)	1.0		365	53 (14.5)	1.0
	Maternal education (years)
		< 4	861	205 (23.8)	1.65 (1.21–2.27)	0.006^e e Ajustado para as variáveis dos níveis A, B, C e D.	-	-	-	-
		4–7	644	138 (21.4)	1.55 (1.15–2.09)		-	-	-	-
		≥ 8	547	63 (11.5)	1.0		-	-	-	-
Proximal level
Group E
	Child's age (months)
		0–11	454	113 (24.9)	1.57 (1.27–1.94)		296	49 (16.6)	1.04 (0.76–1.41)
		12–23	410	112 (27.3)	1.73 (1.41–2.12)	< 0.001^f f Ajustado para as variáveis dos níveis A, B, C, D e E.	347	97 (28.0)	1.77 (1.41–2.23)	< 0.001^f f Ajustado para as variáveis dos níveis A, B, C, D e E.
		24–59	1,188	181 (15.2)	1.0		953	142 (14.9)	1.0

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[1] Correspondence: Maria Josemere de Oliveira Borba, Vasconcelos, Rua dos Coelhos, 300 Boa vista, 50070-550 Recife, PE, Brasil, E-mail: josemereborba@gmail.com