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

Galezzo, Maria-Angelica; Günther, Wanda Maria Risso; Diaz-Quijano, Fredi Alexander; Susa, Manuel Rodriguez

doi:10.11606/s1518-8787.2020054002054

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Original Article • Rev. Saúde Pública 54 • 2020 • https://doi.org/10.11606/s1518-8787.2020054002054 copy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

DESCRIPTORS:
Diarrhea, Infantile, epidemiology; Diarrhea, epidemiology; Risk Factors; Socioeconomic Factors; Rural Sanitation; Rural Health

Characteristics		El Cascajo	La Delfina
Number of households		34	8
Household residents		4 ± 2	4 ± 1
Years of residence		6 ± 7	6 ± 8
Rooms per household		2 ± 1	2 ± 0
Property ownership	Yes	24 (70.6)	4 (50.0)
Season	Dry	12 (35.3)	4 (50.0)
Fuel for cooking	Firewood	26 (76.5)	8 (100.0)
	Bottled gas	20 (58.8)	0 (0.0)
Floor	Dirt	27 (79.4)	7 (87.5)
Walls	Wood	27 (79.4)	5 (62.5)
	Cement	4 (11.8)	1 (12.5)
	Clay	3 (8.8)	2 (25.0)
Monthly income	≤ MMW ^a a MMW: minimum monthly wage (2018 being the reference year = 238.45 USD; 1 USD = 3,276 COP).	28 (82.4)	5 (62.50)
Electricity	No	29 (85.3)	5 (62.5)
	Solar panel	4 (11.8)	3 (37.5)
	Power generator	1 (2.9)	0 (0.0)
Has at least one of the members finished high school?	Yes	14 (41.2)	2 (25.0)
Domestic animals	Poultry	32 (94.1)	8 (100.0)
	Swine	18 (52.9)	6 (75.0)
	Cat	16 (47.1)	5 (62.5)
	Dog	26 (76.5)	7 (87.5)
Waste disposal	Burning	27 (79.4)	6 (75.0)
	Open air	16 (47.1)	3 (37.5)
Toilet facilities	Yes	14 (41.2)	6 (75.0)
Sink	Yes	4 (11.8)	5 (62.5)
Water source ^b b Water source being used at the moment of the interview, it varies in the households according to the season.	Rain	9 (26.5)	1 (12.5)
	Artificial pond	10 (29.4)	0 (0.0)
	Deep well	14 (41.2)	0 (0.0)
	River	1 (2.9)	7 (87.5)
Water treatment	Yes	4 (11.8)	0 (0.0)
Water treatment frequency	Always	1 (2.9)	0(0.0)
Water storage	Plastic	24 (70.6)	5 (62.5)
	Metal	2 (5.9)	3 (37.5)
	Clay	6 (17.7)	0 (0.0)
	Cement	2 (5.9)	0 (0.0)
Water issues	Odor	7 (20.6)	4 (50.0)
	Taste	10 (29.4)	5 (62.5)
	Color	15 (44.1)	4 (50.0)
	Other ^c c Presence of animals such as frogs and worms.	2 (5.9)	0 (0.0)
Water quality	IRCA ^d d IRCA: Water Quality Risk for Human Consumption Index (IRCA, in the Spanish acronym).	60.8 ± 9.1	73.7 ± 5.3
	High risk level	29 (85.3)	8 (100.0)
	Unsanitary	5 (14.7)	0 (0.0)
Number of people		149	27
Age (in years) ^e e Without age information for one person.		22 ± 15	24 ± 26
	0–4	13 (8.7)	4 (14.8)
	5–12	34 (22.8)	4 (14.8)
	13–26	35 (85.37)	6 (22.2)
	27–59	56 (37.6)	6 (22.2)
	> 60	10 (6.7)	7 (25.9)
Gender	Male	83 (55.7)	17 (63.0)
	Female	66 (44.3)	10 (37.0)
Able to read and write	Yes	121 (81.2)	21 (77.8)
Serviced by a healthcare system	Yes	142 (95.3)	25 (92.6)
Symptomatology (cases)	Diarrhoea ^f f Lack of information on diarrhea occurrences for three people.	12 (8.1)	1 (3.7)
	Pre-existing condition	16 (10.7)	2 (7.4)

Exposure variable		Gastrointestinal diseases				Total (N) ^a a Lack of information on diarrheal disease on three people. Estimates based on a total of 103 people.	PR ^b b PR: prevalence ratio	95%CI ^c c 95%CI: 95%confidence interval.
		Yes		No
		N	%	N	%
Season	Rainy	4	3.5	109	96.5	113	0.24	0.07–0.84 ^* * Statistical significance at α = 0,05.
Season	Dry (Ref)	9	15.0	51	85.0	60	1.00	NA
Rural district	La Delfina	1	3.7	26	96.3	27	0.45	0.05–3.98
Rural district	El Cascajo (Ref)	12	8.2	134	91.8	146	1.00	NA
Property ownership status	Owner	8	7.5	99	92.5	107	0.99	0.24–4.09
Property ownership status	Others (Ref)	5	7.6	61	92.4	66	1.00	NA
Floor	Cement	1	2.2	45	97.8	46	0.23	0.03–1.65
Floor	Dirt (Ref)	12	9.5	115	90.6	127	1.00	NA
Walls	Cement	1	5.0	19	95.0	20	0.64	0.10–4.02
Walls	Wood/Clay (Ref)	12	7.8	141	92.2	153	1.00	NA
Educational level ^d d Educational level: at least one resident graduated from high school in the household.	Yes	4	6.4	59	93.7	63	0.78	0.22–2.78
	No (Ref)	9	8.2	101	91.8	110	1.00	NA
Income	> than one MMW	2	4.6	42	95.5	44	0.54	0.13–2.22
Income	≤ than one MMW (Ref)	11	8.5	118	91.5	129	1.00	NA
Swine	Yes	4	3.8	102	96.2	106	0.28	0.08–1.02
Swine	No (Ref)	9	13.4	58	86.6	67	1.00	NA
Dog	Yes	7	5.3	124	94.7	131	0.37	0.09–1.58
Dog	No (Ref)	6	14.3	36	85.7	42	1.00	NA
Cat	Yes	8	9.8	74	90.2	82	1.78	0.33–9.62
Cat	No (Ref)	5	5.5	86	94.5	91	1.00	NA
Gender	Female	7	9.5	67	90.5	74	1.56	0.51–4.75
Gender	Male (Ref)	6	6.1	93	93.9	99	1.00	NA
Age	< 5 years old	4	23.5	13	76.5	17	4.05	1.70–9.68 ^* * Statistical significance at α = 0,05.
Age	≥ 5 years old (Ref)	9	5.8	146	94.2	155	1.00	NA
Pre-existing conditions	Yes	2	11.1	16	88.9	18	1.57	0.31–7.89
Pre-existing conditions	No (Ref)	11	7.10	144	92.9	155	1.00	NA
Health insurance	Subscriber	12	7.3	152	92.7	164	0.65	0.09–4.64
Health insurance	No (Ref)	1	11.1	8	88.9	9	1.00	NA
Water source	Rain	1	2.3	42	97.7	43	0.74	0.05–11.49
	Artificial pond	5	12.5	35	87.5	40	4	0.33–49.04
	Deep well	6	10.3	52	89.7	58	3.31	0.37–29.47
	River (Ref)	1	3.1	31	96.9	32	1.00	NA
Solid waste disposal	Burning	5	5.7	83	94.3	88	1.12	0.27–4.60
	Open air	5	19.2	21	80.8	26	3.78	0.74–19.37
	Both (Ref)	3	5.1	56	94.9	59	1.00	NA
Sinks	Yes	1	3.6	27	96.4	28	0.43	0.05–3.60
Sinks	No (Ref)	12	8.3	133	91.7	145	1.00	NA
Toilet facilities	Yes	3	3.5	82	96.5	85	0.31	0.08–1.24
Toilet facilities	No (Ref)	10	11.4	78	88.6	88	1.00	NA
Septic tank	Yes	4	5.0	76	95.0	80	0.52	0.14–1.93
Septic tank	No (Ref)	9	9.7	84	90.3	93	1.00	NA
Risk level	Unsanitary	4	18.2	18	81.8	22	3.05	0.51–18.2
Risk level	High (Ref)	9	6.0	142	94.0	151	1.00	NA

Exposure variable		PR ^a a PR: prevalence ratio	95%CI ^b b 95%CI: 95% confidence interval.	Set of variables ^c c Variable set for adjusting results of DAG
Season	Rainy	0.24	0.07–0.85 ^* * Statistical significance at α = 0.05.	Rural district
Rural district	La Delfina	0.45	0.05–3.98	NA
Ownership status	Owner	0.95	0.23–3.86	Income
Floors	Cement	0.20	0.03–1.32	Income, ownership status
Walls	Cement	0.96	0.14–6.83	Income, ownership status
Educational level	One person graduated from high school in the household	0.74	0.21–2.64	Rural District
Income	Over than a monthly minimum wage	0.54	0.13–2.22	Educational level
Swine	Yes	0.20	0.05–0.74 ^* * Statistical significance at α = 0.05.	Season, toilet, income, educational level, dogs, presence of septic tank, water source, ownership status, rural district
Dogs	Yes	0.35	0.10–1.26	Swine, season, toilet facilities, income, educational level, presence of septic tank, ownership status, water source
Cat	Yes	1.84	0.40–8.46	Ownership status
Gender	Female	1.56	0.51–4.75	NA
Age	< 5 years old	4.05	1.70–9.68 ^* * Statistical significance at α = 0.05.	NA
Pre-existing conditions	Yes	2.21	0.34–14.47	Age, gender, income, health insurance
Health insurance	Yes	0.59	0.08–4.45	Income, rural district
Water source	Rainwater	5.20	0,60-45,18	Swine, season, toilet facilities, income, educational level, dog, presence of septic tank, ownership status, rural district
	Artificial pond	11.47	1,27-103,29 ^* * Statistical significance at α = 0.05.
	Deep well	16.90	2,45-116,67 ^* * Statistical significance at α = 0.05.
	River	1.00	NA
Solid waste disposal	Burning	1.14	0.26–4.95	Ownership status
	Open air	3.97	0.74–21.35
	Both	1.00	NA
Sinks	Yes	0.60	0.06–6.10	Income, ownership status, toilet facilities
Toilet	Yes	0.23	0.06–0.96 ^* * Statistical significance at α = 0.05.	Income, presence of septic tank, ownership status
Septic tank	Yes	0.55	0.15–1.99	Income, ownership status
Risk level	Unsanitary	1.13	0.13–9.43	Season, presence of sinks, water source

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[1] 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@uniandes.edu.co