Human and Animal Behaviors as Risk Factors for Diarrheal Disease in Rural Madagascar Open Access
Wegner, Christopher William (2013)
Abstract
Purpose: Ecological factors and human and animal behavior play a key role in facilitating ansmission of enteric waterborne and zoonotic pathogens in low- and middle-income countries. While a number of studies have focused on epidemiological or environmental determinants of infection, the influence of human behavior on disease transmission has been less investigated. To address this gap in research we examined transmission dynamics using a mixed-methods approach focusing on water, sanitation, and hygiene behaviors commonly associated with increased risk of enteric waterborne and zoonotic disease transmission.
Methods: From June to August 2012, survey questionnaires asking about basic demographics and water, sanitation, hygiene, and livestock practices were given to villagers (n=190) in three rural villages of Ranomafana National Park, Madagascar. Concurrently, ecological structured observations of four key transmission events were conducted. Chi-square tests, univariate regression analysis, and multivariate regression analysis were performed to test for associations with reported diarrhea in the past four weeks.
Results: Villagers in Ambodiaviavy (23.1%) reported the highest prevalence of reported diarrhea, followed by Ambatolahy (19.2%) and Ankialo (17.1%). Univariate regression analysis revealed significant (p-value < 0.05) association between various risk factors (i.e. medication practices, defecation practices, water treatment, foot hygiene, etc.) and reported diarrhea. Multivariate regression analysis showed animals given medication (OR=5.71, 95%CI-2.01, 16.22), not treating drinking water (OR=19.13, 95%CI-2.92, 125.20), and trading with other villages (OR=5.83, 95%CI-1.39, 24.49) had highest effect on reported diarrhea adjusting for other covariates. Observations shed light on known and unknown transmission pathways.
Conclusions: Our findings suggest that differences in human hygiene and livestock interactions lead to a disproportionate incidence of diarrhea, with direct observations revealing previously unknown pathways of transmission within these rural villages. By using direct observations in conjunction with survey collection we gain a better understanding of waterborne and zoonotic disease transmission dynamics in this rural African setting. In summary, these methods allow close examination of infectious disease transmission, and demonstrate the utility of a mixed-methods approach in elucidating risk factors for diarrheal disease in rural Madagascar.
Table of Contents
Table of Contents
Page
Introduction.........................................................................................................1
Background..........................................................................................................4
Infectious
diseases..................................................................................................4
Enteric waterborne and zoonotic
diseases....................................................................5
Clinical features of diarrheal
disease............................................................................6
Global diarrheal
disease.............................................................................................6
Risk factors for diarrheal disease
transmission...............................................................7
Survey versus structured observation
methodology........................................................9
Madagascar...........................................................................................................10
Ranomafana...........................................................................................................11
Project Aims and
Objectives..................................................................................13
Objectives and
hypothesis........................................................................................15
Relevance to environmental public
health.....................................................................15
Methods...............................................................................................................16
Study
area.............................................................................................................16
Study
population.....................................................................................................17
Survey
questionnaire................................................................................................17
Structured
observations............................................................................................18
Data
analysis..........................................................................................................21
Ethical
considerations...............................................................................................22
Results.................................................................................................................22
Characteristics of all study
subjects............................................................................22
Differences in daily life, behaviors, and responsibilities between
villages..............................24
Examination of basic characteristics of those who reported
diarrhea..................................30
Differences in lifestyle and behaviors among those reporting
diarrhea.................................32
Univariate regression
analysis.....................................................................................35
Multivariate regression
analysis...................................................................................37
Perceived health
problems.........................................................................................40
Handwashing and bathing
observations........................................................................41
Collecting water and cleaning observations...................................................................43
Livestock and domestic animal behavior
observations......................................................45
Discussion.............................................................................................................47
Limitations..............................................................................................................66
Conclusion............................................................................................................68
Recommendations.....................................................................................................71
References............................................................................................................72
Tables...................................................................................................................79
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