Human and Animal Behaviors as Risk Factors for Diarrheal Disease in Rural Madagascar 公开

Wegner, Christopher William (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/4x51hj17q?locale=zh
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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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