Travel as a Risk Factor for Diarrheal Disease: Analysis of a Case-Control Study in Ecuador Open Access
Hall, Eric William (2015)
Background: Enteric and diarrheal disease has long been, and continues to be, a major cause of morbidity and mortality across the world. While there is extensive research describing the individual risks of diarrheal disease, a systems-level approach and investigation of patterns of social interaction and pathogen movement is needed to fully understand the factors that contribute to diarrheal disease. Individual movement and the human population movement are essential to the understanding of disease dynamics. While research has related human movement to transmission of vector-borne diseases, sexually transmitted infections and respiratory illness, the majority of research relating human movement and enteric disease has focused on international travel and traveler's diarrhea.
Methods: This project is a case-control study carried out at four sites (Quito, Esmeraldas, Borbón and within the rural communities around Borbón) in Ecuador from April 2014 to February 2015. Cases were any patients that were seen for acute diarrheal disease or gastroenteritis and controls were recruited from the same facility and matched on age. All participants completed questionnaires that collected data related to demographic information, socio-economic status, water and sanitation practices and travel history. Multiple logistic regression models were fit to assess the effect travel in the past year, travel to urban areas and travel to specific destinations had on diarrheal disease.
Results: Across all four sites (N=673), 62% of participants reported traveling away from their home areas at least once in the past year. When controlling for sex and water treatment at home, cases were 1.4 times more likely to have traveled in the past year than controls (aOR=1.40, 95%CI: 1.02, 1.92). From the same model, treating water at home (aOR=0.67, 95%CI: 0.49, 0.91) was found to have a protective effect against diarrheal disease. Travel in the past week was not associated with diarrheal disease.
Conclusion: Travel is associated with diarrheal disease, but the degree of this association differs by study site and the length of the travel history recall period.
Table of Contents
GLOBAL BURDEN OF DIARRHEAL DISEASE 1
HISTORY OF ENTERIC DISEASE RESEARCH 4
HUMAN MOVEMENT 6
ENTERIC DISEASE IN ECUADOR 12
STUDY DESIGN AND PARTICIPANT RECRUITMENT 14
DATA COLLECTION 15
DATA ANALYSIS 16
Data cleaning and summary 16
Analysis dataset and bivariate analysis 16
Multivariate analysis 17
DATA SUMMARY 20
ANALYSIS BY SITE 21
ANALYSIS DATASET 22
TRAVEL RESULTS 23
BIVARIATE RESULTS 25
MULTIVARIATE RESULTS 26
KEY FINDINGS AND PLAUSIBILITY 29
FUTURE DIRECTIONS AND CONCLUSIONS 33
SUPPLEMENTAL FIGURES AND TABLES 35
WORKS CITED 48
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