Travel as a Risk Factor for Diarrheal Disease: Analysis of a Case-Control Study in Ecuador 公开

Hall, Eric William (2015)

Permanent URL: https://etd.library.emory.edu/concern/etds/sx61dm52z?locale=zh
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Abstract

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

INTRODUCTION 1

GLOBAL BURDEN OF DIARRHEAL DISEASE

1

HISTORY OF ENTERIC DISEASE RESEARCH

4

HUMAN MOVEMENT

6

ENTERIC DISEASE IN ECUADOR

12 METHODS 14

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 RESULTS 20

DATA SUMMARY

20

ANALYSIS BY SITE

21

ANALYSIS DATASET

22

TRAVEL RESULTS

23

BIVARIATE RESULTS

25

MULTIVARIATE RESULTS

26 DISCUSSION 29

KEY FINDINGS AND PLAUSIBILITY

29 LIMITATIONS 31

FUTURE DIRECTIONS AND CONCLUSIONS

33 APPENDIX 35

SUPPLEMENTAL FIGURES AND TABLES

35 WORKS CITED 48

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