Challenges in reducing the burden of childhood diarrhea in Peru Público
Delahoy, Miranda (Summer 2019)
Abstract
Diarrhea is an important cause of childhood morbidity. Improving drinking water and sanitation and vaccinating infants for rotavirus can reduce diarrhea cases; however, these interventions face challenges in achieving optimal performance. Associations between higher temperature and diarrhea highlight challenges in reducing childhood diarrhea as climate change progresses. A spatially-detailed national longitudinal dataset was constructed to examine these factors and the rate of clinic visits for diarrhea in children under five from 2005-2015 in Peru. Drinking water and infant stool samples were collected from 96 households in Piura, Peru in 2016 to examine water quality and infant enteropathogen infections and diarrhea.
In Peru, the rate of childhood diarrhea clinic visits decreased by 3% per year from 2005-2015. The rate was 6.7% lower in the rotavirus vaccine era (2010-2015, when most infants were vaccinated; incidence rate ratio (IRR): 0.93, 95% confidence interval (CI): 0.90-0.97); however, there was no impact of ongoing rotavirus immunization in provinces in the lowest quartiles of piped water or sewerage access. A 1 °C temperature increase was associated with a 3.8% higher rate of childhood diarrhea clinic visits (IRR: 1.04, 95% CI: 1.03-1.04). Controlling for temperature, there was higher diarrhea incidence during El Niño periods (IRR: 1.03, 95% CI: 1.01-1.04). In Piura, we found high prevalence of arsenic, pesticides/herbicides, and E. coli in drinking water samples mostly originating from piped water connections. Storing drinking water was associated with higher odds of E. coli (odds ratio (OR): 4.50, 95% CI: 2.04-9.95), and pesticide/herbicide detection (OR: 6.55, 95% CI: 2.05-20.96). Infants had high prevalence of diarrhea (14%) and enteropathogen infections (68%); enteropathogen detection was higher among infants from households with pesticide/herbicide presence in drinking water (OR: 2.93, 95% CI: 1.13-7.61).
These results underscore the importance of considering multiple strategies to reduce diarrheal disease: water/sanitation improvements may operate synergistically with rotavirus vaccination to reduce childhood diarrhea. Provision of piped drinking water should be accompanied by concurrent microbiological and chemical assessments and messaging on safe storage. Although childhood diarrhea clinic visits are declining in Peru, higher temperatures and intensifying El Niño events potentially resulting from climate change could threaten this progress.
Table of Contents
Chapter 1 Introduction .................................................................................................................... 1
Chapter 2 Impact of rotavirus vaccination varies with differential access to piped water and
sewerage: an analysis of childhood clinic visits for diarrhea in Peru, 2005-2015 ........................ 34
ABSTRACT .............................................................................................................................. 34
INTRODUCTION .................................................................................................................... 35
METHODS ............................................................................................................................... 38
RESULTS ................................................................................................................................. 43
DISCUSSION ........................................................................................................................... 47
FUNDING/DISCLAIMER ....................................................................................................... 51
ACKNOWLEDGEMENTS ...................................................................................................... 52
APPENDIX ............................................................................................................................... 59
Chapter 3 Historic associations between meteorological factors and childhood diarrhea cases in
Peru (2005-2015): implications for climate change...................................................................... 71
ABSTRACT .............................................................................................................................. 71
INTRODUCTION .................................................................................................................... 72
METHODS ............................................................................................................................... 74
RESULTS ................................................................................................................................. 80
DISCUSSION ........................................................................................................................... 85
FUNDING/DISCLAIMER ....................................................................................................... 90
ACKNOWLEDGEMENTS ...................................................................................................... 90
APPENDIX ............................................................................................................................... 97
Chapter 4 Chemical and microbiological drinking water risks for infants in coastal Peru ........ 108
ABSTRACT ............................................................................................................................ 108
INTRODUCTION .................................................................................................................. 109
METHODS ............................................................................................................................. 111
RESULTS ............................................................................................................................... 119
DISCUSSION ......................................................................................................................... 124
FUNDING/DISCLAIMER ..................................................................................................... 132
ACKNOWLEDGEMENTS .................................................................................................... 133
APPENDIX ............................................................................................................................. 144
Chapter 5 Conclusion .................................................................................................................. 154
Chapter 6 (Appendix Chapter) Pathogens transmitted in animal feces in low- and middle-income
countries ...................................................................................................................................... 174
ABSTRACT ............................................................................................................................ 174
INTRODUCTION .................................................................................................................. 176
METHODS ............................................................................................................................. 177
RESULTS ............................................................................................................................... 181
DISCUSSION ......................................................................................................................... 200
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