Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013;8(1):e54395.
doi: 10.1371/journal.pone.0054395. Epub 2013 Jan 18.

Risk factors for severe cholera among children under five in rural and urban Bangladesh, 2000-2008: a hospital-based surveillance study

Danny V Colombara  1 , Karen D Cowgill, Abu S G Faruque
Affiliations

Risk factors for severe cholera among children under five in rural and urban Bangladesh, 2000-2008: a hospital-based surveillance study

Danny V Colombara et al. PLoS One. 2013.

Abstract

Background: Children under five bear the largest cholera burden. We therefore sought to identify modifiable risk factors among Bangladeshi children.

Methodology/principal findings: We used multivariate Poisson regression to assess risk factors for severe cholera among diarrheal patients presenting at hospitals in Matlab (rural) and Dhaka (urban), Bangladesh. Risk increased with age. Compared to those under one, rural and urban four-year-olds had adjusted risk ratios (aRR) of 4.17 (95% confidence interval (CI) 2.43-7.15) and 6.32 (95% CI: 4.63-8.63), respectively. Breastfeeding halved the risk in both rural (aRR = 0.49, 95% CI: 0.35-0.67) and urban (aRR = 0.51, 95% CI: 0.41-0.62) settings. Rural children's risk decreased with maternal education (P-trend: <0.001) and increased among those with a family member with diarrhea in the past week (aRR = 1.61, 95% CI: 1.22-2.14) and those with prior vitamin A supplementation (aRR = 1.65, 95% CI: 1.12-2.43). Urban children whose mothers daily (aRR = 0.41, 95% CI: 0.21-0.79) or occasionally (aRR = 0.55, 95% CI: 0.36-0.84) read a newspaper experienced reduced risk. Urban children from households with incomes between 34-84 USD/month had a 30% increased risk compared to those from households with incomes >84 USD/month.

Conclusion/significance: Increasing age, lower socioeconomic status, and lack of breastfeeding are key correlates of increased risk for cholera hospitalization among those under five in rural and urban Bangladesh. In addition, having a family member with diarrhea in the past week was associated with increased risk among rural children. Continued attention should be directed to the promotion of breastfeeding. Further research is needed to elucidate the relationship between maternal education and cholera risk. Renewed research regarding the use of chemoprophylaxis among family members of cholera cases may be warranted in rural endemic settings.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Frequency of detected enteric pathogens among children under five in ICDDR,B hospitals, Bangladesh, 2000–2008.
* Co-infection is defined as a positive assay for two or more non-cholera pathogens. Patients with V. cholerae co-infection were excluded from analyses.
See this image and copyright information in PMC

References

    1. Ali M, Lopez AL, Ae You Y, Eun Kim Y, Sah B, et al. (2012) The global burden of cholera. Bull World Health Organ 90: 209–218 doi:10.2471/BLT.11.093427. - DOI - PMC - PubMed
    1. Mosley WH, Benenson AS, Barui R (1968) A serological survey for cholera antibodies in rural east Pakistan. 2. A comparison of antibody titres in the innunized and control populationd of a cholera-vaccine field-trial area and the relation of antibody titre to cholera case rate. Bull World Health Organ 38: 335–346. - PMC - PubMed
    1. Gunn Ra, Kimball aM, Pollard Ra, Feeley JC, Feldman Ra, et al. (1979) Bottle feeding as a risk factor for cholera in infants. Lancet 2: 730–732. - PubMed
    1. Clemens JD, Sack DA, Harris JR, Khan MR, Chakraborty J, et al. (1990) Breast feeding and the risk of severe cholera in rural Bangladeshi children. Am J Epidemiol 131: 400–411. - PubMed
    1. Qureshi K, Mølbak K, Sandström A, Kofoed P-E, Rodrigues A, et al. (2006) Breast milk reduces the risk of illness in children of mothers with cholera: observations from an epidemic of cholera in Guinea-Bissau. Pediatr Infect Dis J 25: 1163–1166 doi:10.1097/01.inf.0000246977.58697.a5. - DOI - PubMed

Publication types