Summary Risk factors associated with diarrhoeal disease and diarrheagenic E. coli disease in Duc Giang Hospital, north-eastern corner of Ha Noi, Viet NamBackground: Diarrheagenic E. coli (DEC) disease is more prevalent in infants and children is a very important cause of sporadic diarrhoea cases and diarrhoea outbreaks in many countries. Currently, DEC also stands as a chief causal factor for diarrhoea among travellers. DEC disease is usually transmitted through food or water contaminated with human or animal faeces. Person-to-person transmission might also take place, but is probably less common. Poor sanitation, personal hygiene and environmental conditions are some of the factors that facilitate the transmission of the disease. Thus, DEC disease is more prevalent in developing countries. Viet Nam is a tropical country in Southeast Asian area with low social-economic level. It has a high prevalence of diarrhoea. According to a report from Ministry of Health, there were over 1.000.000 hospital cases of diarrhoea that occurred in Viet Nam in 2002. Recent literature has shown that E. coli is the most important etiologic agent that causes diarrhoea in Viet Nam (2).To date, there has not been any study about risk factors associated with DEC disease in these areas and with a focus on children less than 5 in Ha Noi. Such studies could contribute to reduce the morbidity and mortality from the DEC diseases and prevent outbreaks caused by DEC.
Objectives: The objectives of this study was to identify the risk factors associated with diarrhoeal disease and DEC disease in Long Bien and Gia Lam Districts and to identify diarrhoeagenic E. coli in diarrhoea patients in Duc Giang Hospital.Methods: A hospital-based case-control study was performed. DEC cases were defined by positive stool cultures and/or PCR test from suspected cases who were admitted to hospitals between July and December 2005. Controls were randomly chosen among patients in Duc Giang Hospital and were matched by sex and age. Interviews were performed using a standard questionnaire collecting information regarding their recent contacts with diarrhoeal disease, patient’s history of travel, eating habits, hygiene and socio-economic indicators.
Results: Between July and December 2005, 62 DEC cases that were recorded and 124 diarrhoeal controls and 62 non-diarrhoeal controls were selected. 79% of cases were among children under 5 years of age. In a conditional logistic regression model for analyzing diarrhoeal versus non-diarrhoeal group, negligence of washing hands before eating (OR = 9.7, 95% CI 3.9 – 24.0, P = <0.001); keeping food outside the fridge (OR = 3.6, 95% CI 1.9 – 6.5, P = <0.001); were independently associated with diarrhoeal disease.In a conditional logistic regression model for analyzing the DEC group versus the non-diarrhoeal group, having contact with diarrhoeal patients (OR = 4.5, 95% CI 1.3 – 16.0, P = 0.02); negligence of washing hands before eating (OR = 9.2, 95% CI 4.1 – 21.0, P = <0.001); keeping food outside the fridge (OR = 4.1, 95% CI 1.9 – 8.7, P = <0.001) were independently associated with DEC disease.In a conditional logistic regression model for analyzing the DEC group versus the non-DEC diarrhoeal group, eating outside more than 1-2 times/month (OR = 4.2, 95% CI 1.8 – 9.6, P = <0.001); roasted meat eating last week (OR = 7.7, 95% CI 2.3 – 25.7, P = 0.001); drinking pond water (OR = 4.8, 95% CI 1.4 – 16.6, P = 0.013) were independently associated with DEC diseaseConclusion: Our study suggested that unsafe drinking water, keeping food outside the fridge and negligence of washing hands before eating were risk factors for both DEC disease and other diarrhoeal diseases. Eating outside more than 1-2 times/month, having contact with diarrhoeal patients, eating roasted meat last week were risk factors for DEC disease.These findings suggest to the policy makers: safe water should be providing to the community; Regular quality control of foods and beverages sold in restaurants.Hygienic practices should be promoted by providing community health education on the importance of washing hands before eating; boiling drinking water; storing food in refrigerators (for those who have it), warming up food before eating; hand and food hygiene after contact with a patient who has diarrheaKey words: Diarrhoeagenic E. coli, risk factors, Vietnam, diarrhoea, and developing countries.