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Household Hygiene Variables and Its Impact on the Risk of Campylobacter Diarrhea  among Children of Rural Egyptian Villages K. Hassan 1 ,   A. Mansour 1 , A. Hafez 2 , H. I. Shaheen 1 , S. El Alkamy 2 , M.S. Riddle 4,  J. W. Sanders 3 , A.W. Armstrong 4 , and N. El Sayed 2 1  US Naval Medical Research Unit No. 3, Cairo, Egypt,   2  Ministry of Health and Population, Cairo, Egypt,  3  US Naval Medical Research Center Detachment, Lima, Peru,  4   US Naval Medical Research Center, Washington D.C., USA Abstract: Background:   Campylobacter sp.  is one of the most frequently isolated bacteria from stools of infants with diarrhea in developing countries. Among other factors including the host and agent, environmental factors including domestic sanitation and poor hygienic conditions are thought to influence risk of Campylobacteriosis in these endemic settings. The present study aims to identify the impact of various hygiene variables on increased risk of Campylobacter associated diarrhea among children <2 years of age in rural Egyptian villages. Methods:   A prospective birth cohort study of 348 infants was conducted from January 2004 to April 2007 in five villages of the Nile Delta region. Neonates were enrolled at birth and followed up to 24 months of age. Children were visited twice a week to survey for acute diarrhea. A detailed observational household hygiene survey was completed in-house approximately every six months during the two-year follow-up period. The hygiene questionnaire consisted of ten questions and covered the domestic environmental conditions of the home and hygiene characteristics of sleeping room, eating room, cooking room, garbage containers, previously prepared food, washing facilities, bathroom and bathing facilities, water sources and containers, and flies in the house.   Adjusted Incidence Rate Ratios (IRR) of hygiene variables were calculated for the primary outcome of Campylobacter-specific diarrhea illness rates. Results:   The risk of Campylobacter associated diarrhea significantly increased with several household hygiene variables. Presence of human or animal feces around the bathroom (IRR 2.48, p<0.001), non-daily washing of garbage containers (IRR 1.93, p<0.05), location of the bathroom inside the house (IRR 2.39, p<0.05), absence of barriers to keep birds and animals out eating rooms (IRR 1.51, p<0.05), and cooking rooms (IRR 1.70, p<0.05), and drain of latrine open to the environment (IRR 1.53, p<0.05) all increased a child’s risk of Campylobacter-diarrhea in the household.  Conclusion:   Factors related to household hygiene and construction appear to be associated with an increased risk of Campylobacter - associated diarrhea. Further study is warranted to evaluate these factors on all-cause and other pathogen-specific causes of diarrhea.  These data are important in highlighting some potentially modifiable factors which could reduce the burden of disease in resource-poor settings.  Introduction: Campylobacter  enteritis due to  C. jejuni  and  C. coli  are the major forms of Campylobacteriosis of public health importance .  Incidence of  Campylobacter  has gradually increased over the last decade. It is reported now among the leading cause of bacterial gastroenteritis.  Campylobacter  infections represent a considerable burden on economic and public health resources.   The epidemiology of  Campylobacter  diarrhea appears to differ between developed and developing countries. In the developed world, both children and adults are at risk for  Campylobacter  infection, while in the developing world  Campylobacter  is endemic, and infection is usually limited to children.  In the developed world, the transmission of the organism has been associated with the consumption of unpasteurized milk, undercooked meats, contaminated water, and travel to  Campylobacter  endemic areas. In the developing world, poor household hygiene and maternal hygiene behaviors relating to child-care practices are often linked to childhood diarrheal illness. Case-control community-based studies have provided estimates of C ampylobacter  infections in developing world ranging between of 40,000 to 60,000 per 100,000 children less than five years of age. In contrast, the figure for developed countries is 300 per 100,000.    Materials and Methods: A prospective birth cohort study of 348 infants was conducted from January 2004 to April 2007 in five villages located in Abu Homos, a rural district located in the Nile Delta region in northern Egypt. Eligible births were identified from a census of 1,916 households representing a total population of 15,675 people. Neonates were enrolled at birth and followed up to 24 months of age. Written informed consent was obtained from the mother and from the parent of the eligible child. Children were visited twice a week to survey for acute diarrhea. If any loose or liquid stools were reported, a fecal specimen and two rectal swabs were collected. From each specimen, conventional microbiological procedures were used to isolate and identify  Campylobacter  as well as other pathogens.  In addition, a detailed observational household hygiene survey was completed in-house approximately every six months during the two-year follow-up period. The hygiene questionnaire consisted of ten sections and covered the domestic environmental conditions of the home and hygiene characteristics of sleeping room, eating room, cooking room, garbage containers, previously prepared food, washing facilities, bathroom and bathing facilities, water sources and containers, and presence of  flies in the house. A  &quot;diarrheal day&quot;  was defined as the occurrence of ≥3 non-formed stools (or > 1 if bloody) in a 24-h period. In addition, if the child was breast-fed and the stool was not bloody, the mother had to report an increase in frequency or a reduction in consistency of the stools, compared with what she considered to be normal.  A  “diarrheal episode”  was defined to begin on the first day of loose or liquid stools after at least three consecutive non diarrheal days and ending on the last diarrheal day to be followed by at least three consecutive non diarrheal days. An episode of diarrhea was classified as  Campylobacter  diarrhea, if  Campylobacter  was isolated at any time in the entire duration of the episode. From the twice-weekly surveillance data, incidence rates of  Campylobacter  diarrhea episodes were calculated. Data of diarrhea episodes were linked to the prior household hygiene survey. The household hygiene survey information was assumed to be time invariant for the interval between two surveys. Bi-variant analysis was utilized to assess the association between  Campylobacter  diarrhea and each hygiene variable. Crude relative rate was computed as a ratio of the incidence rates in the presence and absence of each household hygiene variable under consideration. Significant crude relative rates were adjusted for child’s age in years, season of diarrhea  Disclaimer:   Authors’ Disclaimer Statement:   The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.  Work was funded by work unit # 6000.RAD1.D.E0301.   Human Use Statement:   The study protocol # 145 was approved by the Naval Medical Research Unit No. 3 Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects.   Copyright Assignment statement:   I am a military service member (or employee of the U.S. Government).  This work was prepared as part of my official duties.  Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’  Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. Incidence rate (IR), crude and adjusted relative risk (IRR) of sole Campylobacter diarrhea by hygiene variables, Natural Immunity Study, 2004 - 2007, Abu Homos, Egypt.  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],*:  Adjusted for child’s age in years, season of diarrhea occurrence, child’s breastfeeding status, crowding (number of persons per sleeping room, >= 3.5 person as high or moderate crowding versus <3.5 person as low crowding), and for the repeated subject of the same child, using Logistic Regression Model and SAS Software. (1): includes sewage system, sealed pit, unsealed pit, and non-governmental drain net.  §: P <0.05  ¶: P <0.001 ,[object Object],[object Object],[object Object],[object Object],[object Object],Presentation No.  2915 ,  Authors contact:  [email_address] Hygiene variables Code IR Crude IRR Adjusted IRR* Barrier to keep birds and animals out of eating room No Yes 0.55 (1/1.8) 0.48 (200/419.1) 1.50 (0.98, 2.27)  1.00  1.51 (1.00, 2.27) § 1.00 Barrier to keep birds and animals out of cooking room No Yes 0.52 (130/250.1) 0.42 (71/170.8) 1.73 (1.15, 2.59) § 1.00 1.70 (1.15, 2.51) § 1.00 Washing of garbage containers Not daily Daily 0.76 (34/  44.7) 0.44 (167/376.2) 1.96 (1.25, 3.05) § 1.00 1.93 (1.27, 2.92) § 1.00 Fixed raised bowl or basin  in washing facility No Yes 0.61 (67/109.8) 0.43 (134/311.1) 1.72 (1.09, 2.74) § 1.00 1.48 (1.01, 2.18) § 1.00 Location of the bathroom Inside the house Outside the house 0.49 (195/399.4) 0.28 (6/21.5) 2.19 (1.01, 4.78) § 1.00 2.39 (1.06, 5.38) § 1.00 Latrine drain To  open environment To others  (1) 0.52 (104/199.0) 0.44 (97/221.9) 1.41 (0.95, 2.10) 1.00 1.53 (1.06, 2.20) § 1.00 Feces on bathroom floor Yes No 1.58 (6/3.8) 0.47 (195/417.1) 2.61 (1.10, 6.19) § 1.00 1.84 (1.02, 3.33) § 1.00 Human or animal feces within 3 paces of the outside wall of the bathroom Yes No 1.74 (8/4.6) 0.46 (193/416.3) 3.29 (1.90, 5.69) ¶ 1.00 2.48 (1.56, 3.95) ¶ 1.00 Functioning tap in the compound is the home water source No Yes 0.71 (52/73.4) 0.43 (149/347.5) 2.01 (1.24, 3.23) § 1.00 1.57 (1.04, 2.37) § 1.00 Drinking water source is tap in compound No Yes 0.41 (132/321.6) 0.69 (69/99.3) 1.93 (1.23, 3.04) § 1.00 1.40 (0.94, 2.08) 1.00 Cooking water source is tap in compound No Yes 0.41 (132/321.7) 0.70 (69/99.2) 1.95 (1.25, 3.07) § 1.00 1.40 (0.94, 2.08) 1.00

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International migration on north africa

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