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  • Title: Diarrheal disease in Cambodian children at a camp in Thailand.
    Author: Arthur JD, Bodhidatta L, Echeverria P, Phuphaisan S, Paul S.
    Journal: Am J Epidemiol; 1992 Mar 01; 135(5):541-51. PubMed ID: 1570820.
    Abstract:
    The etiology of acute diarrhea (less than or equal to 3 days duration) and persistent diarrhea (greater than or equal to 14 days duration) was determined in Cambodian children under age 5 years in a refugee camp on the Thai-Cambodian border between May and October 1989; potential risk factors associated with persistent diarrhea were examined in an age-matched case-control study. Specimens collected from children and environmental sources were examined by standard microbiologic methods; Escherichia coli isolates were examined for hybridization with specific DNA probes and in tissue culture adherence assays. The same bacterial, viral, or parasitic agents were identified in 79 children with persistent diarrhea and in 408 children with acute diarrhea. Only one of nine children with persistent diarrhea excreted the same organism, Cryptosporidium, for that extended period. The most important risk factors identified for developing persistent diarrhea were living with other young children (odds ratio (OR) = 2.0, 95% confidence interval (Cl) 1.2-3.4) and being undernourished (OR = 2.6, 95% Cl 1.2-5.7). Persistent diarrhea in children in this camp was associated with several different agents rather than persistent infections with a single organism. Researchers conducted a age matched case control study from May-October 1989 of 5 year old Cambodian refugees with diarrhea examined at Greenhill hospital at Site B UN resettlement camp near Surin, Thailand on the Thai-Cambodian border to determine the etiology of the diarrhea and to identify potential risk factors. The age specific diarrheal disease rate stood at 63 episodes/1000 5 year old children and 123/1000 for 1 year old infants. Incidence was 9.5/1000 5 year old children and 17/1000 for 1 year old infants. Rotavirus was responsible for 24% of the 487 children with diarrhea. Campylobacter species and enterotoxigenic Escherichia coli caused the most frequent bacterial infections. The same enteric pathogens infected children with persistent diarrhea as well as those with acute diarrhea. Children with persistent diarrhea tended to not shed the same pathogen the entire time. 1 patient did excrete Cryptosporidium for an extended period, however. 37% of the children with persistent diarrhea received antibiotics after a positive culture, but they did not stop diarrhea. Besides 98% of the Shigella strains in children with acute diarrhea and all 4 strains in those with persistent diarrhea were resistant to sulfamethoxazole-trimethoprim. All Shigella strains were resistant to nalidixic acid. Further all aggregative adherent E. coli were resistant to colistin. Oral rehydration solution use and readily available medical care limited the number of deaths from diarrhea to 1. Living with other young children and malnutrition (3rd percentile weight/height standard) were the most significant risk factors for diarrhea (odds ration=2 and 2.6 respectively). In fact, with each percentile increment in weight for height, the risk for persistent diarrhea fell 1%. The hands of both mothers and children harbored enteric pathogens. Enteric pathogens were also isolated from water and animals, especially cats. Thus preventive measures should include hand washing, reduce overcrowding, and supplemental feeding.
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