Risk factors for the transmission of diarrhoea in children: a case-control study in rural Malaysia.

In response to a recorded increasing incidence of diarrhoea in Tumpat District, Malaysia, a case-control study was performed to identify modifiable risk factors for the transmission of diarrhoea, in children aged 4-59 months. Ninety-eight pairs of children, matched on age and sex, were recruited prospectively from health centres. Exposure status was determined during a home visit. Interviewers were 'blinded' as to the disease status of each child. Odds ratios were measured through matched pair analysis and conditional logistic regression. Risk factors for diarrhoea identified were: reported--drinking of unboiled water, storage of cooked food before consumption and bottle feeding; and observations--animals inside the house and absence of washing water in latrines. Water quality, source of drinking water, reported hand washing behaviour, indiscriminate defecation by children, cup use and the absence of a functional latrine were not associated with diarrhoea. Nonsignificant associations were found for: accessibility of washing water source, type of water storage container and use of fly covers for food.

PIP: In February-March 1989, during home visits, health investigators collected data on 98 pairs of 4-59 month old children recruited from 5 government health centers in rural Tumpat District in Malaysia to identify the risk factors for transmission of diarrhea. The controls had acute respiratory infections. Households not boiling drinking water and children drinking that water were leading risk factors of diarrhea transmission (adds ration [OR]=15, p=.02 and OR=3.13, p.001, respectively). 80.3% of reported boiled drinking water samples did not have any fecal coliforms. Storage of cooked food for 2 hours before consumption was a risk factor OR of conditional logistic regression=3 for 2 hours, p=.02; 2.44 for 2 hours=1/2 day, p=.03; and 9.82 for 1.2 day, p=.03). Another risk factor was animals (cats and chickens) living inside the dwelling (OR=2.41, p=.06). Socioeconomic status could not account for these 2 risk factors. Even though having no latrine in the house was not associated with diarrhea (OR=1.7, p=5), no water available with which to wash the anus and hand in latrines located in those houses which had latrines was significantly associated with diarrhea (OR=2.8, p=.05). This may have reflected overall poor hygienic standards. Even though breast feeding did not have a strong protective effect against diarrhea, bottle feeding was significantly associated with diarrhea (OR=8.07, p=.06). The lack of negative association between breast feeding and diarrhea may have been due to the controls' had respiratory infections, and breast feeding does have a protective effect against them. These results can help health officials to develop intervention strategies to reduce the incidence of diarrhea in rural children in Malaysia.

An evaluation of the hydrogen sulphide water screening test and coliform counts for water quality assessment in rural Malaysia.

The H2S water screening test and the membrane filtration faecal coliform count were compared with Escherichia coli counts for water samples collected from household water sources and domestic drinking water in rural Malaysia. Water samples were taken from 151 wells, 44 taps supplying water from the treated municipal supply and 192 domestic stored water supplies. E. coli were detected in 20% of the samples (42% of wells, 7% of tap water and 6% of drinking water). Excellent correlation (Spearman's rank correlation rs = 0.93) was found between the faecal coliform and E. coli counts for all sample types. The H2S method was poorly correlated whether read at 18 or 30 h. False positive rates were highest for well water, and false negative rates were highest for both well and drinking water samples, with low E. coli counts. The faecal coliform test was an excellent predictor of the presence of E. coli in these water samples, while the H2S test was very inadequate.