RISK OF DIARRHEAL DISEASE IN ECUADORIAN DAY-CARE-CENTERS

To determine the risk for diarrheal disease (DD) in day-care centers ( DCC) for children residing in a poor urban slum area of Quite, Ecuador , compared with that for children from the same environment but cared for in their own residential home (RH), a prospective age-, sex-and lo cale-controlled study of DD was conducted, including 115 children in D CC and 115 in PR, ages 12 to 42 months. The overall incidence of DD wa s 46/1000 child weeks. Diarrhea was more common in DCC than in RH (rel ative risk (RR), 1.75; 95% confidence interval (CI), 1.38 to 2.22; P < 0.001). Poor hygienic practices were more prevalent in DCC than in RH . The use of reused water for child handwashing before eating and for washing raw vegetables was associated with a higher risk of DD in DCC than in RH (RR = 4.08, CI 2,93 to 5.67, P < 0.001; RR = 3.90, CI 2.79 to 5.44, P < 0.001, respectively), These two practices were risk facto rs in the DCC (RR = 2.74, CI 2.08 to 3.68, P < 0.001; RR = 2.05, CI 1. 55 to 2.71, P < 0.001, respectively) when compared with their absence in the same DCC, Shigella (RR = 3.58, CI 1.19 to 10.78, P < 0.02). Aer omonas (RR = 10.47, CI 1.35 to 81.05, P < 0.01), rotavirus (RR = 2.86, CI 1.87 to 4.39, P < 0.001) and Giardia (RR = 1.59, CI 1.00 to 2.59, P < 0.05) were more common in DCC than in RH, More than two-Fifths of the Shigella and Aeromonas isolates were resistant to trimethoprim-sul famethoxazole. Although the incidence of DD was lower in this high And ean community than reported in many developing countries, DCC signific antly increased the risk of disease. Poor hygiene in DCC, particularly the reuse of the scarce available water, was identified as an importa nt risk factor. Increasing use of DCC in poor communities will likely increase DD and its adverse consequences in developing country setting s unless an effort is made to improve hygienic practices.