A HOUSEHOLD SURVEY OF DYSENTERY IN BURUNDI - IMPLICATIONS FOR THE CURRENT PANDEMIC IN SUB-SAHARAN AFRICA

To characterize the epidemiology of dysentery (defined as bloody diarr hoea) in Burundi, we reviewed national surveillance data and conducted a household cluster survey including two case-control studies: one at the household, the other at the individual level. We estimated that c ommunity incidences for dysentery (per 1000 residents) in Kibuye Secto r were 15.3 and 27.3, and that dysentery accounted for 6% and 12% of a ll deaths, in 1991 and 1992, respectively. Factors associated (P less than or equal to 0.05) with contracting dysentery were being female, u sing a cloth rag after defecation, a history of recent weight loss, an d not washing hands before preparing food. The attributable risk, at t he household level, of not washing hands before preparing food was 30% . Secondary household transmission accounted for at most 11% of dysent ery cases. This study suggests that Shigella dysenteriae type 1 may be one of the leading causes of preventable mortality in Burundi and oth er African countries where effective antimicrobial agents are no longe r affordable. Since hands were the most important mode of transmission of S. dysenteriae in this study, community-based interventions aimed at increasing hand washing with soap and water, particularly after def ecation and before food preparation, may be effective for controlling dysentery epidemics caused by S. dysenteriae type 1 in Africa.