A Hierarchical Model for Defining Priorities of Environmental and Non-Environmental Risk Factors of Childhood Diarrhea

Background Acute diarrhea constitutes a major cause of morbidity and mortality, especially among the children. Objective To identify and determine the contribution of each of the risk factors associated with diarrhea occurrence in children in the commercial capital of Yemen, city of Aden. Methods This outpatient-based case-control and questionnaire study was conducted during the first half of 2010, on random population of a total 304 cases of diarrhea and 517 controls. The explanatory variables were grouped according to the conceptual model, and analyzed by using a hierarchical approach, to provide a more dynamic view of the transmission characteristics of childhood diarrhea. Non-conditional logistic regression was used, and odds ratio and population-attributable fractions were estimated. Results Factors related to food handling made a smaller contribution to diarrhea occurrence, compare to much more contribution by environmental contamination (fecal-oral transmission), and contact with one has diarrhea/ high density of housing. However the most determinant for diarrhea occurrence was the contribution of the socioeconomic factors. Conclusion The data indicates that factors from all hierarchical levels were implicated in spreading of diarrhea, with relative high role for environmental contamination, and contact / crowding in the transmission. This is compatible with a predominance of the parasitic over the viral, spread by these routes. Diarrhea control strategies must emphasize on policies that improving the socioeconomic circumstances, and reducing the environmental contamination for the prevention of diarrhea