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© 1994 Oxford University Press

other

Family Latrines and Paediatric Shigellosis in Rural Bangladesh: Benefit or Risk?

FARUQUE AHMED*,{dagger}, JOHN D CLEMENS*,{dagger},, MALLA R RAO*,{dagger} and A K BANIK*

* International Centre for Diarrhoeal Disease Research, Bangladesh Dhaka, Bangladesh
{dagger} Division of Epidemilogy, Statistics, and Prevention Research, National Institute of Child Healt and Human Development Bethesda, MD, USA

Reprint requests to: John D Clemeni, Division of Epidemiology, Statistics, and Prevention Research, National Institute of Child Health and Human Development, 6100 Executive Plaza Building, Bethesda, MD 20892, USA.

BackgroundThe potential benefits of installing excreta disposal facilities on the burden of paediatric diarrhoea in less-developed settings remain controversial. We conducted a longitudinal study to evaluate whether family latrines are associated with interruption of the transmission of shigellosis to younger children in rural Bangladesh.

MethodsWe prospectively studied 1529 children under 5 years of age exposed to index cases of Shigella dysentery. In all 219 children with culture-proven shigellosis detected during 1 month of follow-up were compared with 1310 control children who did not develop shigellosis or Shigella-negative dysentery.

ResultsOverall, the presence of a family latrine appeared to be associated with a higher, not a lower, risk of paediatric shigellosis (adjusted odds ratio (ORa)=1.37, 95% confidence interval (CI): 0.99–1.89). While use of a pit or sanitary latrine revealed no evidence of a protective association (ORa=0.96, 95% CI: 0.43–2.15), use of a hanging latrine in which faeces were discharged directly onto the ground or into a body of water was associated with a notable increase of risk (ORa=1.42, 95% CI: 1.02–1.98, P<0.05).

ConclusionsWhile cautioning that installation of sanitary latrines may not be sufficient to reduce the burden of paediatric shigellosls in less-developed settings, these data suggest that eliminating unsanitary latrines constitutes a potentially important intervention in its own right in these settings.

Received 1 December 1993


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