Pathogen-Specific Risk Factors and Protective Factors for Acute Diarrheal Illness in Children Aged 12–59 Months in São Paulo, Brazil

Diarrheal diseases are a leading cause of childhood morbidity and mortality in Latin America. Most studies have focused on infants but not on older children. We enrolled 505 children (age 12-59 months) with diarrhea and age-matched controls in a case-control study in Sao Paulo Brazil. Independent risk factors for diarrhea included another household member with diarrhea (matched odds ratio [mOR] 8.1; attributable fraction [AF] 0.17; P<.001) and consumption of homemade juice (mOR 1.8; AF 0.10; P=.01); protective factors included boiling of the baby bottle or nipple (mOR 0.60; AF 0.19; P=.026) childcare at home (mOR 0.58; AF 0.12; P=.004) and piped sewage (mOR 0.58; AF 0.05; P=.047). Hand washing by the caretaker after helping the child defecate protected against Shigella infection (mOR 0.35; P<.05). Preparation of rice beans or soup in the morning and serving it to children after noon were associated with enterotoxigenic Escherichia coli infection (mOR 8.0; P<.05). In these poor households 28% of cases of diarrhea in 1-4-year-old children was attributable to easily modifiable exposures. (authors)