Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh

Abstract

SUMMARYThe objective of our analysis was to describe the aetiology, clinical features, and socio-demographic background of adults with diarrhoea attending different urban and rural diarrhoeal disease hospitals in Bangladesh. Between January 2010 and December 2011, a total of 5054 adult diarrhoeal patients aged ⩾20 years were enrolled into the Diarrhoeal Disease Surveillance Systems at four different hospitals (two rural and two urban) of Bangladesh. Middle-aged [adjusted odds ratio (aOR) 0·28, 95% confidence interval (CI) 0·23–0·35,P < 0·001] and elderly (aOR 0·15, 95% CI 0·11–0·20,P < 0·001) patients were more likely to present to rural diarrhoeal disease facilities than urban ones.Vibrio choleraewas the most commonly isolated pathogen (16%) of the four pathogens tested followed by rotavirus (5%), enterotoxigenicEscherichia coli(ETEC) (4%), andShigella(4%). Of these pathogens,V. cholerae(19%vs. 11%,P < 0·001), ETEC (9%vs. 4%,P < 0·001), and rotavirus (5%vs. 3%,P = 0·013) were more commonly detected from patients presenting to urban hospitals than rural hospitals, butShigellawas more frequently isolated from patients presenting to rural hospitals than urban hospitals (7%vs. 2%,P< 0·001). The isolation rate ofShigellawas higher in the elderly than in younger adults (8%vs. 3%,P < 0·001). Some or severe dehydration was higher in urban adults than rural adults (P< 0·001). Our findings indicate that despite economic and other progress made, conditions facilitating transmission ofV. choleraeandShigellaprevail in adults with diarrhoea in Bangladesh and further efforts are needed to control these infections.