Pathogen-specific predicting factors of childhood diarrhoea and their seasonality: evaluation from Rohingya refugees and host population in Cox's Bazar, Bangladesh.

BACKGROUND

Bangladesh observed a sudden massive influx of Rohingya refugees in August 2017. This large migrant population relative to a smaller host community placed a burden and threat on the public health sector. Due to the lack of pathogen-specific predicting factors and the influence of seasonal variation on childhood diarrhoeal pathogens in a densely populated area, we aimed to explore the same among Rohingya refugees and the host population.

METHODS

We collected data from under-five children of Rohingya refugees and hosts between 2018 and 2023 from the Diarrhea Treatment Center (DTC)-based surveillance system that served our study population. We collected and tested stool samples to detect enteric pathogens. We performed a multiple logistic regression analysis to identify factors associated with individual pathogens.

RESULTS

Out of 3534 children, 1479 (41.9%) were Rohingya refugees, and 2055 (58.1%) were host children who visited DTCs. Bacterial pathogens were identified in 15% (n/N = 533/3534) of children, and rotavirus in 58% (n/N = 1492/2564). We found higher odds of Vibrio cholerae (adjusted odds ratio (aOR) = 2.12; 95% confidence interval (CI) = 1.21-3.74), non-typhoidal Salmonella (NTS) (aOR = 4.45; 95% CI = 2.04-9.68), and lower odds of rotavirus infection (aOR = 0.72; 95% CI = 0.59-0.89) during the wet season compared to the cold season. Lack of handwashing with soap before feeding the child increased the risk of Aeromonas infection (aOR = 1.85; 95% CI = 1.21-2.81). Drinking tube well water lowers the risk of Vibrio cholerae (95% CI = 0.24-0.71), rotavirus (95% CI = 0.57-0.86), and Aeromonas (95% CI = 0.36-0.75) infection. We found that the recent intake of vitamin A was a protective factor for Vibrio cholerae (95% CI = 0.26-0.76), Aeromonas (95% CI = 0.44-0.89), and NTS (95% CI = 0.12-0.56) enteric infections.

CONCLUSIONS

Our results underscore the necessity of reinforcing routine diarrhoea surveillance for early detection of epidemics, vitamin A supplementation for children under five, and health education to prevent diarrhoea in vulnerable areas such as refugee camps.