Factors Predisposing Infants To Gastroenteritis Among Poor, Urban, Filipino Families

摘要

A cross-sectional study was undertaken between November 1989 and January 1990 to assess the relationship between nutritional status, water quality, feeding practices and diarrhoeal diseases in 50 infants who had gastroenteritis, and 50 healthy infants from poor urban families in Metropolitan Manila. Information was obtained from mothers in a hospital setting concerning feeding practices, age and sex of the infant, quality of the water supply, and whether water used for feeding was boiled. Infants were weighed and examined to determine the degree of malnutrition. Better nutrition and supplementation of water in addition to feeds were inversely associated with the occurrence of gastroenteritis. Breast-fed infants were better nourished than formula-fed infants. These findings underscore the importance of adequate nutrition and hygiene in reducing rates of infant morbidity. Introduction Diarrhoeal illnesses account for a large proportion of childhood morbidity and mortality in the developing world where the levels of hygiene and nutrition may be poor1 2. Infants have proven to be particularly vulnerable3. Factors associated with infant diarrhoeal illnesses can be divided into exposure and resistance factors. The former includes water quality, availability, and household sanitation, and the latter includes infant feeding methods and nutritional status. These, together with other variables, have been collectively referred to as “intermediate,” or “proximate” determinants in the epidemiology of diarrhoeal diseases4.The infant mortality rate in the Philippines in 1990 was 43 per 1005 with diarrhoeal diseases accounting for 17% of all deaths for children under two6. These causes are not, however, mutually exclusive as undernutrition can severely increase the risks of respiratory and gastrointestinal illnesses for infants while episodes of diarrhoea, in turn, exacerbate nutritional ill health. Simpson-Hebert and Makil7 speculated that rates for diarrhoeal diseases were relatively low in Metropolitan Manila because the water supply is of better quality than in other areas, although the rates are in fact comparable to those in other areas of the Philippines. The present study examines three of the critical intermediate variables predisposing infants to gastroenteritis in a poor, urban sector of Metropolitan Manila in an attempt to isolate some of the factors that may be governing the lower rates of infant morbidity in this region of the Philippines. These variables are: water sources available to families, nutritional status, and feeding practices. The study was implemented at the end of 1989 in the Dr. Jose Fabella Memorial (JFM) Hospital, and the Lower Bicutan Health Center, both situated in Metropolitan Manila. The JFM Hospital, which is a government institution housed in an old converted prison, is a maternal and child hospital serving women of low socioeconomic status who live in one of the poor urban sectors of Manila. The Lower Bicutan Health Center is in one of the suburbs of Manila. Most of the families attending this clinic subsist by manual labour in Metropolitan Manila. The socioeconomic level of patient catchment areas served by both health services are similar; both used government health care, while people of even limited financial resources are under social pressure to pay for health care services. There are no significant differences between the two areas in access to piped water among the families sampled for this study. Methods Fifty infants admitted with symptoms of gastroenteritis to the JFM Hospital were studied between November 1989 and January 1990. All of these infants had one or more of the following symptoms or signs: diarrhoea, vomiting, pyrexia and dehydration. Diagnoses upon admission included acute infectious diarrhoea, enterotoxic Escherichia coli [ETEC], enteropathic Escerichia coli [EPEC], acute ileocolitis, acute gastroenteritis and ameobiasis. Nearly all the infants suffered from an estimated 5-10% dehy