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Locals get travellers’ diarrhoea too: risk factors for diarrhoeal illness and pathogenic Escherichia coli infection across an urban‐rural gradient in Ecuador
Author(s) -
Smith Sha M.,
Montero Lorena,
Paez Maritza,
Ortega Estefania,
Hall Eric,
Bohnert Kate,
Sanchez Xavier,
Puebla Edison,
Endara Pablo,
Cevallos William,
Trueba Gabriel,
Levy Karen
Publication year - 2019
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13183
Subject(s) - christian ministry , transmission (telecommunications) , diarrhoeal disease , diarrhea , medicine , rural area , destinations , environmental health , demography , geography , tourism , pathology , philosophy , theology , electrical engineering , archaeology , sociology , engineering
Objectives Diarrhoea is a common and well‐studied cause of illness afflicting international travellers. However, traveller's diarrhoea can also result from travel between high and low disease transmission regions within a country, which is the focus of this study. Methods We recruited participants for a case‐control study of diarrhoea at four sites along an urban‐rural gradient in Northern Ecuador: Quito, Esmeraldas, Borbón and rural communities outside of Borbón. At each of these sites, approximately 100 subjects with diarrhoea (cases) were recruited from Ministry of Health clinics and were age‐matched with subjects visiting the same clinics for other complaints (controls). Results Travellers to urban destinations had higher risk of diarrhoea and diarrhoeagenic Escherichia coli ( DEC ) infections. Travel to Quito was associated with diarrhoea ( aOR = 2.01, 95% CI = 1.10–3.68) and travel to Guayaquil (another urban centre in Ecuador) was associated with Diffuse Adherent E. coli infection ( OR = 2.09, 95% CI = 1.01–4.33). Compared to those not travelling, urban origins were also associated with greater risk of diarrhoea in Esmeraldas ( aOR = 2.28, 95% CI = 1.20–4.41), and with higher risk of diarrhoeagenic E. coli infections in Quito ( aOR = 2.61, 95% CI = 1.16–5.86), with >50% of travel from Quito and Esmeraldas specified to another urban destination. Conclusions This study suggests that individuals travelling from lower‐transmission regions (rural areas) to higher transmission regions (urban centres) within a single country are at a greater risk of acquiring a diarrhoea‐related illness. Investments to improve water, sanitation and hygiene conditions in urban areas could have impacts on outlying rural areas within a given country.