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Journal of Water and Health Vol 6 No 3 pp 323–332 © IWA Publishing 2008 doi:10.2166/wh.2008.062
Factors determining vulnerability to diarrhoea during and after severe floods in Bangladesh
Masahiro Hashizume, Yukiko Wagatsuma, Abu S. G. Faruque, David A. Sack, Taiichi Hayashi, Paul R. Hunter and Ben Armstrong
Research Center for Tropical Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-12-4, Nagasaki City, Nagasaki, 852-8523, Japan Tel.: (81) 95 819 7808 Fax: (81) 95 819 7808 hashizum@nagasaki-u.ac.jp
Department of Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh
Disaster Prevention Research Institute, Kyoto University, Gokasho, Uji, Kyoto, 611-0011, Japan
School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK
Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
ABSTRACT
This paper identifies groups vulnerable to the effect of flooding on hospital visits due to diarrhoea during and after a flood event in 1998 in Dhaka, Bangladesh. The number of observed cases of cholera and non-cholera diarrhoea per week was compared to expected normal numbers during the flood and post-flood periods, obtained as the season-specific average over the two preceding and subsequent years using Poisson generalised linear models. The expected number of diarrhoea cases was estimated in separate models for each category of potential modifying factors: sex, age, socio-economic status and hygiene and sanitation practices. During the flood, the number of cholera and non-cholera diarrhoea cases was almost six and two times higher than expected, respectively. In the post-flood period, the risk of non-cholera diarrhoea was significantly higher for those with lower educational level, living in a household with a non-concrete roof, drinking tube-well water (vs. tap water), using a distant water source and unsanitary toilets. The risk for cholera was significantly higher for those drinking tube-well water and those using unsanitary toilets. This study confirms that low socio-economic groups and poor hygiene and sanitation groups were most vulnerable to flood-related diarrhoea.
Keywords: Bangladesh; cholera; diarrhoea; episode analysis; floods; vulnerable population
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