Skip to main content
×
Home

The burden and determinants of self-reported acute gastrointestinal illness in an Indigenous Batwa Pygmy population in southwestern Uganda

  • S. CLARK (a1), L. BERRANG-FORD (a1), S. LWASA (a2), D. B. NAMANYA (a3), V. L. EDGE (a4), IHACC Research Team and S. HARPER (a4)...
Summary
SUMMARY

Acute gastrointestinal illness (AGI) is an important public health priority worldwide. Few studies have captured the burden of AGI in developing countries, and even fewer have focused on Indigenous populations. This study aimed to estimate the incidence and determinants of AGI within a Batwa Pygmy Indigenous population in southwestern Uganda. A retrospective cross-sectional survey was conducted in January 2013 via a census of 10 Batwa communities (n = 583 participants). The AGI case definition included any self-reported symptoms of diarrhoea or vomiting in the past 2 weeks. The 14-day prevalence of AGI was 6·17% [95% confidence interval (CI) 4·2–8·1], corresponding to an annual incidence rate of 1·66 (95% CI 1·1–2·2) episodes of AGI per person-year. AGI prevalence was greatest in children aged <3 years (11·3%). A multivariable mixed-effects logistic regression model controlling for clustering at the community level indicated that exposure to goats [odds ratio (OR) 2·6, 95% CI 1·0–6·8], being a child aged <3 years (OR 4·8, 95% CI 1·2–18·9), and being a child, adolescent or senior Batwa in the higher median of wealth (OR 7·0, 95% CI 3·9–9·2) were significantly associated with having AGI. This research represents the first Indigenous community-census level study of AGI in Uganda, and highlights the substantial burden of AGI within this population.

Copyright
Corresponding author
* Author for correspondence: Dr S. Harper, Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada, N1G2W1. (Email: harpers@uoguelph.ca) [S.H.] (Email: lea.berrangford@mcgill.ca) [L.B-F.]
References
Hide All
1. Cheng AC, et al. Infectious diarrhea in developed and developing countries. Journal of Clinical Gastroenterology 2005; 39: 757773.
2. Walker CLF, et al. Global burden of childhood diarrhoea and pneumonia. Lancet 2013; 381: 14051416.
3. Thapar N, Sanderson IR. Diarrhoea in children: an interface between developing and developed countries. Lancet 2004; 36: 641653.
4. WHO. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks. Geneva: World Health Organization, 2009.
5. Jones TF, et al. A population-based estimate of the substantial burden of diarrhoeal disease in the United States; FoodNet, 1996–2003. Epidemiology and Infection 2007; 135: 293301.
6. Baumann-Popczyk A, et al. Incidence of self-reported acute gastrointestinal infections in the community in Poland: a population-based study. Epidemiology and Infection 2012; 140: 11731184.
7. Van Cauteren D, et al. Burden of acute gastroenteritis and healthcare-seeking behaviour in France: a population-based study. Epidemiology and Infection 2012; 140: 697705.
8. Doorduyn Y, Van Pelt W, Havelaar AH. The burden of infectious intestinal disease (IID) in the community: a survey of self-reported IID in The Netherlands. Epidemiology and Infection 2012; 140: 11851192.
9. Thomas MK, et al. Population distribution and burden of acute gastrointestinal illness in British Columbia, Canada. BMC Public Health 2006; 6.
10. Scallan E, et al. Prevalence of diarrhoea in the community in Australia, Canada, Ireland, and the United States. International Journal of Epidemiology 2005; 34: 454460.
11. Scavia G, et al. The burden of self-reported acute gastrointestinal illness in Italy: a retrospective survey, 2008–2009. Epidemiology and Infection 2012; 140: 11931206.
12. Müller L, Korsgaard H, Ethelberg S. Burden of acute gastrointestinal illness in Denmark 2009: a population-based telephone survey. Epidemiology and Infection 2012; 140: 290298.
13. Hall G V, et al. Frequency of infectious gastrointestinal illness in Australia, 2002: regional, seasonal and demographic variation. Epidemiology and Infection 2006; 134: 111118.
14. Chen Y, et al. Burden of self-reported acute gastrointestinal illness in China: a population-based survey. BMC Public Health 2013; 13.
15. Adlam SB, et al. Acute gastrointestinal illness in New Zealand: a community study. Epidemiology and Infection 2011; 139: 302308.
16. Sargeant JM, Majowicz SE, Snelgrove J. The burden of acute gastrointestinal illness in Ontario, Canada, 2005–2006. Epidemiology and Infection 2008; 136: 451460.
17. Gauci C, et al. The magnitude and distribution of infectious intestinal disease in Malta: a population-based study. Epidemiology and Infection 2007; 135: 12821289.
18. Majowicz SE, et al. Magnitude and distribution of acute, self-reported gastrointestinal illness in a Canadian community. Epidemiology and Infection 2004; 132: 607617.
19. Gurpreet K, et al. Incidence and determinants of acute diarrhoea in Malaysia: a population-based study. Journal of Health, Population, and Nutrition 2011; 29: 103112.
20. Thomas MK, et al. Burden of acute gastrointestinal illness in the Metropolitan region, Chile, 2008. Epidemiology and Infection 2011; 139: 560571.
21. Thomas MK, et al. Burden of acute gastrointestinal illness in Gálvez, Argentina, 2007. Journal of Health, Population, and Nutrition 2010; 28: 149158.
22. Prieto AP, et al. Burden of self-reported acute gastrointestinal illness in Cuba. Journal of Health, Population, and Nutrition 2009; 27: 345357.
23. Ohenjo N, et al. Indigenous Health 3: health of Indigenous people in Africa. Lancet 2006; 367: 19371946.
24. Jackson D. The health situation of women and children in central African Pygmy peoples. Forest Peoples Programme, 2006.
25. Gracey M, King M. Indigenous health part 1: determinants and disease patterns. Lancet 2009; 374: 6575.
26. Berrang-Ford L, et al. Vulnerability of indigenous health to climate change: a case study of Uganda's Batwa Pygmies. Social Science and Medicine 2012; 75: 10671077.
27. Baker W. Uganda: The Marginalization of Minorities. Minority Rights Group, 2001.
28. Jackson D. Twa women, Twa rights in the Great Lakes Region of Africa. Minority Rights Group, 2003.
29. Majowicz SE, et al. A common, symptom-based case definition for gastroenteritis. Epidemiology and Infection 2008; 13: 886894.
30. Harper S. Gastrointestinal illness in Canada’ s North: implications of climate change on current and future Inuit health (dissertation). Guelph, Ontario, Canada: University of Guelph, 2013, 275 pp.
31. Lewis J. The Batwa pygmies of the Great Lakes region. Minority Rights Group, 2000.
32. Kabananukye K, Wily L. Report on a study of the Abayanda pygmies of South Western Uganda for the Mgahinga and Bwindi Impenetrable Forest Conservation Trust, 1996.
33. Uganda Bureau of Statistics. Ugandan Demographic and Health Survey 2006. Kampala, 2007.
34. Cheverud J, Cavalli-Sforza L. Cultural transmission among Aka pygmies. American Anthropologist 1986; 88.
35. Balen J, et al. Comparison of two approaches for measuring household wealth via an asset-based index in rural and peri-urban settings of Hunan province, China. Emerging Themes in Epidemiology 2010; 7: 7.
36. Bwindi Community Hospital (BCH). In-patient database. 30 August 2014.
37. WHO. The Global Burden of Disease: 2004 Update. Geneva: World Health Organisation, 2008.
38. Cantwell LB, et al. The effect of different recall periods on estimates of acute gastroenteritis in the United States, FoodNet Population Survey 2006–2007. Foodborne Pathogens and Disease 2010; 7: 12251228.
39. The Kellermann Foundation. Annual report 2012 (http://www.kellermannfoundation.org/annual_report.pdf). 2012, pp. 14.
40. Bisi-Johnson MA, et al. A survey of indigenous herbal diarrhoeal remedies of O.R. Tambo district, Eastern Cape Province, South Africa. African Journal of Biotechnology 2010; 9: 1245–54.
41. UNICEF. Gender and water, sanitation and hygiene (WASH) (http://www.unicef.org/esaro/7310_Gender_and_WASH.html). Accessed 7 June 2014.
42. Rwego IB, et al. High rates of Escherichia coli transmission between livestock and humans in rural Uganda. Journal of Clinical Microbiology 2008; 46: 3187–91.
43. Rwego IB, et al. Gastrointestinal bacterial transmission among humans, mountain gorillas, and livestock in Bwindi Impenetrable National Park, Uganda. Conservation Biology 2008; 22: 16001607.
44. Bbaale E. Determinants of diarrhoea and acute respiratory infection among under-fives in Uganda. Australasian Medical Journal 2011; 4: 400409.
45. Wikswo M, Hall A. Outbreaks of acute gastroenteritis transmitted by person-to-person contact – United States, 2009–2010. Morbidity and Mortality Weekly Reports. Surveillance Summaries 2012; 6: 112.
46. Merlo J, et al. A brief concept tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. Journal of Epidemiology and Community Health 2006; 60: 290297.
47. Lebel A, et al. Geographic variability in the association between socioeconomic status and BMI in the USA and Canada. PLoS ONE 2014; 9.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Clark Supplementary Material
Questionnaire

 Word (379 KB)
379 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 4
Total number of PDF views: 43 *
Loading metrics...

Abstract views

Total abstract views: 300 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th November 2017. This data will be updated every 24 hours.