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AMERICAN JOURNAL OF EPIDEMIOLOGY. 1992 Mar 1; 135(5):541-51.Researchers conducted a age matched case control study from May-October 1989 of <5 year old Cambodian refugees with diarrhea examined at Greenhill hospital at Site B UN resettlement camp near Surin, Thailand on the Thai-Cambodian border to determine the etiology of the diarrhea and to identify potential risk factors. The age specific diarrheal disease rate stood at 63 episodes/1000 <5 year old children and 123/1000 for <1 year old infants. Incidence was 9.5/1000 <5 year old children and 17/1000 for <1 year old infants. Rotavirus was responsible for 24% of the 487 children with diarrhea. Campylobacter species and enterotoxigenic Escherichia coli caused the most frequent bacterial infections. The same enteric pathogens infected children with persistent diarrhea as well as those with acute diarrhea. Children with persistent diarrhea tended to not shed the same pathogen the entire time. 1 patient did excrete Cryptosporidium for an extended period, however. 37% of the children with persistent diarrhea received antibiotics after a positive culture, but they did not stop diarrhea. Besides 98% of the Shigella strains in children with acute diarrhea and all 4 strains in those with persistent diarrhea were resistant to sulfamethoxazole-trimethoprim. All Shigella strains were resistant to nalidixic acid. Further all aggregative adherent E. coli were resistant to colistin. Oral rehydration solution use and readily available medical care limited the number of deaths from diarrhea to 1. Living with other young children and malnutrition (<3rd percentile weight/height standard) were the most significant risk factors for diarrhea (odds ration=2 and 2.6 respectively). In fact, with each percentile increment in weight for height, the risk for persistent diarrhea fell 1%. The hands of both mothers and children harbored enteric pathogens. Enteric pathogens were also isolated from water and animals, especially cats. Thus preventive measures should include hand washing, reduce overcrowding, and supplemental feeding.
Lancet. 1985 May 4; 1(8436):1046.As part of a study on acute febrile pelvic inflammatory disease and IUDs, reported elsewhere, a significantly lower risk of PID was observed in women using injectable contraceptives. The World Health Organization coordinated the multinational case-control study in 1979-79. Diagnostic criteria were fever, suprapubic tenderness with guarding, cervical or adnexal tenderness or a pelvic mass. 319 cases and 639 matched controls were matched for age, parity, marital status and hospital status. Data were taken from questionnaires. 10 cases (3.1%) currently used injectable contraceptives, mainly Depo-Provera, compared to 38 controls (6.0%). Thus the risk of getting PID was half as great among injectable users, similar in magnitude to risks reported for women using oral contraceptives, barrier methods and sterilization in developing countries.