Abstract:
BACKGROUND : In South Africa, there are limited data on the burden of diarrhoea at a community level, specifically in
older children and adults. This community survey estimated rates of and factors associated with diarrhoea across all
ages and determined the proportion of cases presenting to healthcare facilities.
METHODS : Households were enrolled from an existing urban health and demographic surveillance site. A household
representative was interviewed to determine associated factors and occurrence of diarrhoea in the household, for
all household members, in the past 2 weeks (including symptoms and health seeking behaviour). Diarrhoeal rate of
any severity was calculated for < 5 years, 5–15 years and > 15 years age groups. Factors associated with diarrhoea
and health seeking behaviour were investigated using binomial logistic regression.
RESULTS : Diarrhoeal rate among respondents (2.5 episodes/person-year (95% CI, 1.8–3.5)) was significantly higher
than for other household members (1.0 episodes/person-year (95% CI, 0.8–1.4); IRR = 2.4 (95% CI, 1.5–3.7) p < 0.001).
Diarrhoeal rates were similar between age groups, however younger children (< 5 years) were more likely to
present to healthcare facilities than adults (OR = 5.9 (95% CI, 1.1–31.4), p = 0.039). Oral rehydration solution was used
in 44.8% of cases. Having a child between 5 and 15 years in the household was associated with diarrhoea (OR = 2.3
(95% CI, 1.3–3.9), p = 0.003) and, while 26.4% of cases sought healthcare, only 4.6% were hospitalised and only 3.4%
of cases had a stool specimen collected. While the majority of cases were mild, 13.8% of cases felt they required
healthcare but were unable to access it.
CONCLUSION : Diarrhoeal rate was high across all age groups in this community; however, older children and adults
were less likely to present to healthcare, and are therefore underrepresented through facility-based clinical
surveillance. Current diarrhoeal surveillance represents a fraction of the overall cases occurring in the community.
