Urban-rural differentials in overweight and obese individuals with diarrhea in bangladesh.

OBJECTIVE

The study aimed to determine urban and rural differences in overweight and obesity (OO) with diarrhea regarding subjects' sociodemographic, clinical characteristics, etiology, and antimicrobial susceptibility.

METHODS

Relevant information from 2000 to 2011 were extracted from the data archive of the Diarrheal Disease Surveillance System of urban Dhaka (1248, 4.5%) and rural Matlab (615, 3.4%) hospitals of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).

RESULTS

The proportion of OO significantly increased in both urban (3-7%; chi-square for trend p < 0.001) and rural (1-6%; p < 0.001) areas over the study period. In multivariate modeling, monthly income more than US$100 (odds ratio [OR] = 54.44, 95% confidence interval [CI], 25.37-116.82, p < 0.001), high wealth quintile (OR = 18.23, 95% CI, 8.63-38.49, p < 0.001), access to sanitary toilet (OR = 3.07. 95% CI. 1.76-5.26. p < 0.001), boiled drinking water (OR = 2.77, 95% CI, 1.09-7.05, p = 0.032), antimicrobial use before hospitalization (OR = 4.99, 95% CI, 2.85-8.74, p < 0.001), fever (OR = 0.14, 95% CI, 0.37, 0.50, p < 0.001), watery stools (OR = 5.59, 95% CI, 2.11-14.80, p < 0.001), dehydrating diarrhea (OR = 5.17, 95% CI, 2.54-10.52, p < 0.001), intravenous saline infusion after hospitalization (OR = 2.65, 95% CI, 1.28-5.49, p = 0.009), and Salmonella infection (OR = 0.20, 95% CI, 0.50-0.83, p = 0.027) remained significantly associated with urban OO individuals. At least 88% of Shigella isolates were susceptible to ciprofloxacin in both urban and rural areas; for mecillinum it was 90%. Ciprofloxacin had the least detected resistance for Vibrio cholerae (0%) and trimethoprim-sulfamethoxazole (TMP-SMX) showed the greatest resistance (Dhaka 86%; Matlab 98%). Susceptibility for Salmonella showed ampicillin (95%), chloramphenecol (100%), ciprofloxacin (95%), ceftraxone (93%), TMP-SMX (95%) at both sites.

CONCLUSIONS

Urban OO with diarrheal illnesses was significantly different from that in rural areas, including antimicrobial susceptibility.