Infectious diarrheal disease caused by contaminated well water in Chinese schools: A systematic review and meta-analysis

Abstract

BackgroundIn China, waterborne outbreaks of infectious diarrheal disease mainly occur in schools, and contaminated well water is a common source of pathogens. The objective of this review was to present the attack rates, durations of outbreak, pathogens of infectious diarrheal disease, and sanitary conditions of wells in primary and secondary schools in China, and to analyze risk factors and susceptibility of school children.MethodsRelevant articles and reports were identified by searching PubMed, Web of Science, China National Knowledge Infrastructure, China Information System for Disease Control and Prevention, and the Chinese Field Epidemiology Training Program. Essential information, including urban/rural areas, school types, attack rates, pathogens, durations of outbreak, report intervals, and interventions were extracted from the eligible articles. Wilcoxon signed-rank test, Kruskal–Wallis H test, and Spearman correlation test were conducted in statistical analyses. Sex- and age-specific attack rate ratios were calculated as pooled effect sizes.ResultsWe screened 2188 articles and retrieved data of 85 outbreaks from 1987 to 2014. Attack rates of outbreaks in rural areas (median, 12.63 cases/100 persons) and in primary schools (median, 14.54 cases/100 persons) were higher than those in urban areas (median, 5.62 cases/100 persons) and in secondary schools (median, 8.74 cases/100 persons) (P = 0.004 and P = 0.013, respectively). Shigella, pathogenic Escherichia coli, and norovirus were the most common pathogens. Boys tended toward higher attack rates than girls (sex-specific attack rate ratio, 1.13; 95% CI, 1.00–1.29, P = 0.05). Unsanitary conditions of water wells were reported frequently, and unhealthy behavior habits were common in students.ConclusionSchool children were susceptible to waterborne disease in China. Chinese government should make efforts to improve access to safe water in schools. Health education promotion and conscientiousness of school leaders and teachers should be enhanced.

Challenges to Sustainable Safe Drinking Water: A Case Study of Water Quality and Use across Seasons in Rural Communities in Limpopo Province, South Africa

“…The erratic supply of safe drinking and domestic water often affects good hygiene practices. In most developing countries of the world, inadequate supplies of drinking water can contribute to the underage death of children in the region [4][5][6][7][8][9][10].…”

Characterization of diarrheagenic E. coli causing a diarrheal outbreak in the south of Iran, Summer 2015

“…To our knowledge this is the first report of diarrheagenic E. coli as a causative agent of gastroenteritis outbreak in Iran. However, several outbreaks of gastroenteritis due to diarrheagenic E. coli have been previously reported in Japan, Korea, China, Brazil and the Kenya [17][18][19][20][21][22].…”

“…From 16-22 July 2015, Sepidan local health authorities noticed an increased incidence of watery and bloody diarrheal illness among the Sepidan inhabitants and the visitors who travelled to this city because of the long weekend vacation (18)(19). The epidemiological investigation was conducted by the local health authorities and the Iranian Centers for Disease Control and Prevention immediately after the outbreak was reported.…”

The Effect of Environmental Factors on the Event of Acute Diarrhea

“…Safe and healthy water is a basic requirement for good health [4]. Water sources in low-income countries and rural areas are at risk of contamination [5].…”