# Pathogen-specific predicting factors of childhood diarrhoea and their seasonality: evaluation from Rohingya refugees and host population in Cox’s Bazar, Bangladesh

## TL;DR

The study identifies factors and seasonal patterns affecting childhood diarrhoea in Rohingya refugees and host communities in Bangladesh.

## Contribution

The study reveals pathogen-specific predicting factors and seasonal influences on childhood diarrhoea in a refugee-host population.

## Key findings

- Higher odds of Vibrio cholerae and non-typhoidal Salmonella infections occur during the wet season.
- Drinking tube well water reduces the risk of several enteric infections.
- Vitamin A supplementation protects against multiple diarrhoeal pathogens.

## Abstract

Bangladesh observed a sudden massive influx of Rohingya refugees in August 2017. This large migrant population relative to a smaller host community placed a burden and threat on the public health sector. Due to the lack of pathogen-specific predicting factors and the influence of seasonal variation on childhood diarrhoeal pathogens in a densely populated area, we aimed to explore the same among Rohingya refugees and the host population.

We collected data from under-five children of Rohingya refugees and hosts between 2018 and 2023 from the Diarrhea Treatment Center (DTC)-based surveillance system that served our study population. We collected and tested stool samples to detect enteric pathogens. We performed a multiple logistic regression analysis to identify factors associated with individual pathogens.

Out of 3534 children, 1479 (41.9%) were Rohingya refugees, and 2055 (58.1%) were host children who visited DTCs. Bacterial pathogens were identified in 15% (n/N = 533/3534) of children, and rotavirus in 58% (n/N = 1492/2564). We found higher odds of Vibrio cholerae (adjusted odds ratio (aOR) = 2.12; 95% confidence interval (CI) = 1.21–3.74), non-typhoidal Salmonella (NTS) (aOR = 4.45; 95% CI = 2.04–9.68), and lower odds of rotavirus infection (aOR = 0.72; 95% CI = 0.59–0.89) during the wet season compared to the cold season. Lack of handwashing with soap before feeding the child increased the risk of Aeromonas infection (aOR = 1.85; 95% CI = 1.21–2.81). Drinking tube well water lowers the risk of Vibrio cholerae (95% CI = 0.24–0.71), rotavirus (95% CI = 0.57–0.86), and Aeromonas (95% CI = 0.36–0.75) infection. We found that the recent intake of vitamin A was a protective factor for Vibrio cholerae (95% CI = 0.26–0.76), Aeromonas (95% CI = 0.44–0.89), and NTS (95% CI = 0.12–0.56) enteric infections.

Our results underscore the necessity of reinforcing routine diarrhoea surveillance for early detection of epidemics, vitamin A supplementation for children under five, and health education to prevent diarrhoea in vulnerable areas such as refugee camps.