Factors Associated With Diarrheal Illness Among Children Aged One to Five Years in Haiti

Diarrheal illness is a major cause of morbidity and mortality among children in Haiti, and the impact of diarrheal illness was compounded by a cholera outbreak between 2010 and 2019. Yet our understanding of risk factors for diarrhea among children during this outbreak is limited. We conducted a secondary analysis of data collected as part of a cholera vaccine effectiveness study to identify factors associated with diarrheal illness among children in Haiti from October of 2012 through November of 2016. We identified 47 children aged one to five years old who presented with acute, watery diarrhea, and 166 matched controls who did not have diarrhea, and we performed conditional logistic regression to identify factors associated with diarrheal illness. Discontinuing exclusive breastfeeding within one month of birth was associated with increased risk of diarrheal illness (RR 6.9, 95% CI 1.46 – 32.64), and diarrheal illness was inversely associated with reported history of supplementation with vitamin A (RR 0.05, 95% CI 0.004 – 0.56) and zinc (reported among 0% of cases vs. 17% of controls). While having a respondent who correctly identified ≥3 means of avoiding cholera was associated with reduced risk of diarrheal illness (RR 0.43, 95% CI 0.19 - 1.01), self-reported household sanitation practices and knowledge of cholera were not consistently associated with risk of diarrheal illness. These findings support ongoing efforts to promote breastfeeding and pediatric supplementation with vitamin A and zinc in Haiti. Given the reduced efficacy of current oral cholera vaccines (OCVs) among children, the results reinforce the importance of breastfeeding and micronutrient supplementation in general and during cholera outbreaks to prevent pediatric morbidity from diarrheal illness.