Uncommon Presentations of Some Common Malignancies

Abstract

Between January 1987 and March 1988 a case-control study of the impactof improved water sources on childhood diarrhoea was conducted inKurunegala District, Sri Lanka. Two thousand four hundred and fiftyeight cases of diarrhoea were recruited at five of the hospitalsin the district. Another 4140 children presenting at the same hospitalswith complaints other than diarrhoea were recruited as controls.Data from the five hospitals suggest that children in householdsdrawing their drinking water from handpumps suffer 46% fewer episodesof diarrhoea than children in families using unprotected traditionalsources (95% c. i. 29-59%), while children in families using protectedtraditional wells suffer 35% fewer episodes than children in familiesusing unprotected traditional sources (95% c. i. 27-41%). Therewere, however, substantial differences between the different hospitals.Among children recruited at one of the hospitals, the reduction indiarrhoea rates associated with the use of improved sources was estimatedto be 93% compared with an average of 18% for the other four hospitals.In common with other case-control studies conducted in Malawi andthe Philippines, little evidence of confounding of the associationbetween diarrhoea and water supply was observed. Our results suggestthat, in Sri Lanka, the use of improved water supplies, includingprotected traditional wells, rather than unprotected traditionalsources may lead to a substantial reduction in diarrhoea morbidityamong children under five years of age.