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An evaluation of diarrhoea and enteric infection surveillance methods in urban informal settlements and refugee camps
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Rego, Ryan Trevor Titus (2021) An evaluation of diarrhoea and enteric infection surveillance methods in urban informal settlements and refugee camps. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3719076
Abstract
Surveillance of diarrhoea and enteric infection among infants is key to improving infant health in LMICs. However, the performance of current surveillance methods in estimating rates of diarrhoea and enteric infection have been called into question by various academics. Diarrhoea rates are often estimated through subjective measures such as community surveys. These measures may introduce variation into the estimated rates. Rates of enteric infection are often estimated using diarrhoea as a proxy marker. However, it is possible that diarrhoea does not classify enteric infection well. In this thesis, I examine variation in estimates of diarrhoea rates associated with the method used; and the extent of misclassification when using diarrhoea as a proxy marker of enteric infection.
To examine variation in estimates of diarrhoea rates associated with the method used, I conducted two studies: 1) a systematic review and meta-analysis of the literature; and 2) a randomised controlled trial (RCT) in a Tanzanian urban informal settlement. My findings in both confirmed that the methods used in estimating diarrhoea rates are associated with variations in estimates. The RCT in Tanzania also showed that text message surveys are a suitable substitute for in-person surveys.
To examine the reliability of diarrhoea to classify enteric infection, I conducted a ‘diagnostic’ study in a Bangladeshi Refugee Camp. The evidence showed that diarrhoea misclassified enteric infection, offering no better a classification of enteric infection than flipping a coin. I also found evidence of clear seasonality in infection.
I have demonstrated that the methods used in diarrhoea surveillance can influence estimated rates, and that diarrhoea widely misclassifies enteric infection when used as a proxy marker. For this reason, I hazard against the use of the current methods in epidemiological surveys when trying to estimate rates of diarrhoea and classify cases of enteric infection. Alternative, less subjective, methods, such as stool sampling for enteric infection, should be used.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine |
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Library of Congress Subject Headings (LCSH): | Diarrhea, Wireless communication systems in medical care, Telecommunication in medicine, Medical care -- Evaluation, Communicable diseases -- Transmission, Medicine -- Communication systems | ||||
Official Date: | May 2021 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | ilford, Richard, 1950- ; Watson, Samuel I. ; Gill, Paramjit | ||||
Sponsors: | University of Warwick ; National Institute for Health Research (Great Britain) | ||||
Format of File: | |||||
Extent: | 242 leaves : illustrations | ||||
Language: | eng |
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