Incidence and risk factors of diarrheal diseases among 3-5 year old Israeli Arab children attending kindergartens

Background: The existing limited data on diarrheal diseases in Israel indicate higher rates and more severe illness among Arab children compared to Jewish children. Objectives: To determine the incidence and risk factors of diarrheal diseases in 3-5 year old Israeli Arab children from villages of Northern Israel. Methods: We carried out a follow-up study in 343 children who attended 9 kindergartens from 3 villages of Northern Israel. Daily surveillance was conducted on children's absenteeism from the kindergartens. The causes of absenteeism were recorded based on information received from parents' interviews. During the summer vacation, the follow-up was based on biweekly interviews. We also performed a nested case control study to identify potential risk factors of diarrheal disease; data were obtained through mothers' interviews. Results: During the follow-up period, 100 new episodes of diarrhea were recorded yielding an incidence rate of 0.51 episodes/12 child-months, while 55% of the episodes were associated with visits to the clinic. In the multivariate analysis, the risk of diarrheal diseases was increased in males (OR 2.31 95% CI 1.3-4), in children aged 4 years or less compared to older children (OR 1.76 95% CI 1.01-3.06), and when the mother's education was 8 years or less (OR 1.88, 95% CI 1.08-3.26). Having siblings younger than 5 years old was associated with a reduced risk of diarrheal diseases (OR 0.57 95% CI 0.3-0.9). Conclusions: The incidence rate of diarrheal diseases among Israeli Arab toddlers attending kindergartens in villages from northern Israel is high. The risk factors of diarrheal disease in this population are significantly associated with features of the child and his family rather than environmental characteristics of the community or kindergarten.