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American Journal of Epidemiology Vol. 127, No. 4: 808-817
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health

research-article

DIARRHEAL ILLNESS AMONG INFANTS AND TODDLERS IN DAY CARE CENTERS: EFFECTS OF ACTIVE SURVEILLANCE AND STAFF TRAINING WITHOUT SUBSEQUENT MONITORING

ALFRED V. BARTLETT1,, BETTY A. JARVIS2, VIRGINIA ROSS3, THEODORE M. KATZ4, MARGARET A. DALIA2, STEVEN J. ENGLENDER5 and LARRY J. ANDERSON6

1Department of International Health, The Johns Hopkins University School of Hygiene and Public Health Baltimore, MD
2Division of Disease Control, Maricopa County Health Department Phoenix, AZ
3Training and Laboratory Program Office, Centers for Disease Control, Public Health Services, US Department of Health and Human Services Atlanta, GA
4National Institute for Occupational Safety and Health, Centers for Disease Control, US Public Health Service, US Department of Health and Human Services Atlanta, GA
5Division of Disease Control Services, Arizona Department of Health Services Phoenix, AZ
6Division of Viral Diseases, Center for Infectious Diseases, Centers for Disease Control, US Public Health Service, US Department of Health and Human Services Atlanta, GA

Reprint requests to Dr. Alfred V. Bartlett at present address: Division de Nutrición y Salud, INCAP, Apartado Postal 1188, Guatemala, Guatemala, C.A.

From October 1981 to September 1984, the authors conducted a three-year longitudinal study of diarrhea among infants and toddlers attending day care centers in Maricopa County, Arizona. in the third year of study, they evaluated the effects on diarrhea rates of staff training without external monitoring and of active surveillance conducted throughout the study. From 21 study day care centers, they randomly selected 10 ("Intervention day care centers") to receive staff training in procedure. to reduce transmission of infectious diarrhea. Continuing active surveillance in the 10 intervention and 11 control day care centers found no difference between diarrhea rates in intervention day care centers in the pre- and posttraining years and no difference between diarrhea rates in the two groups of centers either before or after the training intervention. Biweekly family-based surveys during the two months after training also demonstrated no difference between infant-toddler diarrhea rates in intervention and control day care centers. These surveys found the 21 study day care centers to have significantly higher diarrhea rates than did day care homes or households not using day care, but significantly lower rates than day care centers not included in the active surveillance. Continuous surveillance without training was associated with a significant decrease in diarrheal illness during the course of longitudinal study. One-time staff training without subsequent monitoring did not result in additional decreases and did not lower day care center diarrhea rates to the levels observed in day care homes and households not using day care.

day care; diarrhea; Giardia


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