A household survey of dysentery in Burundi : implications for the current pandemic in sub-Saharan Africa

National surveillance data were reviewed and a household cluster survey conducted including two case-control studies at the household and individual levels to characterize the epidemiology of dysentery (bloody diarrhea) in Burundi. Community incidences for dysentery per 1000 residents in Kibuye Sector were estimated at 15.3 and 27.3 with dysentery accounting for 6% and 12% of all deaths in 1991 and 1992 respectively. Being female using a cloth rag after defecation a history of recent weight loss and not washing hands before preparing food were associated with contracting dysentery. The attributable risk at the household level of not washing hands before preparing food was 30%. Secondary household transmission accounted for at most 11% of dysentery cases. These findings suggest that Shigella dysenteriae type one may be one of the leading causes of preventable mortality in Burundi and other African countries where effective antimicrobial agents are no longer affordable.