{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T01:17:43Z","timestamp":1791508663604,"version":"4.3.4"},"reference-count":53,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,6]],"date-time":"2018-12-06T00:00:00Z","timestamp":1544054400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["1K01AI103544"],"award-info":[{"award-number":["1K01AI103544"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Diarrhoea is a common and well\u2010studied cause of illness afflicting international travellers. However, traveller's diarrhoea can also result from travel between high and low disease transmission regions within a country, which is the focus of this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We recruited participants for a case\u2010control study of diarrhoea at four sites along an urban\u2010rural gradient in Northern Ecuador: Quito, Esmeraldas, Borb\u00f3n and rural communities outside of Borb\u00f3n. At each of these sites, approximately 100 subjects with diarrhoea (cases) were recruited from Ministry of Health clinics and were age\u2010matched with subjects visiting the same clinics for other complaints (controls).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Travellers to urban destinations had higher risk of diarrhoea and diarrhoeagenic <jats:italic>Escherichia coli<\/jats:italic> (<jats:styled-content style=\"fixed-case\">DEC<\/jats:styled-content>) infections. Travel to Quito was associated with diarrhoea (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\u00a0=\u00a02.01, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.10\u20133.68) and travel to Guayaquil (another urban centre in Ecuador) was associated with Diffuse Adherent <jats:italic>E.\u00a0coli<\/jats:italic> infection (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\u00a0=\u00a02.09, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.01\u20134.33). Compared to those not travelling, urban origins were also associated with greater risk of diarrhoea in Esmeraldas (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\u00a0=\u00a02.28, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.20\u20134.41), and with higher risk of diarrhoeagenic <jats:italic>E.\u00a0coli<\/jats:italic> infections in Quito (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content>\u00a0=\u00a02.61, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.16\u20135.86), with &gt;50% of travel from Quito and Esmeraldas specified to another urban destination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study suggests that individuals travelling from lower\u2010transmission regions (rural areas) to higher transmission regions (urban centres) within a single country are at a greater risk of acquiring a diarrhoea\u2010related illness. Investments to improve water, sanitation and hygiene conditions in urban areas could have impacts on outlying rural areas within a given country.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13183","type":"journal-article","created":{"date-parts":[[2018,11,16]],"date-time":"2018-11-16T18:55:42Z","timestamp":1542394542000},"page":"205-219","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Locals get travellers\u2019 diarrhoea too: risk factors for diarrhoeal illness and pathogenic <i>Escherichia coli<\/i> infection across an urban\u2010rural gradient in Ecuador"],"prefix":"10.1111","volume":"24","author":[{"given":"Shanon M.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Environmental Health Rollins School of Public Health Emory University Atlanta GA 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