Determinants of national diarrheal disease burden

Predictive modeling for infectious diarrheal disease in pediatric populations: A systematic review

Introduction

Diarrhea is still a significant global public health problem. There are currently no systematic evaluation of the modeling areas and approaches to predict diarrheal illness outcomes. This paper reviews existing research efforts in predictive modeling of infectious diarrheal illness in pediatric populations.

Methods

We conducted a systematic review via a PubMed search for the period 1990-2021. A comprehensive search query was developed through an iterative process and literature on predictive modeling of diarrhea was retrieved. The following filters were applied to the search results: human subjects, English language, and children (birth to 18 years). We carried out a narrative synthesis of the included publications.

Results

Our literature search returned 2671 articles. After manual evaluation, 38 of these articles were included in this review. The most common research topic among the studies were disease forecasts 14 (36.8%), vaccine-related predictions 9 (23.7%), and disease/pathogen detection 5 (13.2%). Majority of these studies were published between 2011 and 2020, 28 (73.7%). The most common technique used in the modeling was machine learning 12 (31.6%) with various algorithms used for the prediction tasks. With change in the landscape of diarrheal etiology after rotavirus vaccine introduction, many open areas (disease forecasts, disease detection, and strain dynamics) remain for pathogen-specific predictive models among etiological agents that have emerged as important. Additionally, the outcomes of diarrheal illness remain under researched. We also observed lack of consistency in the reporting of results of prediction models despite the available guidelines highlighting the need for common data standards and adherence to guidelines on reporting of predictive models for biomedical research.

Conclusions

Our review identified knowledge gaps and opportunities in predictive modeling for diarrheal illness, and limitations in existing attempts whilst advancing some precursory thoughts on how to address them, aiming to invigorate future research efforts in this sphere.

The effects of climate variability and seasonal influence on diarrhoeal disease in the tropical city-state of Singapore - A time-series analysis

BACKGROUND

Diarrhoeal disease is common and imposes substantial health and economic burdens across the globe, especially in the African and Southeast Asian regions. Besides causing high mortality and morbidity, diarrhoeal disease has also been associated with growth and cognitive shortfalls in children in low-resource settings. Extreme weather events brought about by climate change may increase diarrhoeal disease and impact vulnerable populations in countries regardless of levels of development. We examined the seasonal and climatic influences of acute diarrhoeal disease reports in Singapore, a city-state located in Southeast Asia.

METHODS

We used a time-series analysis, adjusting for time-varying potential confounders in a negative binomial regression model and fitting fractional polynomials to investigate the relationship between climatic factors (temperature, relative humidity and rainfall) and reported diarrhoeal disease.

RESULTS

We included 1,798,198 reports of diarrhoeal disease from 2005 to 2018. We observed annual trimodal peaks in the number of reports. Every 10% increase in relative humidity in the present week was positively associated with an increase in reports one week later [Incidence Rate Ratio (IRR): 1.030, 95% CI 1.004-1.057] and negatively associated with a decrease in reports six weeks later (IRR: 0.979, 95% CI 0.961-0.997). We observed effect modification of relative humidity on the risk of diarrhoeal disease in the first calendar quarter (January to March). There was weak evidence of a delayed effect of ambient air temperature on reports of diarrhoeal disease one week later (IRR: 1.013, 95% CI 0.998-1.027). No threshold effects of climatic factors were observed. Each week of school holidays was associated with a 14.4% reduction in diarrhoeal disease reports (IRR: 0.856, 95% CI: 0.840 to 0.871). Public holidays were associated with a reduction in reports in the same week and an increase a week later.

CONCLUSIONS

Diarrhoeal disease is highly seasonal and is associated with climate variability. Food safety and primary healthcare resource mitigation could be timed in anticipation of seasonal and climate driven increases in disease reports.

Global burden of diarrheal disease attributable to the water supply and sanitation system in the State of Minas Gerais, Brazil: 2005

Advances have occurred in relation to the coverage of water supply and sanitation in Brazil, however inequalities are still observed in relation to the coverage of these services, reflecting the importance of diarrheal disease in the Brazilian epidemiological context. The aim of this study was to measure the impact of the water supply and sanitation system on diarrheal diseases among children aged under five. The global burden of diarrhea was calculated based on the attributable population fraction, using information on prevalence and relative risks from the 2000/2010 censuses and a study by Pruss et al. The north of the State of Minas Gerais, the Northeast and Jequitinhonha regions had the highest disability-adjusted life year (DALY) rates and ratios. The fraction of diarrhea attributable to the water supply and sanitation system was 83%, decreasing to 78.3% where sanitation had 100% coverage. An inverse relationship was found between DALY rates and attributable fractions and per capita GDP. Broadening the scope and coverage of services and improving the quality of water available in homes is an urgent requirement. These measures will bring economic and social benefits related to the reduction of diarrheal diseases and consequent improvement of the quality of life of children aged under five.

Socioeconomic factors associated with diarrheal diseases among under-five children of the nomadic population in northeast Ethiopia

BACKGROUND

Diarrheal disease remains the leading cause of morbidity and mortality among under-five children worldwide. Every day, more than 4000 children lose their lives due to diarrhea. In Ethiopia, diarrhea is the second killer of under-five children next to pneumonia.

METHODS

A cross-sectional study was conducted to assess the prevalence of under-five diarrhea and socioeconomic factors among the nomadic people in Hadaleala District. A total of 704 under-five children were included in this study, and subjects were recruited by the multistage cluster sampling technique. Data were collected by a pre-tested questionnaire. The multivariable logistic regression analysis was used to identify socioeconomic variables associated with childhood diarrhea.

RESULTS

The 2-week period prevalence of diarrhea among under-five children was 26.1% (95% CI 22.9, 29.3%). The highest prevalence (37.5%) of diarrhea occurred among children aged between 12.0 and 23.0 months. The occurrence of diarrheal disease was associated with the presence of two (AOR = 4.3, p < 0.001) and three (AOR = 22.4, p < 0.001) under-five children in each household. The age of the children ranged between 6.0 and 11.0 months (AOR = 4.8, p < 0.001), 12.0 and 23.0 months (AOR = 6.0, p < 0.001), and 24.0 and 35.0 months (AOR = 2.5, p < 0.05), illiterate mothers (AOR = 2.5, p < 0.05), and poor households (AOR = 1.6, p < 0.05).

CONCLUSIONS

Diarrhea prevalence was quite high among under-five children in Hadaleala District, and it was significantly concentrated among children aged between 12.0 and 23.0 months. The number of under-five children, age of children, mothers' education, and household economic status were significantly associated with childhood diarrhea. To minimize the magnitude of childhood diarrhea, implementing various prevention strategies such as health education, child care, personal hygiene, and household sanitation which can be integrated with the existing national health extension program are essential.

Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis

ABSTRACT

Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.

Multimodel predictive system for carbon dioxide solubility in saline formation waters

The prediction of carbon dioxide solubility in brine at conditions relevant to carbon sequestration (i.e., high temperature, pressure, and salt concentration (T-P-X)) is crucial when this technology is applied. Eleven mathematical models for predicting CO(2) solubility in brine are compared and considered for inclusion in a multimodel predictive system. Model goodness of fit is evaluated over the temperature range 304-433 K, pressure range 74-500 bar, and salt concentration range 0-7 m (NaCl equivalent), using 173 published CO(2) solubility measurements, particularly selected for those conditions. The performance of each model is assessed using various statistical methods, including the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC). Different models emerge as best fits for different subranges of the input conditions. A classification tree is generated using machine learning methods to predict the best-performing model under different T-P-X subranges, allowing development of a multimodel predictive system (MMoPS) that selects and applies the model expected to yield the most accurate CO(2) solubility prediction. Statistical analysis of the MMoPS predictions, including a stratified 5-fold cross validation, shows that MMoPS outperforms each individual model and increases the overall accuracy of CO(2) solubility prediction across the range of T-P-X conditions likely to be encountered in carbon sequestration applications.

Freshwater availability and water fetching distance affect child health in sub-Saharan Africa

Currently, more than two-thirds of the population in Africa must leave their home to fetch water for drinking and domestic use. The time burden of water fetching has been suggested to influence the volume of water collected by households as well as time spent on income generating activities and child care. However, little is known about the potential health benefits of reducing water fetching distances. Data from almost 200, 000 Demographic and Health Surveys carried out in 26 countries were used to assess the relationship between household walk time to water source and child health outcomes. To estimate the causal effect of decreased water fetching time on health, geographic variation in freshwater availability was employed as an instrumental variable for one-way walk time to water source in a two-stage regression model. Time spent walking to a household's main water source was found to be a significant determinant of under-five child health. A 15-min decrease in one-way walk time to water source is associated with a 41% average relative reduction in diarrhea prevalence, improved anthropometric indicators of child nutritional status, and a 11% relative reduction in under-five child mortality. These results suggest that reducing the time cost of fetching water should be a priority for water infrastructure investments in Africa.

Interventions to improve disposal of human excreta for preventing diarrhoea

BACKGROUND

Diarrhoeal diseases are a leading cause of mortality and morbidity, especially among young children in low-income countries, and are associated with exposure to human excreta.

OBJECTIVES

To assess the effectiveness of interventions to improve the disposal of human excreta for preventing diarrhoeal diseases.

SEARCH STRATEGY

We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in The Cochrane Library; MEDLINE; EMBASE; LILACS; the metaRegister of Controlled Trials (mRCT); and Chinese-language databases available under the Wan Fang portal, and the China National Knowledge Infrastructure (CNKI-CAJ). We also handsearched relevant conference proceedings, and contacted researchers and organizations working in the field, as well as checking references from identified studies.

SELECTION CRITERIA

Randomized, quasi-randomized, and non-randomized controlled trials (RCTs) were selected, comparing interventions aimed at improving the disposal of human excreta to reduce direct or indirect human contact with no such intervention. Cluster (eg at the level of household or community) controlled trials were included.

DATA COLLECTION AND ANALYSIS

We determined study eligibility, extracted data, and assessed methodological quality in accordance with the methods prescribed by the protocol. We described the results and summarized the information in tables. Due to substantial heterogeneity among the studies in terms of study design and type of intervention, no pooled effects were calculated.

MAIN RESULTS

Thirteen studies from six countries covering over 33,400 children and adults in rural, urban, and school settings met the review's inclusion criteria. In all studies the intervention was allocated at the community level. While the studies reported a wide range of effects, 11 of the 13 studies found the intervention was protective against diarrhoea. Differences in study populations and settings, in baseline sanitation levels, water, and hygiene practices, in types of interventions, study methodologies, compliance and coverage levels, and in case definitions and outcome surveillance limit the comparability of results of the studies included in this review. The validity of most individual study results are further compromised by the non-random allocation of the intervention among study clusters, an insufficient number of clusters, the lack of adjustment for clustering, unclear loss to follow-up, potential for reporting bias and other methodological shortcomings.

AUTHORS' CONCLUSIONS

This review provides some evidence that interventions to improve excreta disposal are effective in preventing diarrhoeal disease. However, this conclusion is based primarily on the consistency of the evidence of beneficial effects. The quality of the evidence is generally poor and does not allow for quantification of any such effect. The wide range of estimates of the effects of the intervention may be due to clinical and methodological heterogeneity among the studies, as well as to other important differences, including exposure levels, types of interventions, and different degrees of observer and respondent bias. Rigorous studies in multiple settings are needed to clarify the potential effectiveness of excreta disposal on diarrhoea.