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Haque F, Lampe FC, Hajat S, Stavrianaki K, Hasan SMT, Faruque ASG, Ahmed T, Jubayer S, Kelman I. Is heat wave a predictor of diarrhoea in Dhaka, Bangladesh? A time-series analysis in a South Asian tropical monsoon climate. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003629. [PMID: 39226251 PMCID: PMC11371214 DOI: 10.1371/journal.pgph.0003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 07/29/2024] [Indexed: 09/05/2024]
Abstract
While numerous studies have assessed the association between temperature and diarrhoea in various locations, evidence of relationship between heat wave and diarrhoea is scarce. We defined elevated daily mean and maximum temperature over the 95th and 99th percentiles lasting for at least one day between March to October 1981-2010 as TAV95 and TAV99 and D95 and D99 heat wave, respectively. We investigated the association between heat wave and daily counts of hospitalisations for all-cause diarrhoea in Dhaka, Bangladesh using time series regression analysis employing constrained distributed lag-linear models. Effects were assessed for all ages and children aged under 5 years of age. Diarrhoea hospitalisation increased by 6.7% (95% CI: 4.6%- 8.9%), 8.3% (3.7-13.1), 7.0 (4.8-9.3) and 7.4 (3.1-11.9) in all ages on a TAV95, TAV99, D95 and D99 heat wave day, respectively. These effects were more pronounced for under-5 children with an increase of 13.9% (95% CI: 8.3-19.9), 24.2% (11.3-38.7), 17.0 (11.0-23.5) and 19.5 (7.7-32.6) in diarrhoea hospitalisations on a TAV95, TAV99, D95 and D99 heat wave day, respectively. At lags of 3 days, we noticed a negative association indicating a 'harvesting' effect. Our findings suggest that heat wave was a significant risk factor for diarrhoea hospitalisation in Dhaka. Further research is needed to elucidate the causal pathways and identify the preventive measures necessary to mitigate the impacts of heat waves on diarrhoea. Given that no heat wave definitions exist for Dhaka, these results may help to define heat waves for Dhaka and trigger public health interventions including heat alerts to prevent heat-related morbidity in Dhaka, Bangladesh.
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Affiliation(s)
- Farhana Haque
- Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
- UK Public Health Rapid Support Team (UK-PHRST), Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Fiona C. Lampe
- Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Katerina Stavrianaki
- Department of Statistical Science, Department of Risk and Disaster Reduction, University College London (UCL), London, United Kingdom
| | | | - A. S. G. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Shamim Jubayer
- National Heart Foundation Hospital and Research Institute (NHF&RI), Dhaka, Bangladesh
| | - Ilan Kelman
- Department of Risk and Disaster Reduction, Institute for Global Health (IGH), University College London (UCL), London, United Kingdom
- University of Agder, Kristiansand, Norway
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Geremew G, Cumming O, Haddis A, Freeman MC, Ambelu A. Rainfall and Temperature Influences on Childhood Diarrhea and the Effect Modification Role of Water and Sanitation Conditions: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:823. [PMID: 39063400 PMCID: PMC11276699 DOI: 10.3390/ijerph21070823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 07/28/2024]
Abstract
The latest report from the Intergovernmental Panel on Climate Change (IPCC) highlighted the worsening impacts of climate change. Two climate factors-temperature and rainfall uncertainties-influence the risk of childhood diarrhea, which remains a significant cause of morbidity and mortality in low- and middle-income countries. They create a conducive environment for diarrhea-causing pathogens and overwhelm environmental prevention measures. This study aimed to produce comprehensive evidence on the association of temperature and rainfall variability with the risk of childhood diarrhea and the influence of water and sanitation conditions on those associations. We conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) approach. Records published in English from 2006 to 2023 were searched on 8 January 2024 via PubMed, EMBASE, ScienceDirect, Scopus, the Cochrane Library, and Google/Google Scholar using comprehensive search terms. We assessed studies for any risk of bias using the Navigation Guide and rated the quality of the evidence using the GRADE approach. The heterogeneity among estimates was assessed using I-squared statistics (I2). The findings of the analysis were presented with forest plots using an incidence rate ratio (IRR). A meta-analysis was conducted on effect modifiers (water supply and sanitation conditions) using a random effects model with a 95% confidence interval (CI). The statistical analyses were conducted using R 4.3.2 software and Review Manager 5.3. A total of 2017 records were identified through searches, and only the 36 articles that met the inclusion criteria were included. The analysis suggests a small positive association between increased temperature and the occurrence of under-five diarrhea, with the pooled IRR = 1.04; 95% CI [1.03, 1.05], at I2 = 56% and p-value < 0.01, and increased rainfall and U5 diarrhea, with IRR = 1.14; 95% CI [1.03, 1.27], at I2 = 86% and p-value < 0.01. The meta-analysis indicated a positive association between unimproved latrine facilities and drinking water sources with a rainfall-modified effect on U5 diarrhea, with IRR = 1.21; 95% CI [0.95, 1.53], at I2 = 62% and p-value = 0.03. We found that an increase in mean temperature and rainfall was associated with an increased risk of childhood diarrhea. Where there were unimproved latrine facilities and drinking water sources, the increase in mean rainfall or temperature would increase the incidence of childhood diarrhea. The results of this review help in assessing the effectiveness of current intervention programs, making changes as needed, or creating new initiatives to lower the prevalence of childhood diarrhea.
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Affiliation(s)
- Gorfu Geremew
- Department of Environmental Health Science and Technology, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious Tropical Disease, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Alemayehu Haddis
- Department of Environmental Health Science and Technology, Jimma University, Jimma P.O. Box 378, Ethiopia;
| | - Matthew C. Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Argaw Ambelu
- Division of Water and Health, Ethiopian Institute of Water Resources, Addis Ababa University, Addis Ababa P.O. Box 1165, Ethiopia;
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Nguyen AT, Grembi JA, Riviere M, Barratt Heitmann G, Hutson WD, Athni TS, Patil A, Ercumen A, Lin A, Crider Y, Mertens A, Unicomb L, Rahman M, Luby SP, Arnold BF, Benjamin-Chung J. Influence of Temperature and Precipitation on the Effectiveness of Water, Sanitation, and Handwashing Interventions against Childhood Diarrheal Disease in Rural Bangladesh: A Reanalysis of the WASH Benefits Bangladesh Trial. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:47006. [PMID: 38602833 PMCID: PMC11008709 DOI: 10.1289/ehp13807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Diarrheal disease is a leading cause of childhood morbidity and mortality globally. Household water, sanitation, and handwashing (WASH) interventions can reduce exposure to diarrhea-causing pathogens, but meteorological factors may impact their effectiveness. Information about effect heterogeneity under different weather conditions is critical to refining these targeted interventions. OBJECTIVES We aimed to determine whether temperature and precipitation modified the effect of low-cost, point-of-use WASH interventions on child diarrhea. METHODS We analyzed data from a trial in rural Bangladesh that compared child diarrhea prevalence between clusters (N = 720 ) that were randomized to different WASH interventions between 2012 and 2016 (NCT01590095). We matched temperature and precipitation measurements to diarrhea outcomes (N = 12,440 measurements, 6,921 children) by geographic coordinates and date. We estimated prevalence ratios (PRs) using generative additive models and targeted maximum likelihood estimation to assess the effectiveness of each WASH intervention under different weather conditions. RESULTS Generally, WASH interventions most effectively prevented diarrhea during monsoon season, particularly following weeks with heavy rain or high temperatures. The PR for diarrhea in the WASH interventions group compared with the control group was 0.49 (95% CI: 0.35, 0.68) after 1 d of heavy rainfall, with a less-protective effect [PR = 0.87 (95% CI: 0.60, 1.25)] when there were no days with heavy rainfall. Similarly, the PR for diarrhea in the WASH intervention group compared with the control group was 0.60 (95% CI: 0.48, 0.75) following above-median temperatures vs. 0.91 (95% CI: 0.61, 1.35) following below-median temperatures. The influence of precipitation and temperature varied by intervention type; for precipitation, the largest differences in effectiveness were for the sanitation and combined WASH interventions. DISCUSSION WASH intervention effectiveness was strongly influenced by precipitation and temperature, and nearly all protective effects were observed during the rainy season. Future implementation of these interventions should consider local environmental conditions to maximize effectiveness, including targeted efforts to maintain latrines and promote community adoption ahead of monsoon seasons. https://doi.org/10.1289/EHP13807.
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Affiliation(s)
- Anna T. Nguyen
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Jessica A. Grembi
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Marie Riviere
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | | | - William D. Hutson
- Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tejas S. Athni
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Arusha Patil
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Ayse Ercumen
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina, USA
| | - Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, California, USA
| | - Yoshika Crider
- King Center on Global Development, Stanford University, Stanford, California, USA
| | - Andrew Mertens
- Division of Epidemiology and Biostatistics, University of California, Berkeley, Berkeley, California, USA
| | - Leanne Unicomb
- Environmental Health and WASH, Health System and Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | - Mahbubur Rahman
- Environmental Health and WASH, Health System and Population Studies Division, ICDDR,B, Dhaka, Bangladesh
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Benjamin F. Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Jade Benjamin-Chung
- Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA
- Chan Zuckerberg Biohub, San Francisco, California, USA
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Valenzuela X, Hedman H, Villagomez A, Cardenas P, Eisenberg JN, Levy K, Zhang L, Trueba G. Distribution of blaCTX-M-gene variants in E. coli from different origins in Ecuador. MEDICINE IN MICROECOLOGY 2023; 18:100092. [PMID: 38148908 PMCID: PMC10751039 DOI: 10.1016/j.medmic.2023.100092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
The increasing abundance of extended spectrum (β-lactamase (ESBL) genes in E. coli, and other commensal and pathogenic bacteria, endangers the utility of third or more recent generation cephalosporins, which are major tools for fighting deadly infections. The role of domestic animals in the transmission of ESBL carrying bacteria has been recognized, especially in low- and middle-income countries, however the horizontal gene transfer of these genes is difficult to assess. Here we investigate blaCTX-M gene diversity (and flanking nucleotide sequences) in E. coli from chicken and humans, in an Ecuadorian rural community and from chickens in another location in Ecuador. The blaCTX-M associated sequences in isolates from humans and chickens in the same remote community showed greater similarity than those found in E. coli in a chicken industrial operation 200 km away. Our study may provide evidence of blaCTX-M transfer between chickens and humans in the community.
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Affiliation(s)
- Xavier Valenzuela
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
- Facultad de Medicina, Universidad de la Americas (UDLA), Quito, Ecuador
| | - Hayden Hedman
- School for Environment and Sustainability, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Alma Villagomez
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Paul Cardenas
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
| | - Joseph N.S. Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Lixin Zhang
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, 48824, United States
| | - Gabriel Trueba
- Instituto de Microbiología, Colegio de Ciencias Biológicas y Ambientales, Universidad San Francisco de Quito, Quito, Ecuador
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Kikuchi M. Influence of sanitation facilities on diarrhea prevalence among children aged below 5 years in flood-prone areas of Bangladesh: a multilevel analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:97925-97935. [PMID: 37603245 PMCID: PMC10495509 DOI: 10.1007/s11356-023-29373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
Although the improvement of sanitation facilities has been a major contributor to improving public health, it is not guaranteed to prevent negative health outcomes. This is especially true in areas affected by severe natural disasters, such as flooding or extreme rainfall. Previous studies have examined the association between catastrophic natural disasters and negative health outcomes. However, studies on disaster-prone areas are limited. This study focused on the impact of flood risks and examined whether the improvement of sanitation facilities would be sufficient to suppress the prevalence of diarrhea in flood-prone areas. Two secondary datasets including geodata on flood-prone areas were used for the analysis: one each was obtained from the Bangladesh Demographic and Health Survey and Bangladesh Agricultural Research Council. Two models with categorizations of sanitation facilities based on containment type and excreta flow were applied for analysis. Results showed that the severe flood-prone areas and "diffused" type of sanitation, where the feces are diffused without any containment, had significant positive associations with diarrhea prevalence; however, the interaction between them was negative. Moderate flood-prone areas had a significant positive association with diarrhea prevalence; however, the interaction with unimproved sanitation, which includes containment without clear partition from feces, was significantly negative. These findings indicate that improved sanitation or containment type of sanitation may not positively contribute to the prevention of diarrhea in these severe- and moderate-flood prone areas. The urgent need for alternative sanitation technologies should be addressed in flood-prone regions.
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Affiliation(s)
- Michiko Kikuchi
- Graduate School of Frontier Sciences, The University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa City, Chiba Prefecture, 277-8561, Japan.
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6
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Powers JE, Mureithi M, Mboya J, Campolo J, Swarthout JM, Pajka J, Null C, Pickering AJ. Effects of High Temperature and Heavy Precipitation on Drinking Water Quality and Child Hand Contamination Levels in Rural Kenya. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:6975-6988. [PMID: 37071701 PMCID: PMC10157894 DOI: 10.1021/acs.est.2c07284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Climate change may impact human health through the influence of weather on environmental transmission of diarrhea. Previous studies have found that high temperatures and heavy precipitation are associated with increased diarrhea prevalence, but the underlying causal mechanisms have not been tested and validated. We linked measurements of Escherichia coli in source water (n = 1673), stored drinking water (n = 9692), and hand rinses from children <2 years old (n = 2634) with publicly available gridded temperature and precipitation data (at ≤0.2 degree spatial resolution and daily temporal resolution) by the GPS coordinates and date of sample collection. Measurements were collected over a 3-year period across a 2500 km2 area in rural Kenya. In drinking water sources, high 7-day temperature was associated with a 0.16 increase in log10 E. coli levels (p < 0.001, 95% CI: 0.07, 0.24), while heavy 7-day total precipitation was associated with a 0.29 increase in log10 E. coli levels (p < 0.001, 95% CI: 0.13, 0.44). In household stored drinking water, heavy 7-day precipitation was associated with a 0.079 increase in log10 E. coli levels (p = 0.042, 95% CI: 0.07, 0.24). Heavy precipitation did not increase E. coli levels among respondents who treated their water, suggesting that water treatment can mitigate effects on water quality. On child hands, high 7-day temperature was associated with a 0.39 decrease in log10 E. coli levels (p < 0.001, 95% CI: -0.52, -0.27). Our findings provide insight on how climate change could impact environmental transmission of bacterial pathogens in Kenya. We suggest water treatment is especially important after heavy precipitation (particularly when preceded by dry periods) and high temperatures.
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Affiliation(s)
- Julie E Powers
- University of California, Berkeley, Berkeley, California 94704, United States
| | - Maryanne Mureithi
- Innovations for Poverty Action, Sandalwood Lane, Nairobi 00500, Kenya
| | - John Mboya
- Innovations for Poverty Action, Sandalwood Lane, Nairobi 00500, Kenya
| | - Jake Campolo
- Farmers Business Network, San Carlos, California 94070, United States
| | | | - Joseph Pajka
- Tufts University, Medford, Massachusetts 02155, United States
| | - Clair Null
- Mathematica, Washington, D.C. 20002, United States
| | - Amy J Pickering
- University of California, Berkeley, Berkeley, California 94704, United States
- Chan Zuckerberg Biohub, San Francisco, California 94158, United States
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Uttajug A, Ueda K, Seposo X, Francis JM. Association between extreme rainfall and acute respiratory infection among children under-5 years in sub-Saharan Africa: an analysis of Demographic and Health Survey data, 2006-2020. BMJ Open 2023; 13:e071874. [PMID: 37185183 PMCID: PMC10152048 DOI: 10.1136/bmjopen-2023-071874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Despite an increase in the number of studies examining the association between extreme weather events and infectious diseases, evidence on respiratory infection remains scarce. This study examined the association between extreme rainfall and acute respiratory infection (ARI) in children aged <5 years in sub-Saharan Africa. SETTING Study data were taken from recent (2006-2020) Demographic and Health Survey data sets from 33 countries in sub-Saharan Africa. PARTICIPANTS 280 157 children aged below 5 years were included. OUTCOME MEASURES The proportions of ARI according to individual, household and geographical characteristics were compared using the χ2 test. The association between extreme rainfall (≥90th percentile) and ARI was examined using multivariate logistic regression for 10 of 33 countries with an adequate sample size of ARI and extreme rainfall events. The model was adjusted for temperature, comorbidity and sociodemographic factors as covariates. Stratification analyses by climate zone were also performed. RESULTS The prevalence of ARI in children aged <5 years ranged from 1.0% to 9.1% across sub-Saharan Africa. By country, no significant association was observed between extreme rainfall and ARI, except in Nigeria (OR: 2.14, 95% CI 1.06 to 4.31). Larger effect estimates were observed in the tropical zone (OR: 1.13, 95% CI 0.69 to 1.84) than in the arid zone (OR: 0.72, 95% CI 0.17 to 2.95), although the difference was not statistically significant. CONCLUSION We found no association between extreme rainfall and ARI in sub-Saharan Africa. Effect estimates tended to be larger in the tropical zone where intense rainfall events regularly occur. Comprehensive studies to investigate subsequent extreme climate events, such as flooding, are warranted in the future.
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Affiliation(s)
- Athicha Uttajug
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Kayo Ueda
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Xerxes Seposo
- Department of Hygiene, Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Mero S, Lääveri T, Ursing J, Rombo L, Kofoed PE, Kantele A. Seasonal variation of diarrhoeal pathogens among Guinea-Bissauan children under five years of age. PLoS Negl Trop Dis 2023; 17:e0011179. [PMID: 36913409 PMCID: PMC10035853 DOI: 10.1371/journal.pntd.0011179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/23/2023] [Accepted: 02/17/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Diarrhoea remains a major cause of childhood morbidity and mortality in low-income countries (LICs). The frequency of diarrhoeal episodes may vary by season, yet few prospective cohort studies have examined seasonal variation among various diarrhoeal pathogens using multiplex qPCR to analyse bacterial, viral and parasitic pathogens. METHODS We combined our recent qPCR data of diarrhoeal pathogens (nine bacterial, five viral and four parasitic) among Guinea-Bissauan children under five years old with individual background data, dividing by season. The associations of season (dry winter and rainy summer) and the various pathogens were explored among infants (0-11 months) and young children (12-59 months) and those with and without diarrhoea. RESULTS Many bacterial pathogens, especially EAEC, ETEC and Campylobacter, and parasitic Cryptosporidium, prevailed in the rainy season, whereas many viruses, particularly the adenovirus, astrovirus and rotavirus proved common in the dry season. Noroviruses were found constantly throughout the year. Seasonal variation was observed in both age groups. CONCLUSION In childhood diarrhoea in a West African LIC, seasonal variation appears to favour EAEC, ETEC, and Cryptosporidium in the rainy and viral pathogens in the dry season.
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Affiliation(s)
- Sointu Mero
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tinja Lääveri
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Johan Ursing
- Department of Infectious Diseases, Danderyds Hospital, Stockholm, Sweden
- Department of Clinical Science, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Lars Rombo
- Department of Medical Biochemistry and Microbiology, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Sörmland County Council, Eskilstuna, Sweden and Uppsala University, Uppsala, Sweden
| | - Poul-Erik Kofoed
- Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Anu Kantele
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Meilahti Infectious Diseases and Vaccine Research Center, MeiVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Wibawa BSS, Maharani AT, Andhikaputra G, Putri MSA, Iswara AP, Sapkota A, Sharma A, Syafei AD, Wang YC. Effects of Ambient Temperature, Relative Humidity, and Precipitation on Diarrhea Incidence in Surabaya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032313. [PMID: 36767679 PMCID: PMC9916310 DOI: 10.3390/ijerph20032313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Diarrhea remains a common infectious disease caused by various risk factors in developing countries. This study investigated the incidence rate and temporal associations between diarrhea and meteorological determinants in five regions of Surabaya, Indonesia. METHOD Monthly diarrhea records from local governmental health facilities in Surabaya and monthly means of weather variables, including average temperature, precipitation, and relative humidity from Meteorology, Climatology, and Geophysical Agency were collected from January 2018 to September 2020. The generalized additive model was employed to quantify the time lag association between diarrhea risk and extremely low (5th percentile) and high (95th percentile) monthly weather variations in the north, central, west, south, and east regions of Surabaya (lag of 0-2 months). RESULT The average incidence rate for diarrhea was 11.4 per 100,000 during the study period, with a higher incidence during rainy season (November to March) and in East Surabaya. This study showed that the weather condition with the lowest diarrhea risks varied with the region. The diarrhea risks were associated with extremely low and high temperatures, with the highest RR of 5.39 (95% CI 4.61, 6.17) in the east region, with 1 month of lag time following the extreme temperatures. Extremely low relative humidity increased the diarrhea risks in some regions of Surabaya, with the highest risk in the west region at lag 0 (RR = 2.13 (95% CI 1.79, 2.47)). Extremely high precipitation significantly affects the risk of diarrhea in the central region, at 0 months of lag time, with an RR of 3.05 (95% CI 2.09, 4.01). CONCLUSION This study identified a high incidence of diarrhea in the rainy season and in the deficient developed regions of Surabaya, providing evidence that weather magnifies the adverse effects of inadequate environmental sanitation. This study suggests the local environmental and health sectors codevelop a weather-based early warning system and improve local sanitation practices as prevention measures in response to increasing risks of infectious diseases.
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Affiliation(s)
- Bima Sakti Satria Wibawa
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
| | | | - Gerry Andhikaputra
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
| | - Marsha Savira Agatha Putri
- Department of Environmental Health, Faculty of Health Science, Universitas Islam Lamongan, Lamongan 62211, Indonesia
| | - Aditya Prana Iswara
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
- Department of Civil Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
| | - Amir Sapkota
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, Maryland, MD 20742, USA
| | - Ayushi Sharma
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
- Department of Civil Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
| | - Arie Dipareza Syafei
- Department of Environmental Engineering, Institut Teknologi Sepuluh Nopember, Surabaya 60111, Indonesia
| | - Yu-Chun Wang
- Department of Environmental Engineering, College of Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Zhongli, Taoyuan City 320314, Taiwan
- Research Center for Environmental Changes, Academia Sinica, 128 Academia Road, Section 2, Nankang, Taipei 11529, Taiwan
- Correspondence:
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Chen NT, Chen YC, Wu CD, Chen MJ, Guo YL. The impact of heavy precipitation and its impact modifiers on shigellosis occurrence during typhoon season in Taiwan: A case-crossover design. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 848:157520. [PMID: 35882342 DOI: 10.1016/j.scitotenv.2022.157520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
Because of climate change, heavy precipitation is likely to become frequent and intense, thereby increasing the risk of shigellosis occurrence. However, few studies examined the impact of heavy precipitation on shigellosis and its impact modifiers in developed countries. This study aims to analyze the association between heavy precipitation and shigellosis in Taiwan, and to identify the vulnerable population and impact modifiers. We adopted a case-crossover design, and used conditional logistic regression to estimate odds ratios (ORs) for shigellosis occurrence. Information were collected on the daily shigellosis cases, precipitation, temperature, and typhoons from 1994 to 2015, and yearly data of medical resources and environmental factors were obtained at the city level from 1998 to 2015. Stratification analyses were performed by age, sex, medical resource, and environmental factors. We discovered that heavy precipitation ≥80 mm/day considerably increased the risk of shigellosis occurrence. The ORs of heavy rain (80 to <200 mm/day) were 2.08-2.26 at lags 0-1. The ORs of extremely heavy rain (≥200 mm/day) increased to 2.17-4.73 at lags 5-8. Moreover, the effect of heavy precipitation was greater under high temperature condition (≥23.6 °C). Adults were more susceptible to heavy-precipitation-associated shigellosis, especially the elderly. Males experienced marginally higher effects than females did. Moreover, cities with more medical resources and forest cover and higher percentage of completed storm sewers had lower effects; however, dense population and higher pig density were the risk factors. Although the high water-supply penetration rate did not decrease Shigella infection after heavy precipitation, it did lower the risk of typhoon-related shigellosis. In conclusion, hot temperature could enhance the impact of heavy precipitation on shigellosis. Public health interventions should be introduced according to the lag period after heavy precipitation, particularly in areas with high population density, proportion of elderly people, and pig density. The improvement of medical resources and tree cover as well as the construction of storm sewers and piped water systems might be mitigation measures that can be considered.
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Affiliation(s)
- Nai-Tzu Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli 35053, Taiwan; Research Center of Environmental Trace Toxic Substances, National Cheng Kung University, Tainan 704302, Taiwan
| | - Yu-Cheng Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli 35053, Taiwan; Department of Occupational Safety and Health, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan
| | - Chih-Da Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli 35053, Taiwan; Department of Geomatics, National Cheng Kung University, Tainan 70101, Taiwan
| | - Mu-Jean Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli 35053, Taiwan
| | - Yue-Liang Guo
- National Institute of Environmental Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Town, Miaoli 35053, Taiwan; Department of Environmental and Occupational Medicine, College of Medicine, National Taiwan University (NTU) and NTU Hospital, Taipei 10051, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.
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Epidemiology and pre-vaccine burden of rotavirus diarrhea in Democratic Republic of Congo (DRC): Results of sentinel surveillance, 2009-2019. Vaccine 2022; 40:5933-5941. [PMID: 36068112 DOI: 10.1016/j.vaccine.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Since August 2009, the Democratic Republic of Congo (DRC) has implemented sentinel site surveillance for rotavirus gastroenteritis. Limited hospital studies have been carried out, in DRC, describing the epidemiology of rotavirus diarrhea before rotavirus vaccine introduction in October 2019. This analysis describes the epidemiology of rotavirus gastroenteritis and characteristics of circulating viral strains from 2009 to 2019. MATERIALS AND METHODS We analyzed demographic and clinic data collected from children < 5 years old enrolled at three rotavirus sentinel surveillance sites in DRC during 2009-2019, prior to rotavirus vaccine introduction in 2019. Data have been described and presented as mean ± standard deviation for quantitative variables with normal distribution, or as median with an interquartile range [Q1-Q3] for quantitative variables with non-normal distribution, or as absolute value with percentage for qualitative variables. RESULTS Between August 2009 and December 2019, 4,928 children < 5 years old were admitted to sentinel surveillance sites for gastroenteritis in the DRC; the rotavirus positivity rate was 60 %. There was a slight male gender predominance (56 %), and the majority of children (79 %) were 0-11 months of age. Every year, the incidence was highest between May and September corresponding to the dry and cool season. Genotyping was performed for 50 % of confirmed rotavirus cases. The most common G genotypes were G1 (39 %) and G2 (24 %) and most common P genotypes were P[6] (49 %) and P[8] (37 %). The most common G-P genotype combinations were G1P[8] (22 %), G2P[6] (16 %) and G1P[6] (14 %). Genotype distribution varied by site, age group, and year. CONCLUSION From 2009 to 2019, rotavirus-associated gastroenteritis represented a significant burden among DRC children under 5 who were admitted to sentinel sites. G1P[8] was the most commonly identified genotype. Continued monitoring after the introduction of rotavirus vaccine will be essential to monitor any changes in epidemiology.
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Grau-Pujol B, Cano J, Marti-Soler H, Casellas A, Giorgi E, Nhacolo A, Saute F, Giné R, Quintó L, Sacoor C, Muñoz J. Neighbors' use of water and sanitation facilities can affect children's health: a cohort study in Mozambique using a spatial approach. BMC Public Health 2022; 22:983. [PMID: 35578273 PMCID: PMC9109333 DOI: 10.1186/s12889-022-13373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 05/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Impact evaluation of most water, sanitation and hygiene (WASH) interventions in health are user-centered. However, recent research discussed WASH herd protection - community WASH coverage could protect neighboring households. We evaluated the effect of water and sanitation used in the household and by household neighbors in children's morbidity and mortality using recorded health data. METHODS We conducted a retrospective cohort including 61,333 children from a district in Mozambique during 2012-2015. We obtained water and sanitation household data and morbidity data from Manhiça Health Research Centre surveillance system. To evaluate herd protection, we estimated the density of household neighbors with improved facilities using a Kernel Density Estimator. We fitted negative binomial adjusted regression models to assess the minimum children-based incidence rates for every morbidity indicator, and Cox regression models for mortality. RESULTS Household use of unimproved water and sanitation displayed a higher rate of outpatient visit, diarrhea, malaria, and anemia. Households with unimproved water and sanitation surrounded by neighbors with improved water and sanitation high coverage were associated with a lower rate of outpatient visit, malaria, anemia, and malnutrition. CONCLUSION Household and neighbors' access to improve water and sanitation can affect children's health. Accounting for household WASH and herd protection in interventions' evaluation could foster stakeholders' investment and improve WASH related diseases control. Distribution of main water and sanitation facilities used during study period.
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Affiliation(s)
- Berta Grau-Pujol
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique ,Mundo Sano Foundation, Buenos Aires, Argentina
| | - Jorge Cano
- grid.463718.f0000 0004 0639 2906Expanded Special Project for Elimination of NTDs, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Helena Marti-Soler
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain
| | - Aina Casellas
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.5841.80000 0004 1937 0247Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona (UB), Casanova 143, 08036 Barcelona, Spain
| | - Emanuele Giorgi
- grid.9835.70000 0000 8190 6402Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YW UK
| | - Ariel Nhacolo
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Francisco Saute
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ricard Giné
- grid.454010.40000 0001 1009 1661Stockholm International Water Institute, Stockholm, Sweden
| | - Llorenç Quintó
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain ,grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Charfudin Sacoor
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Jose Muñoz
- grid.410458.c0000 0000 9635 9413Barcelona Institute for Global Health, Hospital Clínic - Universitat de Barcelona, C/Rosselló 132 4°1ª, 08036 Barcelona, Spain
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Kemajou DN. Climate variability, water supply, sanitation and diarrhea among children under five in Sub-Saharan Africa: a multilevel analysis. JOURNAL OF WATER AND HEALTH 2022; 20:589-600. [PMID: 35482376 DOI: 10.2166/wh.2022.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Climate variability is expected to increase the risk of diarrhea diseases, a leading cause of child mortality and morbidity in Sub-Saharan Africa (SSA). The risk of diarrhea is more acute when populations have poor access to improved water and sanitation. This study seeks to determine individual and joint effects of climate variation, water supply and sanitation on the occurrence of diarrhea among children under five in SSA using multilevel mixed-effect Poisson regression including cross-level interaction. We merged 57 Demographic and Health Surveys (DHS) from 25 SSA countries covering the period 2000-2019 with climatic data from the DHS geolocation databases. The results of the research indicate that 77.7% of the variation in the occurrence of diarrhea in Sub-Saharan households is due to climatic differences between clusters. Also, a household residing in a cluster with a high incidence of diarrhea is 1.567 times more likely to have diarrhea cases than a household from a cluster with a low incidence. In addition, when average temperature and rainfall increase, households using unimproved sanitation or unimproved water have more cases of diarrhea. For SSA, the results of the multilevel analysis suggest the adoption at both levels; macro (national) and micro (household), of climate change adaption measures in the water sector to reduce the prevalence of diarrhea.
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Dimitrova A, McElroy S, Levy M, Gershunov A, Benmarhnia T. Precipitation variability and risk of infectious disease in children under 5 years for 32 countries: a global analysis using Demographic and Health Survey data. Lancet Planet Health 2022; 6:e147-e155. [PMID: 35150623 DOI: 10.1016/s2542-5196(21)00325-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 11/04/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Precipitation variability is a potentially important driver of infectious diseases that are leading causes of child morbidity and mortality worldwide. Disentangling the links between precipitation variability and disease risk is crucial in a changing climate. We aimed to investigate the links between precipitation variability and reported symptoms of infectious disease (cough, fever, and diarrhoea) in children younger than 5 years. METHODS We used nationally representative survey data collected between 2014 and 2019 from Demographic and Health Survey (DHS) surveys for 32 low-income to middle-income countries in combination with high-resolution precipitation data (via the Climate Hazards Group InfraRed Precipitation with Station dataset). We only included DHS data for which interview dates and GPS coordinates (latitude and longitude) of household clusters were available. We used a regression modelling approach to assess the relationship between different precipitation variability measures and infectious disease symptoms (cough, fever, and diarrhoea), and explored the effect modification of different climate zones and disease susceptibility factors. FINDINGS Our global analysis showed that anomalously wet conditions increase the risk of cough, fever, and diarrhoea symptoms in humid, subtropical regions. These health risks also increased in tropical savanna regions as a result of anomalously dry conditions. Our analysis of susceptibility factors suggests that unimproved sanitation and unsafe drinking water sources are exacerbating these effects, particularly for rural populations and in drought-prone areas in tropical savanna. INTERPRETATION Weather shifts can affect the survival and transmission of pathogens that are particularly harmful to young children. As our findings show, the health burden of climate-sensitive infectious diseases can be substantial and is likely to fall on populations that are already among the most disadvantaged, including households living in remote rural areas and those lacking access to safe water and sanitation infrastructure. FUNDING University of California, San Diego FY19 Center Launch programme.
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Affiliation(s)
- Anna Dimitrova
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA.
| | - Sara McElroy
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA; School of Public Health, San Diego State University, San Diego, CA, USA
| | - Morgan Levy
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA; School of Global Policy and Strategy, University of California, San Diego, CA, USA
| | - Alexander Gershunov
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
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Amato HK, Hemlock C, Andrejko KL, Smith AR, Hejazi NS, Hubbard AE, Verma SC, Adhikari RK, Pokhrel D, Smith K, Graham JP, Pokhrel A. Biodigester Cookstove Interventions and Child Diarrhea in Semirural Nepal: A Causal Analysis of Daily Observations. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:17002. [PMID: 34985305 PMCID: PMC8729225 DOI: 10.1289/ehp9468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 11/02/2021] [Accepted: 12/02/2021] [Indexed: 05/08/2023]
Abstract
BACKGROUND Hundreds of thousands of biodigesters have been constructed in Nepal. These household-level systems use human and animal waste to produce clean-burning biogas used for cooking, which can reduce household air pollution from woodburning cookstoves and prevent respiratory illnesses. The biodigesters, typically operated by female caregivers, require the handling of animal waste, which may increase domestic fecal contamination, exposure to diarrheal pathogens, and the risk of enteric infections, especially among young children. OBJECTIVE We estimated the effect of daily reported biogas cookstove use on incident diarrhea among children < 5 y old in the Kavrepalanchok District of Nepal. Secondarily, we assessed effect measure modification and statistical interaction of individual- and household-level covariates (child sex, child age, birth order, exclusive breastfeeding, proof of vaccination, roof type, sanitation, drinking water treatment, food insecurity) as well as recent 14-d acute lower respiratory infection (ALRI) and season. METHODS We analyzed 300,133 person-days for 539 children in an observational prospective cohort study to estimate the average effect of biogas stove use on incident diarrhea using cross-validated targeted maximum likelihood estimation (CV-TMLE). RESULTS Households reported using biogas cookstoves in the past 3 d for 23% of observed person-days. The adjusted relative risk of diarrhea for children exposed to biogas cookstove use was 1.31 (95% confidence interval (CI): 1.00, 1.71) compared to unexposed children. The estimated effect of biogas stove use on diarrhea was stronger among breastfed children (2.09; 95% CI: 1.35, 3.25) than for nonbreastfed children and stronger during the dry season (2.03; 95% CI: 1.17, 3.53) than in the wet season. Among children exposed to biogas cookstove use, those with a recent ALRI had the highest mean risk of diarrhea, estimated at 4.53 events (95% CI: 1.03, 8.04) per 1,000 person-days. DISCUSSION This analysis provides new evidence that child diarrhea may be an unintended health risk of biogas cookstove use. Additional studies are needed to identify exposure pathways of fecal pathogen contamination associated with biodigesters to improve the safety of these widely distributed public health interventions. https://doi.org/10.1289/EHP9468.
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Affiliation(s)
- Heather K. Amato
- Division of Environmental Health Sciences, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Caitlin Hemlock
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Kristin L. Andrejko
- Division of Epidemiology, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Anna R. Smith
- Division of Environmental Health Sciences, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Nima S. Hejazi
- Division of Biostatistics, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Alan E. Hubbard
- Division of Biostatistics, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | | | - Ramesh K. Adhikari
- Tribhuvan University, Institute of Medicine, Maharajgunj Medical Campus, Kathmandu, Nepal
| | - Dhiraj Pokhrel
- Society for Legal and Environmental Analysis and Development Research (LEADERS), Nepal
| | - Kirk Smith
- Division of Environmental Health Sciences, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Jay P. Graham
- Division of Environmental Health Sciences, University of California, Berkeley School of Public Health, Berkeley, California, USA
| | - Amod Pokhrel
- Division of Environmental Health Sciences, University of California, Berkeley School of Public Health, Berkeley, California, USA
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Boo YY, Rai K, Cupp MA, Lakhanpaul M, Factor-Litvak P, Parikh P, Panda R, Manikam L. What are the determinants of childhood infections in India's peri-urban slums? A case study of eight cities. PLoS One 2021; 16:e0257797. [PMID: 34653203 PMCID: PMC8519422 DOI: 10.1371/journal.pone.0257797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Respiratory Tract Infections (RTIs) and Gastro-Intestinal (GI) infections are the leading causes of child mortality and morbidity. This study investigates the associations between the individual, household and slum-level determinants of children's health and vulnerability to RTIs and GI infections in peri-urban slums in India; an area of research interest at the Childhood Infections and Pollution Consortium. METHODS The 2015-16 Indian National Family Health Survey was used for data analysis on children aged 0-5 years. NFHS-4 includes data on slums in eight Indian cities, including Delhi, Meerut, Kolkata, Indore, Mumbai, Nagpur, Hyderabad, Chennai. The outcome variables, having fever and cough (FeCo) and diarrhoea in the last two weeks, were used to define the phenotype of infections; for this analysis fever and cough were measures of RTIs and diarrhoea was used to measure GI infections. Exposures considered in this study include variables at the individual, household and slum level and were all informed by existing literature. Multilevel models were used to estimate the association between exposures and outcomes variables; a prior of Cauchy distribution with a scale of 2.5 was selected when building the multilevel logistic models. RESULTS The total sample size of the number of children included in the analysis was n = 1,424. Data was imputed to account for missingness, and the original and imputed sample showing similar distributions. Results showed that diarrhoea and FeCo were both found to be more present in younger children than older children by a few months. In fixed effects, the odds of developing FeCo were higher if the mother perceives the child was born smaller than average (AOR 4.41, 1.13-17.17, P<0.05) at individual level. On the other hand, the odds of the diarrhoea outcome were lower if the child was older (AOR 0.97, 0.96-0.98, P<0.05) at individual level, and household's water source was public tap or standpipe (AOR 0.54, 0.31-0.96, P<0.05) at household level. CONCLUSION The determinants of health, both social and related to health care, at all levels demonstrated linkages to child morbidity in RTIs and GI infections. The empirical evidence highlights the need for contextualised ideas at each level, including one health approach when designing interventions to improve child health.
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Affiliation(s)
- Yebeen Ysabelle Boo
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kritika Rai
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
| | - Meghan A. Cupp
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Whittington Health NHS Trust, London, United Kingdom
| | - Pam Factor-Litvak
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Priti Parikh
- Engineering for International Development Centre, Bartlett School of Construction and Project Management, Faculty of Built Environment, University College London, London, United Kingdom
| | | | - Logan Manikam
- Aceso Global Health Consultants PTE Ltd., Singapore, Singapore
- Department of Epidemiology and Public Health, University College London Institute of Epidemiology and Health Care, London, United Kingdom
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Graham JP, Amato H, Mendizabal-Cabrera R, Alvarez D, Ramay B. Waterborne Urinary Tract Infections: Have We Overlooked an Important Source of Exposure? Am J Trop Med Hyg 2021; 105:12-17. [PMID: 33939640 DOI: 10.4269/ajtmh.20-1271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/16/2021] [Indexed: 11/07/2022] Open
Abstract
The presence of intestinal pathogenic Escherichia coli in drinking water is well recognized as a risk for diarrhea. The role of drinking water in extraintestinal infections caused by E. coli-such as urinary tract infections (UTIs)-remains poorly understood. Urinary tract infections are a leading cause of outpatient infections globally, with a lifetime incidence of 50-60% in adult women. We reviewed the scientific literature on the occurrence of uropathogenic E. coli (UPEC) in water supplies to determine whether the waterborne route may be an important, overlooked, source of UPEC. A limited number of studies have assessed whether UPEC isolates are present in drinking water supplies, but no studies have measured whether their presence in water may increase UPEC colonization or the risk of UTIs in humans. Given the prevalence of drinking water supplies contaminated with E. coli across the globe, efforts should be made to characterize UTI-related risks associated with drinking water, as well as other pathways of exposure.
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Affiliation(s)
- Jay P Graham
- 1Berkeley School of Public Health, University of California Berkeley, Berkeley, California
| | - Heather Amato
- 2Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | - Danilo Alvarez
- 2Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Brooke Ramay
- 2Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.,3Paul G. Allen School for Global Animal Health, Washington State University Pullman, Guatemala City, Guatemala
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Kraay ANM, Ionides EL, Lee GO, Trujillo WFC, Eisenberg JNS. Effect of childhood rotavirus vaccination on community rotavirus prevalence in rural Ecuador, 2008-13. Int J Epidemiol 2021; 49:1691-1701. [PMID: 32844206 DOI: 10.1093/ije/dyaa124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although live attenuated monovalent human rotavirus vaccine (Rotarix) efficacy has been characterized through randomized studies, its effectiveness, especially in non-clinical settings, is less clear. In this study, we estimate the impact of childhood Rotarix® vaccination on community rotavirus prevalence. METHODS We analyse 10 years of serial population-based diarrhoea case-control study, which also included testing for rotavirus infection (n = 3430), and 29 months of all-cause diarrhoea active surveillance from a child cohort (n = 376) from rural Ecuador during a period in which Rotarix vaccination was introduced. We use weighted logistic regression from the case-control data to assess changes in community rotavirus prevalence (both symptomatic and asymptomatic) and all-cause diarrhoea after the vaccine was introduced. We also assess changes in all-cause diarrhoea rates in the child cohort (born 2008-13) using Cox regression, comparing time to first all-cause diarrhoea case by vaccine status. RESULTS Overall, vaccine introduction among age-eligible children was associated with a 82.9% reduction [95% confidence interval (CI): 49.4%, 94.2%] in prevalence of rotavirus in participants without diarrhoea symptoms and a 46.0% reduction (95% CI: 6.2%, 68.9%) in prevalence of rotavirus infection among participants experiencing diarrhoea. Whereas all age groups benefited, this reduction was strongest among the youngest age groups. For young children, prevalence of symptomatic diarrhoea also decreased in the post-vaccine period in both the case-control study (reduction in prevalence for children <1 year of age = 69.3%, 95% CI: 8.7%, 89.7%) and the cohort study (reduction in hazard for receipt of two Rotarix doses among children aged 0.5-2 years = 57.1%, 95% CI: 16.6, 77.9%). CONCLUSIONS Rotarix vaccination may suppress transmission, including asymptomatic transmission, in low- and middle-income settings. It was highly effective among children in a rural community setting and provides population-level benefits through indirect protection among adults.
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Affiliation(s)
- Alicia N M Kraay
- Department of Epidemiology, University of Michigan-Ann Arbor, Ann Arbor, MI, USA
| | - Edward L Ionides
- Department of Statistics, University of Michigan-Ann Arbor, Ann Arbor, MI, USA
| | - Gwenyth O Lee
- Department of Epidemiology, University of Michigan-Ann Arbor, Ann Arbor, MI, USA
| | | | - Joseph N S Eisenberg
- Department of Epidemiology, University of Michigan-Ann Arbor, Ann Arbor, MI, USA
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Kraay ANM, Man O, Levy MC, Levy K, Ionides E, Eisenberg JNS. Understanding the Impact of Rainfall on Diarrhea: Testing the Concentration-Dilution Hypothesis Using a Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:126001. [PMID: 33284047 PMCID: PMC7720804 DOI: 10.1289/ehp6181] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Projected increases in extreme weather may change relationships between rain-related climate exposures and diarrheal disease. Whether rainfall increases or decreases diarrhea rates is unclear based on prior literature. The concentration-dilution hypothesis suggests that these conflicting results are explained by the background level of rain: Rainfall following dry periods can flush pathogens into surface water, increasing diarrhea incidence, whereas rainfall following wet periods can dilute pathogen concentrations in surface water, thereby decreasing diarrhea incidence. OBJECTIVES In this analysis, we explored the extent to which the concentration-dilution hypothesis is supported by published literature. METHODS To this end, we conducted a systematic search for articles assessing the relationship between rain, extreme rain, flood, drought, and season (rainy vs. dry) and diarrheal illness. RESULTS A total of 111 articles met our inclusion criteria. Overall, the literature largely supports the concentration-dilution hypothesis. In particular, extreme rain was associated with increased diarrhea when it followed a dry period [incidence rate ratio ( IRR ) = 1.26 ; 95% confidence interval (CI): 1.05, 1.51], with a tendency toward an inverse association for extreme rain following wet periods, albeit nonsignificant, with one of four relevant studies showing a significant inverse association (IRR = 0.911 ; 95% CI: 0.771, 1.08). Incidences of bacterial and parasitic diarrhea were more common during rainy seasons, providing pathogen-specific support for a concentration mechanism, but rotavirus diarrhea showed the opposite association. Information on timing of cases within the rainy season (e.g., early vs. late) was lacking, limiting further analysis. We did not find a linear association between nonextreme rain exposures and diarrheal disease, but several studies found a nonlinear association with low and high rain both being associated with diarrhea. DISCUSSION Our meta-analysis suggests that the effect of rainfall depends on the antecedent conditions. Future studies should use standard, clearly defined exposure variables to strengthen understanding of the relationship between rainfall and diarrheal illness. https://doi.org/10.1289/EHP6181.
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Affiliation(s)
- Alicia N. M. Kraay
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Olivia Man
- Department of Epidemiology, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
| | - Morgan C. Levy
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
- School of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA
| | - Karen Levy
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Edward Ionides
- Department of Epidemiology, University of Michigan–Ann Arbor, Ann Arbor, Michigan, USA
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Are There Seasonal Variations in Faecal Contamination of Exposure Pathways? An Assessment in a Low-Income Settlement in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176355. [PMID: 32882804 PMCID: PMC7503969 DOI: 10.3390/ijerph17176355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
Sanitation infrastructure are not able to cope with the increasing population in low-income countries, which leaves populations exposed to faecal contamination from multiple pathways. This study evaluated public health risk (using SaniPath) in a low-income community during the dry season, to identify the dominant exposure pathways, and compare this data to existing data for the rainy season, questioning the assumption that risk of faecal contamination is higher in the rainy season. SaniPath was used to collect and assess exposure and environmental data, and to generate risk profiles for each pathway. In the dry season the highest exposure frequency was for bathing and street food, exposure frequency generally increased, and seasonal variation was found in five pathways. The highest hazards in the dry season were through contact with drains, soil, and street food. Seasonal variation was found in the contamination of open drains and street food, with higher levels of Escherichia coli (E. coli) in the dry season. Open drains were identified as the most dominant risk pathway in both seasons, but risk was higher in the dry season. This highlights the complex nature of seasonal variation of faecal risk, and questions the assumption that risk is higher in the rainy season.
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Omiat G, Shively G. Rainfall and child weight in Uganda. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100877. [PMID: 32470782 DOI: 10.1016/j.ehb.2020.100877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/01/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
We combine data from the 2006 and 2011 Uganda Demographic and Health Surveys (UDHS) with rainfall data and two waves of the Ugandan National Household Survey (UNHS) to study patterns in child weight, as measured by weight-for-height z scores (WHZ), among 3492 rural children below age 5 in Uganda. We focus on rainfall as a nutrition driver along agriculture and disease pathways. We find a positive and significant association between crop yield and WHZ, but the magnitude of this association diminishes as we control for covariates, especially the use of productivity-enhancing agricultural inputs. We find diarrheal disease to have a negative and significant association with WHZ, and modifying effects of social and environmental factors along the disease pathway. Contemporaneous rainfall is associated with a lower likelihood of diarrheal disease in areas with excess rainfall and a higher likelihood of diarrheal disease in rainfall deficit areas. Our findings reinforce calls for targeted and situation-sensitive policies to promote child nutrition.
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Affiliation(s)
- George Omiat
- Department of Agribusiness and Natural Resource Economics, Makerere University, Kampala, Uganda
| | - Gerald Shively
- Department of Agricultural Economics, Purdue University, West Lafayette, IN, USA.
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22
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Rego R, Watson S, Ishengoma P, Langat P, Otieno HP, Lilford R. Effectiveness of SMS messaging for diarrhoea measurement: a factorial cross-over randomised controlled trial. BMC Med Res Methodol 2020; 20:174. [PMID: 32605536 PMCID: PMC7325153 DOI: 10.1186/s12874-020-01062-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Text messaging systems are used to collect data on symptom prevalence. Using a text messaging system, we evaluated the effects of question load, question frequency, and financial incentive on response rates and reported infant diarrhoea rates in an infant diarrhoea survey. METHODS We performed a factorial cross-over randomised controlled trial of an SMS surveying system for infant diarrhoea surveillance with treatments: financial incentive (yes/no), question load (1-question/3-question), and questioning frequency (daily/fortnightly). Participants progressed through all treatment combinations over eight two-week rounds. Data were analysed using multivariable logistic regressions to determine the impacts of the treatments on the response rates and reported diarrhoea rates. Attitudes were explored through qualitative interviews. RESULTS For the 141 participants, the mean response rate was 47%. In terms of percentage point differences (ppd), daily questioning was associated with a lower response rate than fortnightly (- 1·2[95%CI:-4·9,2·5]); high (3-question) question loads were associated with a lower response rate than low (1-question) question loads (- 7·0[95%CI:- 10·8,-3·1]); and financial incentivisation was associated with a higher response rate than no financial incentivisation (6·4[95%CI:2·6,10·2]). The mean two-week diarrhoea rate was 36·4%. Daily questioning was associated with a higher reported diarrhoea rate than fortnightly (29·9[95%CI:22·8,36·9]); with little evidence for impact by incentivisation or question load. CONCLUSIONS Close to half of all participants responded to the SMS survey. Daily questioning evoked a statistically higher rate of reported diarrhoea, while financial incentivisation and low (1-question) question loads evoked higher response rates than no incentive and high (3-question) question loads respectively. TRIAL REGISTRATION The protocol was prospectively registered on ISRCTN on the 20th of March 2019 under number ISRCTN11410773 .
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Affiliation(s)
- Ryan Rego
- Warwick International Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, UK. .,Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Samuel Watson
- Warwick International Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, UK.,Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Philemon Langat
- The United Nations Human Settlement Program, Nairobi, Kenya.,Brooklyn Economic Consulting, Nairobi, Kenya
| | | | - Richard Lilford
- Warwick International Centre for Applied Health Research and Delivery, Warwick Medical School, University of Warwick, Coventry, UK.,Institute for Applied Health Research, University of Birmingham, Birmingham, UK
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Epstein A, Benmarhnia T, Weiser SD. Drought and Illness among Young Children in Uganda, 2009-2012. Am J Trop Med Hyg 2020; 102:644-648. [PMID: 31933457 DOI: 10.4269/ajtmh.19-0412] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Changing precipitation patterns resulting from climate change are likely to have deleterious effects on health. We examined historical relationships between precipitation and diarrhea, cough, and fever among children aged 0-24 months in Uganda, a drought-prone region. Using data from the Uganda National Panel Survey from 2009 to 2012 (2,324 observations), we specified logistic regression models evaluating the relationships between deviations from annual and 30-day precipitation and caregiver-reported diarrhea, cough, and fever, adjusting for sociodemographic characteristics and including enumeration of area-fixed effects. Nonlinearities were assessed using restricted cubic splines. We observed nonlinear (J-shaped) relationships between deviations from annual precipitation and the three child illness outcomes. These J-shaped relationships represented steep reductions in illness with increasing precipitation at lower levels of rainfall and a leveling off at higher levels, with a small increase at higher levels. We did not find evidence for a relationship between 30-day precipitation and childhood illness. Trends of reduced rainfall in Uganda are likely having negative effects on child health.
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Affiliation(s)
- Adrienne Epstein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Anwar MY, Warren JL, Pitzer VE. Diarrhea Patterns and Climate: A Spatiotemporal Bayesian Hierarchical Analysis of Diarrheal Disease in Afghanistan. Am J Trop Med Hyg 2020; 101:525-533. [PMID: 31392940 DOI: 10.4269/ajtmh.18-0735] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Subject to a high burden of diarrheal diseases, Afghanistan is also susceptible to climate change. This study investigated the spatiotemporal distribution of diarrheal disease in the country and how associated it is with climate variables. Using monthly aggregated new cases of acute diarrhea reported between 2010 and 2016 and monthly averaged climate data at the district level, we fitted a hierarchical Bayesian spatiotemporal statistical model. We found aridity and mean daily temperature were positively associated with diarrhea incidence; every 1°C increase in mean daily temperature and 0.01-unit change in the aridity index were associated with a 0.70% (CI: 0.67%, 0.73%) increase and a 4.79% (CI: 4.30%, 5.26%) increase in the risk of diarrhea, respectively. Average annual temperature, on the other hand, was negatively associated, with a 3.7% (CI: 3.74%, 3.68) decrease in risk for every degree Celsius increase in annual average temperature. Temporally, most districts exhibited similar seasonal trends, with incidence peaking in summer, except for the eastern region where differences in climate patterns and population density may be associated with high rates of diarrhea throughout the year. The results from this study highlight the significant role of climate in shaping diarrheal patterns in Afghanistan, allowing policymakers to account for potential impacts of climate change in their public health assessments.
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Affiliation(s)
- Mohammad Y Anwar
- Department of Epidemiology, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Aguiar KCGD, Cohen SC, Maciel EMGDS, Kligerman DC. Fatores de risco para ocorrência de diarreia em crianças residentes na Ilha de Guaratiba (RJ). SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Este artigo visou analisar a ocorrência de diarreia aguda em crianças menores de 5 anos assistidas pela Estratégia Saúde da Família de Ilha de Guaratiba, e as condições habitacionais e de saneamento da localidade. Foi realizado um estudo epidemiológico transversal. A análise das variáveis foi feita por meio de regressão logística simples e múltipla. As variáveis que apresentaram associação com a diarreia foram: (a) criança de idade <2,5 anos; frequentar creche/escola e renda familiar <um salário mínimo; (b) presença de filtro de água e tratamento domiciliar da água; (c) presença de inundações, esgoto a céu aberto, transbordamento de fossa e lixo a céu aberto. No modelo de regressão logística, foram considerados dois cenários epidemiológicos, com e sem inundações. No primeiro cenário, as variáveis que mantiveram associação estatisticamente significante com o desfecho foram: tratamento domiciliar da água, esgoto a céu aberto e presença de inundações. No segundo cenário, encontrou-se evidência de associação também da variável frequência a creche/escola. Portanto, este artigo ressalta a importância de políticas públicas, programas e ações com vistas à ampliação do saneamento básico, ao planejamento de ações de saúde pública e à garantia do acesso à educação infantil.
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Contreras JD, Eisenberg JN. Does Basic Sanitation Prevent Diarrhea? Contextualizing Recent Intervention Trials through a Historical Lens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E230. [PMID: 31905628 PMCID: PMC6981821 DOI: 10.3390/ijerph17010230] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 12/14/2022]
Abstract
Three of four recent major sanitation intervention trials found no effect on diarrhea. These results conflicted with longstanding beliefs from decades of literature. To understand this discordance, we placed recent trials into the historical context that preceded them in two ways. First, we evaluated the history of published literature reviews on sanitation and diarrhea. Second, we conducted meta-analyses on studies from the most recent systematic review to uncover features that predict effectiveness. We found that 13 literature reviews dating to 1983 consistently estimated a significant protective effect of sanitation against diarrhea. However, these were marred by flawed studies and inappropriately averaged effects across widely heterogeneous interventions and contexts. Our meta-analyses highlight that the overall effect of sanitation on diarrhea was largely driven by sewerage and interventions that improved more than sanitation alone. There is no true overall effect of sanitation because variability between intervention types and implementation contexts is too complex to average. Ultimately, the null effects of recent latrine interventions are not surprising. Instead, the one trial that found a strong relative reduction in diarrhea is the historical outlier. The development of transformative sanitation interventions requires a better understanding of the social and environmental contexts that determine intervention effectiveness.
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Hyun C, Burt Z, Crider Y, Nelson KL, Sharada Prasad CS, Rayasam SDG, Tarpeh W, Ray I. Sanitation for Low-Income Regions: A Cross-Disciplinary Review. ANNUAL REVIEW OF ENVIRONMENT AND RESOURCES 2019; 44:287-318. [PMID: 32587484 PMCID: PMC7316187 DOI: 10.1146/annurev-environ-101718-033327] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Sanitation research focuses primarily on containing human waste and preventing disease; thus, it has traditionally been dominated by the fields of environmental engineering and public health. Over the past 20 years, however, the field has grown broader in scope and deeper in complexity, spanning diverse disciplinary perspectives. In this article, we review the current literature in the range of disciplines engaged with sanitation research in low- and middle-income countries (LMICs). We find that perspectives on what sanitation is, and what sanitation policy should prioritize, vary widely. We show how these diverse perspectives augment the conventional sanitation service chain, a framework describing the flow of waste from capture to disposal. We review how these perspectives can inform progress toward equitable sanitation for all [i.e., Sustainable Development Goal (SDG) 6]. Our key message is that both material and nonmaterial flows-and both technological and social functions-make up a sanitation "system." The components of the sanitation service chain are embedded within the flows of finance, decision making, and labor that make material flows of waste possible. The functions of capture, storage, transport, treatment, reuse, and disposal are interlinked with those of ensuring equity and affordability. We find that a multilayered understanding of sanitation, with contributions from multiple disciplines, is necessary to facilitate inclusive and robust research toward the goal of sanitation for all.
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Affiliation(s)
- Christopher Hyun
- Energy and Resources Group, University of California, Berkeley, California 94720, USA
| | - Zachary Burt
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Yoshika Crider
- Energy and Resources Group, University of California, Berkeley, California 94720, USA
| | - Kara L Nelson
- Department of Civil and Environmental Engineering, College of Engineering, University of California, Berkeley, California 94720, USA
| | - C S Sharada Prasad
- School of Development, Azim Premji University, Bengaluru, Karnataka 560100, India
| | | | - William Tarpeh
- Chemical Engineering, Stanford University, Stanford, California 94305, USA
| | - Isha Ray
- Energy and Resources Group, University of California, Berkeley, California 94720, USA
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Cherng ST, Cangemi I, Trostle JA, Remais J, Eisenberg JNS. Social cohesion and passive adaptation in relation to climate change and disease. GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2019; 58:101960. [PMID: 32863604 PMCID: PMC7448570 DOI: 10.1016/j.gloenvcha.2019.101960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Climate change affects biophysical processes related to the transmission of many infectious diseases, with potentially adverse consequences for the health of communities. While our knowledge of biophysical associations between meteorological factors and disease is steadily improving, our understanding of the social processes that shape adaptation to environmental perturbations lags behind. Using computational modeling methods, we explore the ways in which social cohesion can affect adaptation of disease prevention strategies when communities are exposed to different environmental scenarios that influence transmission pathways for diseases such as diarrhea. We developed an agent-based model in which household agents can choose between two behavioral strategies that offer different levels of protection against environmentally mediated disease transmission. One behavioral strategy is initially set as more protective, leading households to adopt it widely, but its efficacy is sensitive to variable weather conditions and stressors such as floods or droughts that modify the disease transmission system. The efficacy of the second strategy is initially moderate relative to the first and is insensitive to environmental changes. We examined how social cohesion (defined as average number of household social network connections) influences health outcomes when households attempt to identify an optimal strategy by copying the behaviors of socially connected neighbors who seem to have adapted successfully in the past. Our simulation experiments suggest that high-cohesion communities are able to rapidly disseminate the initially optimal behavioral strategy compared to low-cohesion communities. This rapid and pervasive change, however, decreases behavioral diversity; i.e., once a high cohesion community settles on a strategy, most or all households adopt that behavior. Following environmental changes that reduce the efficacy of the initially optimal strategy, rendering it suboptimal relative to the alternative strategy, high-cohesion communities can fail to adapt. As a result, despite faring better early in the course of computational experiments, high-cohesion communities may ultimately experience worse outcomes. In the face of uncertainty in predicting future environmental stressors due to climate change, strategies to improve effective adaptation to optimal disease prevention strategies should balance between intervention efforts that promote protective behaviors based on current scientific understanding and the need to guard against the crystallization of inflexible norms. Developing generalizable models allows us to integrate a wide range of theories multiple datasets pertaining to the relationship between social mechanisms and adaptation, which can provide further understanding of future climate change impacts. Models such as the one we present can generate hypotheses about the mechanisms that underlie the dynamics of adaptation events and suggest specific points of measurement to assess the impact of these mechanisms. They can be incorporated as modules within predictive simulations for specific socio-ecological contexts.
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Affiliation(s)
- Sarah T Cherng
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology (Baltimore, MD, USA)
| | - Ivan Cangemi
- University of Michigan School of Public Health, Department of Epidemiology (Ann Arbor, MI, USA)
| | - James A Trostle
- Trinity College, Department of Anthropology (Hartford, CT, USA)
| | - Justin Remais
- University of California Berkeley School of Public Health, Department of Environmental Health Sciences (Berkeley, CA, USA)
| | - Joseph N S Eisenberg
- University of Michigan School of Public Health, Department of Epidemiology (Ann Arbor, MI, USA)
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Chao DL, Roose A, Roh M, Kotloff KL, Proctor JL. The seasonality of diarrheal pathogens: A retrospective study of seven sites over three years. PLoS Negl Trop Dis 2019; 13:e0007211. [PMID: 31415558 PMCID: PMC6711541 DOI: 10.1371/journal.pntd.0007211] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/27/2019] [Accepted: 07/26/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pediatric diarrhea can be caused by a wide variety of pathogens, from bacteria to viruses to protozoa. Pathogen prevalence is often described as seasonal, peaking annually and associated with specific weather conditions. Although many studies have described the seasonality of diarrheal disease, these studies have occurred predominantly in temperate regions. In tropical and resource-constrained settings, where nearly all diarrhea-associated mortality occurs, the seasonality of many diarrheal pathogens has not been well characterized. As a retrospective study, we analyze the seasonal prevalence of diarrheal pathogens among children with moderate-to-severe diarrhea (MSD) over three years from the seven sites of the Global Enteric Multicenter Study (GEMS), a case-control study. Using data from this expansive study on diarrheal disease, we characterize the seasonality of different pathogens, their association with site-specific weather patterns, and consistency across study sites. METHODOLOGY/PRINCIPAL FINDINGS Using traditional methodologies from signal processing, we found that certain pathogens peaked at the same time every year, but not at all sites. We also found associations between pathogen prevalence and weather or "seasons," which are defined by applying modern machine-learning methodologies to site-specific weather data. In general, rotavirus was most prevalent during the drier "winter" months and out of phase with bacterial pathogens, which peaked during hotter and rainier times of year corresponding to "monsoon," "rainy," or "summer" seasons. CONCLUSIONS/SIGNIFICANCE Identifying the seasonally-dependent prevalence for diarrheal pathogens helps characterize the local epidemiology and inform the clinical diagnosis of symptomatic children. Our multi-site, multi-continent study indicates a complex epidemiology of pathogens that does not reveal an easy generalization that is consistent across all sites. Instead, our study indicates the necessity of local data to characterizing the epidemiology of diarrheal disease. Recognition of the local associations between weather conditions and pathogen prevalence suggests transmission pathways and could inform control strategies in these settings.
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Affiliation(s)
- Dennis L. Chao
- Institute for Disease Modeling, Bellevue, Washington, United States of America
- * E-mail:
| | - Anna Roose
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Min Roh
- Institute for Disease Modeling, Bellevue, Washington, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development and Global Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Joshua L. Proctor
- Institute for Disease Modeling, Bellevue, Washington, United States of America
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Levy K, Smith SM, Carlton EJ. Climate Change Impacts on Waterborne Diseases: Moving Toward Designing Interventions. Curr Environ Health Rep 2019; 5:272-282. [PMID: 29721700 DOI: 10.1007/s40572-018-0199-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Climate change threatens progress achieved in global reductions of infectious disease rates over recent decades. This review summarizes literature on potential impacts of climate change on waterborne diseases, organized around a framework of questions that can be addressed depending on available data. RECENT FINDINGS A growing body of evidence suggests that climate change may alter the incidence of waterborne diseases, and diarrheal diseases in particular. Much of the existing work examines historical relationships between weather and diarrhea incidence, with a limited number of studies projecting future disease rates. Some studies take social and ecological factors into account in considerations of historical relationships, but few have done so in projecting future conditions. The field is at a point of transition, toward incorporating social and ecological factors into understanding the relationships between climatic factors and diarrheal diseases and using this information for future projections. The integration of these components helps identify vulnerable populations and prioritize adaptation strategies.
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Affiliation(s)
- Karen Levy
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
| | - Shanon M Smith
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, 13001 E 17th Place B119, Aurora, CO, 80045, USA
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Micro-Space Complexity and Context in the Space-Time Variation in Enteric Disease Risk for Three Informal Settlements of Port au Prince, Haiti. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050807. [PMID: 30841596 PMCID: PMC6427463 DOI: 10.3390/ijerph16050807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
Diffusion of cholera and other diarrheal diseases in an informal settlement is a product of multiple behavioral, environmental and spatial risk factors. One of the most important components is the spatial interconnections among water points, drainage ditches, toilets and the intervening environment. This risk is also longitudinal and variable as water points fluctuate in relation to bacterial contamination. In this paper we consider part of this micro space complexity for three informal settlements in Port au Prince, Haiti. We expand on more typical epidemiological analysis of fecal coliforms at water points, drainage ditches and ocean sites by considering the importance of single point location fluctuation coupled with recording micro-space environmental conditions around each sample site. Results show that spatial variation in enteric disease risk occurs within neighborhoods, and that while certain trends are evident, the degree of individual site fluctuation should question the utility of both cross-sectional and more aggregate analysis. Various factors increase the counts of fecal coliform present, including the type of water point, how water was stored at that water point, and the proximity of the water point to local drainage. Some locations fluctuated considerably between being safe and unsafe on a monthly basis. Next steps to form a more comprehensive contextualized understanding of enteric disease risk in these environments should include the addition of behavioral factors and local insight.
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Watson SI, Sartori J, Uthman O, Lilford RJ. Health effects of sanitation facilities: a Bayesian semiparametric analysis of compositional data. J R Stat Soc Ser C Appl Stat 2019. [DOI: 10.1111/rssc.12339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Thomson P, Bradley D, Katilu A, Katuva J, Lanzoni M, Koehler J, Hope R. Rainfall and groundwater use in rural Kenya. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 649:722-730. [PMID: 30179812 DOI: 10.1016/j.scitotenv.2018.08.330] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
This study examines the relationship between rainfall and groundwater use in rural Kenya, using automatically-transmitted hourly data from handpumps (n = 266), daily rainfall records (n = 19), and household survey data (n = 2508). We demonstrate a 34% reduction in groundwater use during the wet season compared to the dry season, suggesting a large shift from improved to unimproved sources in the wet season. By cross-correlating handpump and rainfall time series, we also reveal substantial short-term changes in groundwater pumping observed immediately following heavy rainfall. Further investigation and modelling of this response reveals a 68% reduction in pump use on the day immediately following heavy rain. We then investigate reasons for this behavioural response to rainfall, using survey data to examine the characteristics, concerns and behaviours of households in the area where the reduction in pump use was most marked. In this area rainwater harvesting was widespread and only 6% of households reported handpumps as their sole source of drinking water in the wet season, compared to 86% in the dry season. These findings shed light on the impact increasing rainfall variability may have on the Sustainable Development Goal of "universal and equitable access to safe and affordable drinking water for all". Specifically, we suggest a flaw in the water policy assumption that the provision of improved sources of drinking water-in this case community handpumps-translates to consistent use and the associated health benefits. We note that failure to understand and account for actual water use behaviour may results in adverse public health outcomes and maladapted WASH policy and interventions.
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Affiliation(s)
- Patrick Thomson
- School of Geography and the Environment, University of Oxford, UK; Smith School of Enterprise and the Environment, University of Oxford, UK; School of Archaeology, Geography and Environmental Science, University of Reading, UK.
| | - David Bradley
- School of Geography and the Environment, University of Oxford, UK; Department of Zoology, University of Oxford, UK; London School of Hygiene and Tropical Medicine, UK
| | | | - Jacob Katuva
- School of Geography and the Environment, University of Oxford, UK; Smith School of Enterprise and the Environment, University of Oxford, UK
| | - Michelle Lanzoni
- School of Geography and the Environment, University of Oxford, UK
| | - Johanna Koehler
- School of Geography and the Environment, University of Oxford, UK; Smith School of Enterprise and the Environment, University of Oxford, UK
| | - Rob Hope
- School of Geography and the Environment, University of Oxford, UK; Smith School of Enterprise and the Environment, University of Oxford, UK
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Pickering AJ, Ercumen A, Arnold BF, Kwong LH, Parvez SM, Alam M, Sen D, Islam S, Kullmann C, Chase C, Ahmed R, Unicomb L, Colford JM, Luby SP. Fecal Indicator Bacteria along Multiple Environmental Transmission Pathways (Water, Hands, Food, Soil, Flies) and Subsequent Child Diarrhea in Rural Bangladesh. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2018; 52:7928-7936. [PMID: 29902374 PMCID: PMC7705120 DOI: 10.1021/acs.est.8b00928] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/09/2018] [Accepted: 06/14/2018] [Indexed: 05/19/2023]
Abstract
Enteric pathogens can be transmitted through multiple environmental pathways, yet little is known about the relative contribution of each pathway to diarrhea risk among children. We aimed to identify fecal transmission pathways in the household environment associated with prospectively measured child diarrhea in rural Bangladesh. We measured the presence and levels of Escherichia coli in tube wells, stored drinking water, pond water, child hand rinses, courtyard soil, flies, and food in 1843 households. Gastrointestinal symptoms among children ages 0-60 months were recorded concurrently at the time of environmental sample collection and again a median of 6 days later. Incident diarrhea (3 or more loose stools in a 24-h period) was positively associated with the concentration of E. coli on child hands measured on the first visit (incidence rate ratio [IRR] = 1.23, 95% CI 1.06, 1.43 for a log10 increase), while other pathways were not associated. In cross-sectional analysis, there were no associations between concurrently measured environmental contamination and diarrhea. Our findings suggest higher levels of E. coli on child hands are strongly associated with subsequent diarrheal illness rates among children in rural Bangladesh.
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Affiliation(s)
- Amy J. Pickering
- Woods Institute for the Environment, Stanford University, Stanford, California United States
- Civil and Environmental Engineering, Tufts University, Science and Engineering Complex, 200 College Avenue, Medford, Massachusetts United States
- Corresponding Author E-mail: . Phone: 617-627-5163
| | - Ayse Ercumen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California United States
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, North Carolina United States
| | - Benjamin F. Arnold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California United States
| | - Laura H. Kwong
- Woods Institute for the Environment, Stanford University, Stanford, California United States
- Civil and Environmental Engineering, Stanford University, Stanford, California United States
| | | | - Mahfuja Alam
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - Debashis Sen
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - Sharmin Islam
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - Craig Kullmann
- Water Global Practice, World Bank, Washington, D.C. 20433, United States
| | - Claire Chase
- Water Global Practice, World Bank, Washington, D.C. 20433, United States
| | - Rokeya Ahmed
- Water Global Practice, World Bank, Dhaka 1207, Bangladesh
| | - Leanne Unicomb
- Infectious Disease Division, icddr,b Dhaka 1000, Bangladesh
| | - John M. Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California United States
| | - Stephen P. Luby
- Woods Institute for the Environment, Stanford University, Stanford, California United States
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Liu Z, Zhang F, Zhang Y, Li J, Liu X, Ding G, Zhang C, Liu Q, Jiang B. Association between floods and infectious diarrhea and their effect modifiers in Hunan province, China: A two-stage model. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 626:630-637. [PMID: 29396332 DOI: 10.1016/j.scitotenv.2018.01.130] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/13/2018] [Accepted: 01/13/2018] [Indexed: 05/13/2023]
Abstract
BACKGROUND Understanding the potential links between floods and infectious diarrhea is important under the context of climate change. However, little is known about the risk of infectious diarrhea after floods and what factors could modify these effects in China. OBJECTIVES This study aims to quantitatively examine the relationship between floods and infectious diarrhea and their effect modifiers. METHODS Weekly number of infectious diarrhea cases from 2004 to 2011 during flood season in Hunan province were supplied by the National Notifiable Disease Surveillance System. Flood and meteorological data over the same period were obtained. A two-stage model was used to estimate a provincial average association and their effect modifiers between floods and infectious diarrhea, accounting for other confounders. RESULTS A total of 134,571 cases of infectious diarrhea were notified from 2004 to 2011. After controlling for seasonality, long-term trends, and meteorological factors, floods were significantly associated with infectious diarrhea in the provincial level with a cumulative RR of 1.22 (95% CI: 1.05, 1.43) with a lagged effect of 0-1 week. Geographic locations and economic levels were identified as effect modifiers, with a higher impact of floods on infectious diarrhea in the western and regions with a low economic level of Hunan. CONCLUSIONS Our study provides strong evidence of a positive association between floods and infectious diarrhea in the study area. Local control strategies for public health should be taken in time to prevent and reduce the risk of infectious diarrhea after floods, especially for the vulnerable regions identified.
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Affiliation(s)
- Zhidong Liu
- Department of Epidemiology, School of Public Health, Shandong University, Jinan City, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Feifei Zhang
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom
| | - Ying Zhang
- School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia
| | - Jing Li
- Department of Environmental Health, School of Public Health and Management, Weifang Medical University, Weifang City, Shandong Province, People's Republic of China
| | - Xuena Liu
- Department of Health Statistics, School of Public Health, Taishan Medical College, Taian City, Shandong Province, People's Republic of China
| | - Guoyong Ding
- Department of Epidemiology, School of Public Health, Taishan Medical College, Taian City, Shandong Province, People's Republic of China
| | - Caixia Zhang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan City, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Qiyong Liu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, China CDC, Beijing 102206, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Shandong University, Jinan City, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China.
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Hasan MA, Mouw C, Jutla A, Akanda AS. Quantification of Rotavirus Diarrheal Risk Due to Hydroclimatic Extremes Over South Asia: Prospects of Satellite-Based Observations in Detecting Outbreaks. GEOHEALTH 2018; 2:70-86. [PMID: 32159010 PMCID: PMC7007079 DOI: 10.1002/2017gh000101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 05/25/2023]
Abstract
Rotavirus is the most common cause of diarrheal disease among children under 5. Especially in South Asia, rotavirus remains the leading cause of mortality in children due to diarrhea. As climatic extremes and safe water availability significantly influence diarrheal disease impacts in human populations, hydroclimatic information can be a potential tool for disease preparedness. In this study, we conducted a multivariate temporal and spatial assessment of 34 climate indices calculated from ground and satellite Earth observations to examine the role of temperature and rainfall extremes on the seasonality of rotavirus transmission in Bangladesh. We extracted rainfall data from the Global Precipitation Measurement and temperature data from the Moderate Resolution Imaging Spectroradiometer sensors to validate the analyses and explore the potential of a satellite-based seasonal forecasting model. Our analyses found that the number of rainy days and nighttime temperature range from 16°C to 21°C are particularly influential on the winter transmission cycle of rotavirus. The lower number of wet days with suitable cold temperatures for an extended time accelerates the onset and intensity of the outbreaks. Temporal analysis over Dhaka also suggested that water logging during monsoon precipitation influences rotavirus outbreaks during a summer transmission cycle. The proposed model shows lag components, which allowed us to forecast the disease outbreaks 1 to 2 months in advance. The satellite data-driven forecasts also effectively captured the increased vulnerability of dry-cold regions of the country, compared to the wet-warm regions.
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Affiliation(s)
- M. Alfi Hasan
- Civil and Environmental EngineeringUniversity of Rhode IslandKingstonRIUSA
| | - Colleen Mouw
- Graduate School of OceanographyUniversity of Rhode IslandNarragansettRIUSA
| | - Antarpreet Jutla
- Civil and Environmental EngineeringWest Virginia UniversityMorgantownWVUSA
| | - Ali S. Akanda
- Civil and Environmental EngineeringUniversity of Rhode IslandKingstonRIUSA
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37
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Chhetri BK, Takaro TK, Balshaw R, Otterstatter M, Mak S, Lem M, Zubel M, Lysyshyn M, Clarkson L, Edwards J, Fleury MD, Henderson SB, Galanis E. Associations between extreme precipitation and acute gastro-intestinal illness due to cryptosporidiosis and giardiasis in an urban Canadian drinking water system (1997-2009). JOURNAL OF WATER AND HEALTH 2017; 15:898-907. [PMID: 29215354 DOI: 10.2166/wh.2017.100] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Drinking water related infections are expected to increase in the future due to climate change. Understanding the current links between these infections and environmental factors is vital to understand and reduce the future burden of illness. We investigated the relationship between weekly reported cryptosporidiosis and giardiasis (n = 7,422), extreme precipitation (>90th percentile), drinking water turbidity, and preceding dry periods in a drinking water system located in greater Vancouver, British Columbia, Canada (1997-2009) using distributed lag non-linear Poisson regression models adjusted for seasonality, secular trend, and the effect of holidays on reporting. We found a significant increase in cryptosporidiosis and giardiasis 4-6 weeks after extreme precipitation. The effect was greater following a dry period. Similarly, extreme precipitation led to significantly increased turbidity only after prolonged dry periods. Our results suggest that the risk of cryptosporidiosis and giardiasis increases with extreme precipitation, and that the effects are more pronounced after a prolonged dry period. Given that extreme precipitation events are expected to increase with climate change, it is important to further understand the risks from these events, develop planning tools, and build resilience to these future risks.
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Affiliation(s)
- Bimal K Chhetri
- British Columbia Centre for Disease Control, Vancouver, BC, Canada E-mail: ; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; 8888 University Drive, Blusson Hall 11300, Burnaby, BC, Canada V5A 1S6
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Robert Balshaw
- British Columbia Centre for Disease Control, Vancouver, BC, Canada E-mail:
| | - Michael Otterstatter
- British Columbia Centre for Disease Control, Vancouver, BC, Canada E-mail: ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Sunny Mak
- British Columbia Centre for Disease Control, Vancouver, BC, Canada E-mail:
| | - Marcus Lem
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Marc Zubel
- Fraser Health Authority, Abbotsford, BC, Canada
| | - Mark Lysyshyn
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Vancouver Coastal Health Authority, North Vancouver, BC, Canada
| | - Len Clarkson
- Vancouver Coastal Health Authority, North Vancouver, BC, Canada
| | - Joanne Edwards
- Office of the Provincial Health Officer, Victoria, BC, Canada
| | | | - Sarah B Henderson
- British Columbia Centre for Disease Control, Vancouver, BC, Canada E-mail: ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Eleni Galanis
- British Columbia Centre for Disease Control, Vancouver, BC, Canada E-mail: ; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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38
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Association between Childhood Diarrhoeal Incidence and Climatic Factors in Urban and Rural Settings in the Health District of Mbour, Senegal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14091049. [PMID: 28895927 PMCID: PMC5615586 DOI: 10.3390/ijerph14091049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 08/31/2017] [Accepted: 09/08/2017] [Indexed: 02/08/2023]
Abstract
We assessed the association between childhood diarrhoeal incidence and climatic factors in rural and urban settings in the health district of Mbour in western Senegal. We used monthly diarrhoeal case records among children under five years registered in 24 health facilities over a four-year period (2011-2014). Climatic data (i.e., daily temperature, night temperature and rainfall) for the same four-year period were obtained. We performed a negative binomial regression model to establish the relationship between monthly diarrhoeal incidence and climatic factors of the same and the previous month. There were two annual peaks in diarrhoeal incidence: one during the cold dry season and one during the rainy season. We observed a positive association between diarrhoeal incidence and high average temperature of 36 °C and above and high cumulative monthly rainfall at 57 mm and above. The association between diarrhoeal incidence and temperature was stronger in rural compared to urban settings, while higher rainfall was associated with higher diarrhoeal incidence in the urban settings. Concluding, this study identified significant health-climate interactions and calls for effective preventive measures in the health district of Mbour. Particular attention should be paid to urban settings where diarrhoea was most common in order to reduce the high incidence in the context of climatic variability, which is expected to increase in urban areas in the face of global warming.
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Wangdi K, Clements AC. Spatial and temporal patterns of diarrhoea in Bhutan 2003-2013. BMC Infect Dis 2017; 17:507. [PMID: 28732533 PMCID: PMC5521140 DOI: 10.1186/s12879-017-2611-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/18/2017] [Indexed: 11/24/2022] Open
Abstract
Background To describe spatiotemporal patterns of diarrhoea in Bhutan, and quantify the association between climatic factors and the distribution and dynamics of the disease. Methods Nationwide data on diarrhoea were obtained for 2003 to 2013 from the Health Information and Management System (HIMS), Ministry of Health, Bhutan. Climatic variables were obtained from the Department of Hydro Met Services, Ministry of Economic Affairs, Bhutan. Seasonal trend decomposition was used to examine secular trends and seasonal patterns of diarrhoea. A Bayesian conditional autoregressive (CAR) model was used to quantify the relationship between monthly diarrhoea, maximum temperature, rainfall, age and gender. Results The monthly average diarrhoea incidence was highly seasonal. Diarrhoea incidence increased by 0.6% (95% CrI: 0.5–0.6%) for every degree increase in maximum temperature; and 5% (95 Cr I: 4.9–5.1%) for a 1 mm increase in rainfall. Children aged <5 years were found to be 74.2% (95% CrI: 74.1–74.4) more likely to experience diarrhoea than children and adults aged ≥5 years and females were 4.9% (95% CrI: 4.4–5.3%) less likely to suffer from diarrhoea as compared to males. Significant residual spatial clustering was found after accounting for climate and demographic variables. Conclusions Diarrhoea incidence was highly seasonal, with positive associations with maximum temperature and rainfall and negative associations with age and being female. This calls for public health actions to reduce future risks of climate change with great consideration of local climatic conditions. In addition, protection of <5 years children should be prioritize through provision of rotavirus vaccination, safe and clean drinking water, and proper latrines. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2611-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Medicine, Environment and Biology, The Australian National University, Canberra, Australia. .,Phuentsholing General Hospital, Phuentsholing, Bhutan.
| | - Archie Ca Clements
- Department of Global Health, Research School of Population Health, College of Medicine, Environment and Biology, The Australian National University, Canberra, Australia
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40
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Harris M, Alzua ML, Osbert N, Pickering A. Community-Level Sanitation Coverage More Strongly Associated with Child Growth and Household Drinking Water Quality than Access to a Private Toilet in Rural Mali. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:7219-7227. [PMID: 28514143 PMCID: PMC5480236 DOI: 10.1021/acs.est.7b00178] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/23/2017] [Accepted: 05/17/2017] [Indexed: 05/23/2023]
Abstract
Sanitation access can provide positive externalities; for example, safe disposal of feces by one household prevents disease transmission to households nearby. However, little empirical evidence exists to characterize the potential health benefits from sanitation externalities. This study investigated the effect of community sanitation coverage versus individual household sanitation access on child health and drinking water quality. Using a census of 121 villages in rural Mali, we analyzed the association of community latrine coverage (defined by a 200 m radius surrounding a household) and individual household latrine ownership with child growth and household stored water quality. Child height-for-age had a significant and positive linear relationship with community latrine coverage, while child weight-for-age and household water quality had nonlinear relationships that leveled off above 60% coverage (p < 0.01; generalized additive models). Child growth and water quality were not associated with individual household latrine ownership. The relationship between community latrine coverage and child height was strongest among households without a latrine; for these households, each 10% increase in latrine coverage was associated with a 0.031 (p-value = 0.040) increase in height-for-age z-score. In this study, the level of sanitation access of surrounding households was more important than private latrine access for protecting water quality and child health.
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Affiliation(s)
- Michael Harris
- Emmett
Interdisciplinary Program in Environment and Resources, Stanford University, Stanford, California 94305, United States
| | - Maria Laura Alzua
- CEDLAS-CONICET-Universidad
Nacional de La Plata, La Plata, Buenos Aires 1900, Argentina
| | | | - Amy Pickering
- Civil
and Environmental Engineering, Stanford
University, Stanford, California 94305, United States
- Civil and
Environmental Engineering, Tufts University, Medford, Massachusetts 02155, United States
- E-mail:
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41
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Emont JP, Ko AI, Homasi-Paelate A, Ituaso-Conway N, Nilles EJ. Epidemiological Investigation of a Diarrhea Outbreak in the South Pacific Island Nation of Tuvalu During a Severe La Niña-Associated Drought Emergency in 2011. Am J Trop Med Hyg 2017; 96:576-582. [PMID: 28138046 DOI: 10.4269/ajtmh.16-0812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The association between heavy rainfall and an increased risk of diarrhea has been well established but less is known about the effect of drought on diarrhea transmission. In 2011, the Pacific island nation of Tuvalu experienced a concurrent severe La Niña-associated drought and large diarrhea outbreak. We conducted a field investigation in Tuvalu to identify factors that contributed to epidemic transmission in the context of a drought emergency. Peak case numbers coincided with the nadir of recorded monthly rainfall, the lowest recorded since 1930. Independent factors associated with increased risk of diarrhea were households with water tank levels below 20% (odds ratio [OR] = 2.31; 95% confidence interval = 1.16-4.60) and decreased handwashing frequency (OR = 3.00 [1.48-6.08]). The resolution of the outbreak occurred after implementation of a hygiene promotion campaign, despite persistent drought and limited water access. These findings are potentially important given projections that future climate change will cause more frequent and severe droughts.
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Affiliation(s)
- Jordan P Emont
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
| | - Albert I Ko
- Fundação Oswaldo Cruz, Salvador, Brazil.,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut
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Mellor J, Kumpel E, Ercumen A, Zimmerman J. Systems Approach to Climate, Water, and Diarrhea in Hubli-Dharwad, India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2016; 50:13042-13051. [PMID: 27783483 DOI: 10.1021/acs.est.6b02092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Anthropogenic climate change will likely increase diarrhea rates for communities with inadequate water, sanitation, or hygiene facilities including those with intermittent water supplies. Current approaches to study these impacts typically focus on the effect of temperature on all-cause diarrhea while excluding precipitation and diarrhea etiology while not providing actionable adaptation strategies. We develop a partially mechanistic, systems approach to estimate future diarrhea prevalence and design adaptation strategies. The model incorporates downscaled global climate models, water quality data, quantitative microbial risk assessment, and pathogen prevalence in an agent-based modeling framework incorporating precipitation and diarrhea etiology. It is informed using water quality and diarrhea data from Hubli-Dharwad, India-a city with an intermittent piped water supply exhibiting seasonal water quality variability vulnerable to climate change. We predict all-cause diarrhea prevalence to increase by 4.9% (Range: 1.5-9.0%) by 2011-2030, 11.9% (Range: 7.1-18.2%) by 2046-2065, and 18.2% (Range: 9.1-26.2%) by 2080-2099. Rainfall is an important modifying factor. Rotavirus prevalence is estimated to decline by 10.5% with Cryptosporidium and E. coli prevalence increasing by 9.9% and 6.3%, respectively, by 2080-2099 in this setting. These results suggest that ceramic water filters would be recommended as a climate adaptation strategy over chlorination. This work highlights the vulnerability of intermittent water supplies to climate change and the urgent need for improvements.
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Affiliation(s)
- Jonathan Mellor
- Department of Civil and Environmental Engineering, University of Connecticut , Storrs, Connecticut 06269, United States
| | | | - Ayse Ercumen
- Division of Epidemiology, University of California at Berkeley , Berkeley, California 94720, United States
| | - Julie Zimmerman
- Department of Chemical and Environmental Engineering, Yale University , New Haven, Connecticut 06511, United States
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43
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Mukabutera A, Thomson D, Murray M, Basinga P, Nyirazinyoye L, Atwood S, Savage KP, Ngirimana A, Hedt-Gauthier BL. Rainfall variation and child health: effect of rainfall on diarrhea among under 5 children in Rwanda, 2010. BMC Public Health 2016; 16:731. [PMID: 27495307 PMCID: PMC4975910 DOI: 10.1186/s12889-016-3435-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 08/03/2016] [Indexed: 11/30/2022] Open
Abstract
Background Diarrhea among children under 5 years of age has long been a major public health concern. Previous studies have suggested an association between rainfall and diarrhea. Here, we examined the association between Rwandan rainfall patterns and childhood diarrhea and the impact of household sanitation variables on this relationship. Methods We derived a series of rain-related variables in Rwanda based on daily rainfall measurements and hydrological models built from daily precipitation measurements collected between 2009 and 2011. Using these data and the 2010 Rwanda Demographic and Health Survey database, we measured the association between total monthly rainfall, monthly rainfall intensity, runoff water and anomalous rainfall and the occurrence of diarrhea in children under 5 years of age. Results Among the 8601 children under 5 years of age included in the survey, 13.2 % reported having diarrhea within the 2 weeks prior to the survey. We found that higher levels of runoff were protective against diarrhea compared to low levels among children who lived in households with unimproved toilet facilities (OR = 0.54, 95 % CI: [0.34, 0.87] for moderate runoff and OR = 0.50, 95 % CI: [0.29, 0.86] for high runoff) but had no impact among children in household with improved toilets. Conclusion Our finding that children in households with unimproved toilets were less likely to report diarrhea during periods of high runoff highlights the vulnerabilities of those living without adequate sanitation to the negative health impacts of environmental events.
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Affiliation(s)
| | - Dana Thomson
- University of Rwanda School of Public Health, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Epidemiology Departments, Harvard School of Public Health, Boston, USA
| | - Paulin Basinga
- University of Rwanda School of Public Health, Kigali, Rwanda.,Rwanda Biomedical Center (RBC), Kigali, Rwanda
| | | | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | - Kevin P Savage
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | - Bethany L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Partners In Health, Kigali, Rwanda
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44
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Pickering AJ, Djebbari H, Lopez C, Coulibaly M, Alzua ML. Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2016; 3:e701-11. [PMID: 26475017 DOI: 10.1016/s2214-109x(15)00144-8] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/30/2015] [Accepted: 07/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Community-led total sanitation (CLTS) uses participatory approaches to mobilise communities to build their own toilets and stop open defecation. Our aim was to undertake the first randomised trial of CLTS to assess its effect on child health in Koulikoro, Mali. METHODS We did a cluster-randomised trial to assess a CLTS programme implemented by the Government of Mali. The study population included households in rural villages (clusters) from the Koulikoro district of Mali; every household had to have at least one child aged younger than 10 years. Villages were randomly assigned (1:1) with a computer-generated sequence by a study investigator to receive CLTS or no programme. Health outcomes included diarrhoea (primary outcome), height for age, weight for age, stunting, and underweight. Outcomes were measured 1·5 years after intervention delivery (2 years after enrolment) among children younger than 5 years. Participants were not masked to intervention assignment. The trial is registered with ClinicalTrials.gov, number NCT01900912. FINDINGS We recruited participants between April 12, and June 23, 2011. We assigned 60 villages (2365 households) to receive the CLTS intervention and 61 villages (2167 households) to the control group. No differences were observed in terms of diarrhoeal prevalence among children in CLTS and control villages (706 [22%] of 3140 CLTS children vs 693 [24%] of 2872 control children; prevalence ratio [PR] 0·93, 95% CI 0·76-1·14). Access to private latrines was almost twice as high in intervention villages (1373 [65%] of 2120 vs 661 [35%] of 1911 households) and reported open defecation was reduced in female (198 [9%] of 2086 vs 608 [33%] of 1869 households) and in male (195 [10%] of 2004 vs 602 [33%] of 1813 households) adults. Children in CLTS villages were taller (0·18 increase in height-for-age Z score, 95% CI 0·03-0·32; 2415 children) and less likely to be stunted (35% vs 41%, PR 0·86, 95% CI 0·74-1·0) than children in control villages. 22% of children were underweight in CLTS compared with 26% in control villages (PR 0·88, 95% CI 0·71-1·08), and the difference in mean weight-for-age Z score was 0·09 (95% CI -0·04 to 0·22) between groups. In CLTS villages, younger children at enrolment (<2 years) showed greater improvements in height and weight than older children. INTERPRETATION In villages that received a behavioural sanitation intervention with no monetary subsidies, diarrhoeal prevalence remained similar to control villages. However, access to toilets substantially increased and child growth improved, particularly in children <2 years. CLTS might have prevented growth faltering through pathways other than reducing diarrhoea. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Amy J Pickering
- Woods Institute for the Environment, and Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA.
| | - Habiba Djebbari
- Aix-Marseille School of Economics, Aix-Marseille University, Centre National de la Recherche Scientifique (CNRS) and École des Hautes Études en Sciences Sociales (EHESS), Marseille, France
| | - Carolina Lopez
- CEDLAS-CONICET-Universidad Nacional de La Plata, La Plata, Argentina
| | | | - Maria Laura Alzua
- CEDLAS-CONICET-Universidad Nacional de La Plata, La Plata, Argentina
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Kim JI, Kim G. Relationship Between the Remaining Years of Healthy Life Expectancy in Older Age and National Income Level, Educational Attainment, and Improved Water Quality. Int J Aging Hum Dev 2016; 83:402-17. [PMID: 27388888 DOI: 10.1177/0091415016657560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The remaining years of healthy life expectancy (RYH) at age 65 years can be calculated as RYH (65) = healthy life expectancy-aged 65 years. This study confirms the associations between socioeconomic indicators and the RYH (65) in 148 countries. The RYH data were obtained from the World Health Organization. Significant positive correlations between RYH (65) in men and women and the socioeconomic indicators national income, education level, and improved drinking water were found. Finally, the predictors of RYH (65) in men and women were used to build a model of the RYH using higher socioeconomic indicators (R(2 )= 0.744, p < .001). Overall country-level educational attainment, national income level, and improved water quality influenced the RYH at 65 years. Therefore, policymaking to improve these country-level socioeconomic factors is expected to have latent effects on RYH in older age.
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Affiliation(s)
- Jong In Kim
- Division of Social Welfare and Public Health Administration, Wonkwang University, Republic of Korea Institute for Longevity Sciences, Wonkwang University, Republic of Korea
| | - Gukbin Kim
- Global Management of Natural Resources, University College London (UCL), UK
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Mellor JE, Levy K, Zimmerman J, Elliott M, Bartram J, Carlton E, Clasen T, Dillingham R, Eisenberg J, Guerrant R, Lantagne D, Mihelcic J, Nelson K. Planning for climate change: The need for mechanistic systems-based approaches to study climate change impacts on diarrheal diseases. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 548-549:82-90. [PMID: 26799810 PMCID: PMC4818006 DOI: 10.1016/j.scitotenv.2015.12.087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 05/20/2023]
Abstract
Increased precipitation and temperature variability as well as extreme events related to climate change are predicted to affect the availability and quality of water globally. Already heavily burdened with diarrheal diseases due to poor access to water, sanitation and hygiene facilities, communities throughout the developing world lack the adaptive capacity to sufficiently respond to the additional adversity caused by climate change. Studies suggest that diarrhea rates are positively correlated with increased temperature, and show a complex relationship with precipitation. Although climate change will likely increase rates of diarrheal diseases on average, there is a poor mechanistic understanding of the underlying disease transmission processes and substantial uncertainty surrounding current estimates. This makes it difficult to recommend appropriate adaptation strategies. We review the relevant climate-related mechanisms behind transmission of diarrheal disease pathogens and argue that systems-based mechanistic approaches incorporating human, engineered and environmental components are urgently needed. We then review successful systems-based approaches used in other environmental health fields and detail one modeling framework to predict climate change impacts on diarrheal diseases and design adaptation strategies.
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Affiliation(s)
- Jonathan E Mellor
- Department of Civil and Environmental Engineering, University of Connecticut, 261 Glenbrook Road, Storrs, CT 06269-3037, USA.
| | - Karen Levy
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Julie Zimmerman
- Department of Chemical and Environmental Engineering, School of Engineering & Applied Science, Yale University, New Haven, CT, USA
| | - Mark Elliott
- Department of Civil, Construction and Environmental Engineering, The College of Engineering, University of Alabama, Tuscaloosa, AL, USA
| | - Jamie Bartram
- Water Institute, Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado at Denver, Aurora, CO, USA
| | - Thomas Clasen
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rebecca Dillingham
- The Center for Global Health, University of Virginia, Charlottesville, VA, USA
| | - Joseph Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Richard Guerrant
- The Center for Global Health, University of Virginia, Charlottesville, VA, USA
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, School of Engineering, Tufts University, Medford, MA, USA
| | - James Mihelcic
- Department of Civil and Environmental Engineering, The College of Engineering, University of South Florida, Tampa, FL, USA
| | - Kara Nelson
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA
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Collender PA, Cooke OC, Bryant LD, Kjeldsen TR, Remais JV. Estimating the microbiological risks associated with inland flood events: Bridging theory and models of pathogen transport. CRITICAL REVIEWS IN ENVIRONMENTAL SCIENCE AND TECHNOLOGY 2016; 46:1787-1833. [PMID: 28757789 PMCID: PMC5533301 DOI: 10.1080/10643389.2016.1269578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Flooding is known to facilitate infectious disease transmission, yet quantitative research on microbiological risks associated with floods has been limited. Pathogen fate and transport models provide a framework to examine interactions between landscape characteristics, hydrology, and waterborne disease risks, but have not been widely developed for flood conditions. We critically examine capabilities of current hydrological models to represent unusual flow paths, non-uniform flow depths, and unsteady flow velocities that accompany flooding. We investigate the theoretical linkages between hydrodynamic processes and spatio-temporally variable suspension and deposition of pathogens from soils and sediments; pathogen dispersion in flow; and concentrations of constituents influencing pathogen transport and persistence. Identifying gaps in knowledge and modeling practice, we propose a research agenda to strengthen microbial fate and transport modeling applied to inland floods: 1) development of models incorporating pathogen discharges from flooded sources (e.g., latrines), effects of transported constituents on pathogen persistence, and supply-limited pathogen transport; 2) studies assessing parameter identifiability and comparing model performance under varying degrees of process representation, in a range of settings; 3) development of remotely sensed datasets to support modeling of vulnerable, data-poor regions; and 4) collaboration between modelers and field-based researchers to expand the collection of useful data in situ.
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Affiliation(s)
- Philip A Collender
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720
| | - Olivia C Cooke
- Department of Architecture and Civil Engineering, University of Bath, Bath, UK BA2 7AY
| | - Lee D Bryant
- Department of Architecture and Civil Engineering, University of Bath, Bath, UK BA2 7AY
| | - Thomas R Kjeldsen
- Department of Architecture and Civil Engineering, University of Bath, Bath, UK BA2 7AY
| | - Justin V Remais
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720
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