@article{c84fa23f55f44713910d92921abc1923,
title = "Spatial distribution of watery diarrhoea in children: Identification of 'risk areas' in a rural community in Bangladesh",
abstract = "To assess the geographic variation of acute watery diarrhoea in children 0 to 5 years old in rural Bangladesh, all cases of 'cholera-like' diarrhoea were plotted on the map. A clustering pattern was noticed, and validated by a nonparametric clustering test for in-homogeneous population. Several risk areas for the disease were identified. In these areas, the point prevalence (8.7%) was notably higher than outside the areas (0.41%), (95% confidence interval, 15.55-29.30). Parents' education, population density and use of sanitary latrines were significantly related to the risk areas (p ≤ 0.001). The results of this study indicate that computer-assisted mapping may be useful in defining and monitoring risk areas for watery diarrhoea in children.",
keywords = "Clustering, Developing countries, Diarrhoea",
author = "J. Myaux and M. Ali and A. Felsenstein and J. Chakraborty and {De Francisco}, A.",
note = "Funding Information: related variables are aggregateda t a village or were the most commonlyi solatedp athogensT. he district level, presents everall imitations and are epidemiologyo f thesed iffers from cholera, being subject to many biases (Morgenstern, 1982). more commonly transmitted from person to Unfortunately,m ore detaileds patiald ataanalyses person,o r by contaminationw ithin the bari. This are rarely conceivablei n developingc ountriesb y may explain the failure of associationo f environ-the lack of demographici nformation and exact mental factors with the presenceo f risk areas. location of the population in the field. Diarrhoea may be associatedw ith high mor-Matlab{\textquoteright}s research area benefits from the tality caused by rapid dehydration. By defining outstanding demographic surveillance that has specific areas where the diseasei s much more covered the total population for more than prevalent,i t would be an effectivei nterventiont o 20 yearsa nd from he communityw orkersn etwork maker ehydrations altsa vailablei n the community who continuouslyr eportd atao n manyv ariablesa t and to train healthw orkersa nd motherst o detect a household level. By setting up a Geographic early signs of dehydrationa nd to administert he Information System,a unique researchf ield was treatmenta dequately. createdf or detaileds patiala nalysiss tudies. Many cholera vaccinet rials have been carried The main findingo f this analysisi s thed efinition out in the Matlab study area, which requiredt he of geographicala reas where prevalenceo f acute follow-up of large cohorts of people over long watery diarrhoea in children is markedly high. periodso f time.B y definingc lusterso f households Moreover, the data show that beyond a simple wheret he risk for the diseaseis much higher,s uch aggregationo f cases of watery diarrhoea, the studiesc ould be conductedm ore easily and at a existenceo f thesea reasi s meaningful.I ndeed,f or lower cost. the few variablesc onsideredt,h e householdsin side This studyp resentss omel imitationsa nd fails to the areass haret he samel evelo f risk for diarrhoea; control a possible reporting bias by community extremely packed population, lower education workers. Acute watery diarrhoeac asesa re based level, lower hygienes tandarda nd possibly other on clinical signsr eportedb y the mothersa nd are, factors not revealedb y this study. thus, subjectt o interpretation.D ue to the large The existenceo f such risk areas is of great number of records in Table f , some significant interestf or a better understandingo f the disease differencesa re not meaningful.H owever, all the transmissiono r the persistenceo f reservoirs,b ut variables remained in the regressionm odel. In also for focusing preventiveo r curativei nterven-addition, the mapping of the risk areas and the tions on a targetedp opulation. clusteringt esta re basedo n thea ggregationo f baris Although acutew ateryd iarrhoeai s defineda s a rather than households, which is relevant for specifice ntity,s everapl athogensa re involved,w ith identifying environmentalr isk factors. However, their own characteristicsi,n cludingage specificity importante nvironmentailn formationo n contami-and seasonalityW. e learnf rom other studiesin the nation sources that would explain the level of Matlab TreatmentC entre that V. cholerae is the clusteringo n the map were not availablef or the most common pathogen that is isolated from analysis. diarrhoea patients aged between2 and 9 years Very little is known on the spatiale nvironment (Black et al., 1980).I n our study, almosth alf the of infectiousd iseasesT. his study demonstratetsh e cases were older than 2 years. The geographic benefitso f usingg eoreferencedda taa nd computer-distribution of the cases is compatible with the assistedm appingp rogramsf or descriptivea nalysis patternd escribede arlier on V. cholerae, showing of the spatial component of communicable how caseso ccur almost simultaneouslya t distant diseasesa, nd for monitoringa control programme points, and suggesting multiple simultaneous on diarrhoea.F urther investigationa re neededt o introductions of the vibrio (McCormack et af., examine particular transmission patterns and 1960;G lass et al., 1982).M oreover, the variation possiblee nvironmentacl ontaminations ourcesl ike over the year, with a peak in May-June is similar water supply, open sewageo r rubbish dumps. to the observationf rom the treatmentc entre on admissiono f cholerap atientso n the samey ear.W e may thus suspectt hat a large number of cases reportedi n this study were cholera cases. This research was supported by the Belgian Administration for The persistenceo f V. cholerae in aquatic Development Cooperation (BADC) and the International reservoirs has been clearly established( Colwell (ICDDR,B). The 1CDDR.B is supported by countries and Centre for Diarrhoeal Disease Research, Bangladesh et al., 1992).T his study, based on retrospective agencies which share its concern for the health problems of data, failed to associatee nvironmentalf actors developing countries. Current donors include: the aid agencies from the map with the presenceo f risk areas. of the Governments of Australia, Bangladesh, Belgium, Ecological associationw ith the diseasen eedst o be Canada, China, Germany, Japan, the Netherlands, Norway, addresseda ppropriately in further studies. In United Kingdom, and the United States; international Saudi Arabia, Sri Lanka, Sweden, Switzerland, Thailand, the children less than two years, Black et al. (1980) organizations including the Arab Gulf Fund, Asian Develop- showedt hat rotavirus and enterotoxigenicE . coli ment Bank, European Union, United Nations Children{\textquoteright}s Fund",
year = "1997",
month = sep,
doi = "10.1016/S1353-8292(97)00013-0",
language = "English (US)",
volume = "3",
pages = "181--186",
journal = "Health and Place",
issn = "1353-8292",
publisher = "Elsevier Limited",
number = "3",
}