The spatial epidemiology of cholera in an endemic area of Bangladesh

Mohammad Ali, Michael Emch, J. P. Donnay, Mohammad Yunus, R. B. Sack

Research output: Contribution to journalArticlepeer-review

Abstract

This paper defines high-risk areas of cholera based on environmental risk factors of the disease in an endemic area of Bangladesh. The risk factors include proximity to surface water, high population density, and low educational status, which were identified in an earlier study by the authors. Cholera data were analyzed by spatially referenced extended household units for two time periods, 1983-1987 and 1992-1996. These periods were chosen because they had different dominant cholera agents. From 1983-1987 classical cholera was dominant and from 1992-1996 El Tor was dominant. By defining high-risk areas based on risk factors, this study builds a spatial risk model for cholera. The model is then evaluated based on the locations of observed cholera cases. The study also identifies the determinants of death due to cholera for the two different time periods dominated by the different cholera agents. The modeled risk areas that were based on the risk factors were found to correspond with actual distributions of cholera morbidity and mortality. The high-risk areas of the dominant cholera agents are relatively stable over time. However, from 1983-1987 El Tor cholera, which was not the dominant agent during that period, was not associated with high-risk areas, suggesting that the El Tor habitat may have changed over time. The case fatality rate for cholera was related to proximity to a diarrhea treatment hospital in the study area.

Original languageEnglish (US)
Pages (from-to)1015-1024
Number of pages10
JournalSocial Science and Medicine
Volume55
Issue number6
DOIs
StatePublished - 2002

Keywords

  • Bangladesh
  • Cholera
  • Disease risk
  • Spatial analysis

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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