Spatial, temporal, and spatiotemporal analysis of under-five diarrhea in Southern Ethiopia

Abstract

BackgroundDespite improvements in prevention efforts, childhood diarrhea remains a public health concern. However, there may be substantial variation influenced by place, time, and season. Description of diarrheal clusters in time and space and understanding seasonal patterns can improve surveillance and management. The present study investigated the spatial and seasonal distribution and purely spatial, purely temporal, and space-time clusters of childhood diarrhea in Southern Ethiopia.MethodsThe study was a retrospective analysis of data from the Health Management Information System (HMIS) under-five diarrheal morbidity reports from July 2011 to June 2017 in Sidama Zone. Annual diarrhea incidence at district level was calculated. Incidence rate calculation and seasonal trend analysis were performed. The Kulldorff SaTScan software with a discrete Poisson model was used to identify statistically significant special, temporal, and space-time diarrhea clusters. ArcGIS 10.1 was used to plot the maps.ResultsA total of 202,406 under-five diarrheal cases with an annual case of 5822 per 100,000 under-five population were reported. An increasing trend of diarrhea incidence was observed over the 6 years with seasonal variation picking between February and May. The highest incidence rate (135.8/1000) was observed in the year 2016/17 in Boricha district. One statistically significant most likely spatial cluster (Boricha district) and six secondary clusters (Malga, Hulla, Aleta Wondo, Shebedino, Loka Abaya, Dale, and Wondogenet) were identified. One statistically significant temporal cluster (LLR = 2109.93, p < 0.001) during December 2013 to May 2015 was observed in all districts. Statistically significant spatiotemporal primary hotspot was observed in December 2012 to January 2015 in Malga district with a likelihood ratio of 1214.67 and a relative risk of 2.03. First, second, third, and fourth secondary hotspots occurred from January 2012 to May 2012 in Loka Abaya, December 2011 in Bursa, from March to April 2014 in Gorchie, and March 2012 in Wonsho districts.ConclusionChildhood diarrhea was not distributed randomly over space and time and showed an overall increasing trend of seasonal variation peaking between February and May. The health department and other stakeholders at various levels need to plan targeted interventional activities at hotspot seasons and areas to reduce morbidity and mortality.Electronic supplementary materialThe online version of this article (10.1186/s41182-018-0101-1) contains supplementary material, which is available to authorized users.

Diarrhoeal Diseases in Children under five years Exhibits space-time disparities and priority areas for control interventions in Rwanda

“…In addition to that a positively association was observed between increase of monthly average temperature and increase of diarrhea cases. Similar ndings have been elucidated in different studies [14,16,17,20,[23][24][25]. The increase cases observed during months with highest temperature justi ed by plausible explanations; higher temperature promotes the development of and growth of bacteria even though some evidences suggest that the survival and transmission of enteric viruses are increased during low temperature [26].…”

“…Previous studies conducted in similar setting like in Rwanda contradict with the ndings [20,21] whereby they reported a decrease tendency. However another study conducted in Ethiopia found similar ndings [16]. Rwanda has made effort to decrease morbidity and mortality of diarrhoeal diseases; in the same context, much have been done to improve and strengthen the health system.…”

Diarrhoeal Diseases in Children Under Five Years Exhibited Space-Time Disparities and Priority Areas for Control Interventions in Rwanda

“…In addition to that a positively association was observed between increase of maximum temperature and increase of diarrhea cases. Similar findings have been elucidated in different studies [14,16,17,20,[23][24][25]. The increase cases observed during months with highest temperature justified by plausible explanations; higher temperature promotes the development of and growth of bacteria even though some evidences suggest that the survival and transmission of enteric viruses are increased during low temperature [26].…”

“…Previous studies conducted in similar setting like in Rwanda contradict with the findings [20,21] whereby they reported a decrease tendency. However another study conducted in Ethiopia found similar findings [16]. Rwanda has made effort to decrease morbidity and mortality of diarrhoeal diseases; in the same context, much have been done to improve and strengthen the health system.…”

“…The morbidity of childhood diarrhoeal diseases has been observed in several studies to be associated with climate changes [10][11][12][13][14]. Furthermore, geographical and time disparities of diarrhoeal diseases were reported in different studies [10,[15][16][17][18].…”