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Climate change is one of the critical determinants affecting life cycles and transmission of most infectious agents, including malaria, cholera, dengue fever, hand, foot, and mouth disease (HFMD), and the recent Corona-virus pandemic. HFMD has been associated with a growing number of outbreaks resulting in fatal complications since the late 1990s. The outbreaks may result from a combination of rapid population growth, climate change, socioeconomic changes, and other lifestyle changes. However, the modeling of climate variability and HFMD remains unclear, particularly in statistical theory development. The statistical relationship between HFMD and climate factors has been widely studied using generalized linear and additive modeling. When dealing with time-series data with clustered variables such as HFMD with clustered states, the independence principle of both modeling approaches may be violated. Thus, a Generalized Additive Mixed Model (GAMM) is used to investigate the relationship between HFMD and climate factors in Malaysia. The model is improved by using a first-order autoregressive term and treating all Malaysian states as a random effect. This method is preferred as it allows states to be modeled as random effects and accounts for time series data autocorrelation. The findings indicate that climate variables such as rainfall and wind speed affect HFMD cases in Malaysia. The risk of HFMD increased in the subsequent two weeks with rainfall below 60 mm and decreased with rainfall exceeding 60 mm. Besides, a two-week lag in wind speeds between 2 and 5 m/s reduced HFMD's chances. The results also show that HFMD cases rose in Malaysia during the inter-monsoon and southwest monsoon seasons but fell during the northeast monsoon. The study's outcomes can be used by public health officials and the general public to raise awareness, and thus, implement effective preventive measures.
Climate change is one of the critical determinants affecting life cycles and transmission of most infectious agents, including malaria, cholera, dengue fever, hand, foot, and mouth disease (HFMD), and the recent Corona-virus pandemic. HFMD has been associated with a growing number of outbreaks resulting in fatal complications since the late 1990s. The outbreaks may result from a combination of rapid population growth, climate change, socioeconomic changes, and other lifestyle changes. However, the modeling of climate variability and HFMD remains unclear, particularly in statistical theory development. The statistical relationship between HFMD and climate factors has been widely studied using generalized linear and additive modeling. When dealing with time-series data with clustered variables such as HFMD with clustered states, the independence principle of both modeling approaches may be violated. Thus, a Generalized Additive Mixed Model (GAMM) is used to investigate the relationship between HFMD and climate factors in Malaysia. The model is improved by using a first-order autoregressive term and treating all Malaysian states as a random effect. This method is preferred as it allows states to be modeled as random effects and accounts for time series data autocorrelation. The findings indicate that climate variables such as rainfall and wind speed affect HFMD cases in Malaysia. The risk of HFMD increased in the subsequent two weeks with rainfall below 60 mm and decreased with rainfall exceeding 60 mm. Besides, a two-week lag in wind speeds between 2 and 5 m/s reduced HFMD's chances. The results also show that HFMD cases rose in Malaysia during the inter-monsoon and southwest monsoon seasons but fell during the northeast monsoon. The study's outcomes can be used by public health officials and the general public to raise awareness, and thus, implement effective preventive measures.
Hand, foot, and mouth disease (HFMD) has become an endemic childhood disease in Asia, including Malaysia, over the last few decades. This infectious disease caused by the Entero and Coxsackie viruses has been a major public health threat in Malaysia since 1997. Climate change has been considered an influential factor in HFMD cases and has been explored in other countries using various statistical analyses. The most popular is the Generalized Linear Model (GLM). However, GLM often fails to capture the non-linearity effect of the variables. The study, therefore, proposes to use the Generalized Additive Model (GAM) to analyse the non-linear effects of temperature, humidity, rainfall, and wind speed at varying time lags of HFMD in Selangor. In summary, the result indicates that the weekly temperature, humidity, and rainfall were significantly associated with HFMD cases in Selangor and clarified with two weeks of lag time. This disease’s risk increased in the subsequent two weeks with a temperature range of 27°C to 30°C, 70% to 85% of humidity, and 5mm to 20mm of rainfall. Besides, this study also found that the seasonal distribution of HFMD in Selangor has a large peak during the Southwest monsoon. A small peak was observed at the end of the year during the Northeast monsoon. The findings of this study could be a practical guide for HFMD intervention strategies, especially in Malaysia.
Background This study adopted complete meteorological indicators, including eight items, to explore their impact on hand, foot, and mouth disease (HFMD) in Fuzhou, and predict the incidence of HFMD through the long short-term memory (LSTM) neural network algorithm of artificial intelligence. Method A distributed lag nonlinear model (DLNM) was used to analyse the influence of meteorological factors on HFMD in Fuzhou from 2010 to 2021. Then, the numbers of HFMD cases in 2019, 2020 and 2021 were predicted using the LSTM model through multifactor single-step and multistep rolling methods. The root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and symmetric mean absolute percentage error (SMAPE) were used to evaluate the accuracy of the model predictions. Results Overall, the effect of daily precipitation on HFMD was not significant. Low (4 hPa) and high (≥ 21 hPa) daily air pressure difference (PRSD) and low (< 7 °C) and high (> 12 °C) daily air temperature difference (TEMD) were risk factors for HFMD. The RMSE, MAE, MAPE and SMAPE of using the weekly multifactor data to predict the cases of HFMD on the following day, from 2019 to 2021, were lower than those of using the daily multifactor data to predict the cases of HFMD on the following day. In particular, the RMSE, MAE, MAPE and SMAPE of using weekly multifactor data to predict the following week's daily average cases of HFMD were much lower, and similar results were also found in urban and rural areas, which indicating that this approach was more accurate. Conclusion This study’s LSTM models combined with meteorological factors (excluding PRE) can be used to accurately predict HFMD in Fuzhou, especially the method of predicting the daily average cases of HFMD in the following week using weekly multifactor data.
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