Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis
Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis
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DOI：
10.1186/1476-069x-9-13
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发表时间：
2010-03-22
影响因子：
6
通讯作者：
Emch, Michael
中科院分区：
文献类型：
--
作者：
Carrel, Margaret;Voss, Paul;Emch, Michael
背景资料：自然或历史水流的改变可能会对水传播疾病流行的地区产生意想不到的后果，这种变化的流行病学影响知之甚少。在孟加拉国的Matlab，对一部分受到严密监测的人群实施防洪措施，使我们能够检查霍乱的结果对旨在控制河流洪水的措施是否有积极或消极的反应。方法：使用零膨胀负二项模型，我们研究了如何选择协变量可以同时解释家庭集群报告没有霍乱从那些积极计数以及区分从霍乱高值地区转移到低值居民区。我们的目标是研究如何居住在一个防洪保护区内或以外的相互作用与霍乱存在的概率和防洪的霍乱prevalence.Results的大小的影响：在Matlab中，生活在一个家庭，是保护每年的季风洪水似乎没有显着的影响，家庭是否经历霍乱，净其他协变量。然而，与直觉相反的是，在家庭中，霍乱报告，生活在防洪保护区显着增加霍乱病例的数量。结论：水坝或其他蓄水战略的经济或社会动机的建设可以有深远的和意想不到的后果，水传播疾病。我们的研究结果表明，孟加拉国农村地区防洪建筑的建设与免受年度季风洪水影响的居民的霍乱病例增加有关。这一发现需要卫生界以及参与现行水管理计划的政府和非政府组织的关注。
Background: Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding.Methods: Using a zero inflated negative binomial model, we examine how selected covariates can simultaneously account for household clusters reporting no cholera from those with positive counts as well as distinguishing residential areas with low counts from areas with high cholera counts. Our goal is to examine how residence within or outside a flood protected area interacts with the probability of cholera presence and the effect of flood protection on the magnitude of cholera prevalence.Results: In Matlab, living in a household that is protected from annual monsoon flooding appears to have no significant effect on whether the household experiences cholera, net of other covariates. However, counter-intuitively, among households where cholera is reported, living within the flood protected region significantly increases the number of cholera cases.Conclusions: The construction of dams or other water impoundment strategies for economic or social motives can have profound and unanticipated consequences for waterborne disease. Our results indicate that the construction of a flood control structure in rural Bangladesh is correlated with an increase in cholera cases for residents protected from annual monsoon flooding. Such a finding requires attention from both the health community and from governments and non-governmental organizations involved in ongoing water management schemes.