Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample.
Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample.
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DOI：
10.1371/journal.pntd.0009447
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发表时间：
2021-06
影响因子：
3.8
通讯作者：
Diggle PJ
中科院分区：
文献类型：
--
作者：
Ediriweera DS;Kasthuriratne A;Pathmeswaran A;Gunawardene NK;Jayamanne SF;Murray K;Iwamura T;Isbister G;Dawson A;Lalloo DG;de Silva HJ;Diggle PJ
蛇咬伤的发病率表现出空间和时间的变化。然而，没有研究详细评估了一个国家或地区蛇咬伤的时空模式。我们使用了一个具有全国代表性的人口样本，以评估在斯里兰卡蛇咬伤的时空模式。我们进行了一项基于社区的横断面调查，代表斯里兰卡所有九个省。我们采访了165665人（占全国人口的0.8%），记录了受访者报告的蛇咬伤事件。斯里兰卡是一个农业国家，中部、南部和西部的降雨主要来自西南季风（5 - 9月），北方和东部的降雨主要来自东北季风（11 - 2月）。我们开发了时空模型，使用多变量泊松过程建模来解释每月蛇咬伤和envenoming发病率在该国。这些模型是在省一级开发的，目的是解释当地的时空格局。蛇咬伤和毒液蛰伤显示出清晰的时空模式。斯里兰卡中北部、西北部、西南部和东部都有蛇咬伤的热点地区。他们表现出一年两次的季节性模式，除了在西南部的内陆，这表明三年一次的季节性。受毒液侵害的热点仅限于该国的中北部、东部和西南部地区。中北部地区的热点呈三年一次的季节性模式，西南部地区呈一年一次的模式。东部地区的热点全年持续存在。斯里兰卡每月的蛇咬伤和毒液中毒事件总数为39起，（95%CI：38-40）和19（95%CI：13-30）/100 000，转换为110 000（95%CI：107 500-112 500）蛇咬伤和45 000（95%CI：32 000-73 000）毒液蛰入。这项研究提供了全国以社区为基础的蛇咬伤和蛇毒每月发病率的信息。因此，它为医疗保健决策提供了有用的见解，例如，优先考虑地点，建立专门的蛇咬伤管理中心，并根据考虑到地点和季节的风险评估分配资源。毒蛇咬伤是一种被忽视的热带疾病，主要影响生活在热带农村地区的人们。蛇咬伤可导致轻度、中度或重度毒液蛰入、心理障碍、长期残疾和死亡。在许多国家，蛇咬伤发病率显示出空间变化和季节性模式，但以前没有对国家一级蛇咬伤风险的时空模式进行过深入评价。我们进行了全岛范围的社区调查，以确定在该国蛇咬伤的时空模式。蛇咬伤和蛇咬伤envenomings显示出明确的时空模式，某些热点持续全年，而其他人在一年内表现出动态变化。我们发现，在斯里兰卡，蛇咬伤的月发病率为每10万人39例，毒液中毒的发病率为每10万人19例。我们制定了每月的蛇咬伤和蛇咬伤中毒风险地图，以确定该国的蛇咬伤热点和冷点。这些地图为医疗决策提供了有用的见解，例如，优先考虑位置以建立专门的蛇咬伤管理中心，并根据考虑位置和季节的风险评估分配资源。我们的方法展示了一个通用的方法来模拟时间和地点的个别事件，并解决变量的调查工作和召回偏见与流行病学调查的影响。
Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka. We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns. Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38–40) and 19 (95%CI: 13–30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500–112 500) snakebites and 45 000 (95%CI: 32 000–73 000) envenomings in a calendar year. This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season. Snakebite envenoming is a neglected tropical disease which mainly affects people living in rural areas of the tropics. Snakebite can result in mild, moderate or severe envenomation, psychological disturbances, long-term disability, and deaths. Snakebite incidence demonstrates both spatial variation and seasonal patterns in many countries, but there have been no previous in-depth evaluations of spatiotemporal patterns of snakebite risk at a country level. We undertook an island-wide community survey to determine the spatiotemporal patterns of snakebite in the country. Both snakebites and snakebite envenomings showed clear spatiotemporal patterns where certain hotspots persisted throughout the year while others showed dynamic changes within a year. We found that the monthly snakebite incidence was 39 per 100 000 and envenoming incidences was 19 per 100 000 in Sri Lanka. We developed monthly snakebite and snakebite envenoming risk maps to identify snakebite hotspots and cold spots in the country. These maps provide useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which consider both location and season. Our methodology demonstrates a general approach to model times and places of individual events and address the effects of variable survey effort and recall bias associated with epidemiological surveys.
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影响因子：
0.6
作者：
Hansdak, SG;Lallar, KS;Koirala, S
通讯作者：
Koirala, S
影响因子：
7.7
作者：
Ediriweera DS;Diggle PJ;Kasturiratne A;Pathmeswaran A;Gunawardena NK;Jayamanne SF;Isbister GK;Dawson A;Lalloo DG;de Silva HJ
通讯作者：
de Silva HJ
影响因子：
15.8
作者：
Kasturiratne A;Wickremasinghe AR;de Silva N;Gunawardena NK;Pathmeswaran A;Premaratna R;Savioli L;Lalloo DG;de Silva HJ
通讯作者：
de Silva HJ
影响因子：
1.4
作者：
Brown, GP;Shine, R;Madsen, T
通讯作者：
Madsen, T
影响因子：
5.9
作者：
Daltry, JC;Ross, T;Wuster, W
通讯作者：
Wuster, W