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孟加拉国一个霍乱流行地区的霍乱空间流行病学

The spatial epidemiology of cholera in an endemic area of Bangladesh.

作者信息

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

机构信息

International Vaccine Institute, Seoul, South Korea.

出版信息

Soc Sci Med. 2002 Sep;55(6):1015-24. doi: 10.1016/s0277-9536(01)00230-1.

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.

摘要

本文基于孟加拉国一个霍乱流行地区该疾病的环境风险因素,界定了霍乱的高风险区域。这些风险因素包括靠近地表水、人口密度高以及教育水平低,这些是作者在早期研究中确定的。霍乱数据按空间参照的扩展家庭单位,针对1983 - 1987年和1992 - 1996年这两个时间段进行了分析。选择这两个时间段是因为它们有着不同的主要霍乱病原体。1983 - 1987年,古典生物型霍乱占主导,1992 - 1996年,埃尔托生物型霍乱占主导。通过基于风险因素界定高风险区域,本研究构建了一个霍乱的空间风险模型。然后根据观察到的霍乱病例位置对该模型进行评估。该研究还确定了在由不同霍乱病原体主导的两个不同时间段内,霍乱致死的决定因素。发现基于风险因素建模的风险区域与霍乱发病率和死亡率的实际分布相对应。主要霍乱病原体的高风险区域随时间相对稳定。然而,在1983 - 1987年期间并非主要病原体的埃尔托生物型霍乱,与高风险区域并无关联,这表明埃尔托生物型霍乱的栖息地可能随时间发生了变化。在研究区域,霍乱的病死率与靠近腹泻治疗医院有关。

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