Department of Geography, CB3220, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA.
Environ Health. 2010 Mar 22;9:13. doi: 10.1186/1476-069X-9-13.
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.
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.
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.
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.
改变自然或历史上的水流会对那些存在水传播疾病且对这种变化的流行病学影响了解甚少的地区产生意想不到的后果。在孟加拉国 Matlab 的一部分人口密集地区实施洪水防护措施，使我们能够检验旨在控制河流洪水的措施是否会对霍乱结果产生积极或消极的影响。
我们使用零膨胀负二项式模型，检验选定的协变量如何同时解释报告无霍乱的家庭集群与具有阳性计数的家庭集群，并区分低计数的居住区域和高霍乱计数的区域。我们的目标是检验居住在洪水保护区内或外与霍乱存在的概率以及洪水保护对霍乱流行程度的影响之间的相互作用。
在 Matlab，免受年度季风洪水侵袭的家庭居住环境似乎对家庭是否经历霍乱没有显著影响，而其他协变量的影响则被净除。然而，与直觉相反的是，在报告霍乱的家庭中，居住在洪水保护区内的家庭霍乱病例数显著增加。
出于经济或社会动机而建造水坝或其他蓄水策略可能会对水传播疾病产生深远而意想不到的后果。我们的结果表明，在孟加拉国农村建造防洪结构与免受年度季风洪水侵袭的居民霍乱病例增加有关。这种发现需要卫生界以及参与正在进行的水资源管理计划的政府和非政府组织的关注。
