Jochem Warren C, Razzaque Abdur, Root Elisabeth Dowling
Department of Geography and Environment, University of Southampton, University Road, Southampton, SO17 1BJ, UK.
Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
Int J Health Geogr. 2016 Sep 1;15(1):32. doi: 10.1186/s12942-016-0061-9.
Respiratory infections continue to be a public health threat, particularly to young children in developing countries. Understanding the geographic patterns of diseases and the role of potential risk factors can help improve future mitigation efforts. Toward this goal, this paper applies a spatial scan statistic combined with a zero-inflated negative-binomial regression to re-examine the impacts of a community-based treatment program on the geographic patterns of acute lower respiratory infection (ALRI) mortality in an area of rural Bangladesh. Exposure to arsenic-contaminated drinking water is also a serious threat to the health of children in this area, and the variation in exposure to arsenic must be considered when evaluating the health interventions.
ALRI mortality data were obtained for children under 2 years old from 1989 to 1996 in the Matlab Health and Demographic Surveillance System. This study period covers the years immediately following the implementation of an ALRI control program. A zero-inflated negative binomial (ZINB) regression model was first used to simultaneously estimate mortality rates and the likelihood of no deaths in groups of related households while controlling for socioeconomic status, potential arsenic exposure, and access to care. Next a spatial scan statistic was used to assess the location and magnitude of clusters of ALRI mortality. The ZINB model was used to adjust the scan statistic for multiple social and environmental risk factors.
The results of the ZINB models and spatial scan statistic suggest that the ALRI control program was successful in reducing child mortality in the study area. Exposure to arsenic-contaminated drinking water was not associated with increased mortality. Higher socioeconomic status also significantly reduced mortality rates, even among households who were in the treatment program area.
Community-based ALRI interventions can be effective at reducing child mortality, though socioeconomic factors may continue to influence mortality patterns. The combination of spatial and non-spatial methods used in this paper has not been applied previously in the literature, and this study demonstrates the importance of such approaches for evaluating and improving public health intervention programs.
呼吸道感染仍然是一种公共卫生威胁，对发展中国家的幼儿尤其如此。了解疾病的地理分布模式以及潜在风险因素的作用有助于改进未来的缓解措施。为实现这一目标，本文应用空间扫描统计方法并结合零膨胀负二项回归，重新审视基于社区的治疗项目对孟加拉国农村某地区急性下呼吸道感染（ALRI）死亡率地理分布模式的影响。接触受砷污染的饮用水也是该地区儿童健康的严重威胁，在评估健康干预措施时必须考虑砷暴露的差异。
从Matlab健康与人口监测系统获取了1989年至1996年2岁以下儿童的ALRI死亡率数据。本研究期涵盖了ALRI控制项目实施后的几年。首先使用零膨胀负二项（ZINB）回归模型，在控制社会经济地位、潜在砷暴露和获得医疗服务的情况下，同时估计相关家庭组中的死亡率和无死亡的可能性。接下来，使用空间扫描统计方法评估ALRI死亡率聚集区的位置和规模。ZINB模型用于针对多种社会和环境风险因素调整扫描统计量。
ZINB模型和空间扫描统计结果表明，ALRI控制项目成功降低了研究区域内的儿童死亡率。接触受砷污染的饮用水与死亡率增加无关。较高的社会经济地位也显著降低了死亡率，即使在治疗项目区域内的家庭中也是如此。
基于社区的ALRI干预措施在降低儿童死亡率方面可能是有效的，尽管社会经济因素可能继续影响死亡模式。本文使用的空间和非空间方法的结合在以往文献中未曾应用，本研究证明了此类方法对评估和改进公共卫生干预项目的重要性。
