Ali Mohammad, Sen Gupta Sanjukta, Arora Nisha, Khasnobis Pradeep, Venkatesh Srinivas, Sur Dipika, Nair Gopinath B, Sack David A, Ganguly Nirmal K
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Policy Center for Biomedical Research, Translational Health Science and Technology Institute, New Delhi, India.
PLoS One. 2017 Aug 24;12(8):e0183100. doi: 10.1371/journal.pone.0183100. eCollection 2017.
Even though cholera has existed for centuries and many parts of the country have sporadic, endemic and epidemic cholera, it is still an under-recognized health problem in India. A Cholera Expert Group in the country was established to gather evidence and to prepare a road map for control of cholera in India. This paper identifies cholera burden hotspots and factors associated with an increased risk of the disease.
METHODOLOGY/PRINCIPLE FINDINGS: We acquired district level data on cholera case reports of 2010-2015 from the Integrated Disease Surveillance Program. Socioeconomic characteristics and coverage of water and sanitation was obtained from the 2011 census. Spatial analysis was performed to identify cholera hotspots, and a zero-inflated Poisson regression was employed to identify the factors associated with cholera and predicted case count in the district. 27,615 cholera cases were reported during the 6-year period. Twenty-four of 36 states of India reported cholera during these years, and 13 states were classified as endemic. Of 641 districts, 78 districts in 15 states were identified as "hotspots" based on the reported cases. On the other hand, 111 districts in nine states were identified as "hotspots" from model-based predicted number of cases. The risk for cholera in a district was negatively associated with the coverage of literate persons, households using treated water source and owning mobile telephone, and positively associated with the coverage of poor sanitation and drainage conditions and urbanization level in the district.
CONCLUSIONS/SIGNIFICANCE: The study reaffirms that cholera continues to occur throughout a large part of India and identifies the burden hotspots and risk factors. Policymakers may use the findings of the article to develop a roadmap for prevention and control of cholera in India.
尽管霍乱已存在数百年，且该国许多地区都有霍乱的散发病例、地方病例和流行病例，但在印度，霍乱仍是一个未得到充分认识的健康问题。该国成立了一个霍乱专家组，以收集证据并制定印度霍乱控制路线图。本文确定了霍乱负担热点地区以及与疾病风险增加相关的因素。
方法/主要发现：我们从综合疾病监测计划中获取了2010 - 2015年各地区霍乱病例报告数据。社会经济特征以及水和卫生设施的覆盖情况来自2011年人口普查。进行空间分析以确定霍乱热点地区，并采用零膨胀泊松回归来确定与霍乱相关的因素以及各地区预测病例数。在这6年期间共报告了27,615例霍乱病例。印度36个邦中有24个邦在这些年报告了霍乱病例，13个邦被归类为霍乱流行地区。在641个区中，根据报告病例，15个邦的78个区被确定为“热点地区”。另一方面，根据模型预测病例数，9个邦的111个区被确定为“热点地区”。一个地区的霍乱风险与识字人口覆盖率、使用经处理水源的家庭以及拥有移动电话的情况呈负相关，与卫生条件差和排水条件以及该地区城市化水平呈正相关。
结论/意义：该研究再次证实霍乱在印度大部分地区持续存在，并确定了负担热点地区和风险因素。政策制定者可利用本文的研究结果制定印度霍乱预防和控制路线图。
