School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou 510275, China.
Int J Environ Res Public Health. 2020 Mar 23;17(6):2140. doi: 10.3390/ijerph17062140.
Diarrhea in children under five years of age remains a challenge in reducing child mortality in Nepal. Understanding the spatiotemporal patterns and influencing factors of the disease is important for control and intervention.
Data regarding diarrhea prevalence and its potential influencing factors were extracted from the Demographic and Health Surveys in Nepal and other open-access databases. A Bayesian logistic regression model with district-specific spatio-temporal random effects was applied to explore the space and time patterns of diarrhea risk, as well as the relationships between the risk and the potential influencing factors.
Both the observed prevalence and the estimated spatiotemporal effects show a decreasing diarrhea risk trend from 2006 to 2016 in most districts of Nepal, with a few exceptions, such as Achham and Rasuwa. The disease risk decreased with mothers' years of education ( 0.93, 95% Bayesian Credible Interval (BCI) 0.87, 0.997). Compared to spring, autumn and winter had lower risks of diarrhea. The risk firstly increased and then decreased with age and children under 12-24 months old were the highest risk group ( 1.20, 95% BCI 1.04, 1.38). Boys had higher risk than girls ( 1.24, 95% BCI 1.13, 1.39). Even though improved sanitation wasn't found significant within a 95% BCI, there was 93.2% of chance of it being a protective factor. There were no obvious spatiotemporal clusters among districts and each district tended to have its own spatiotemporal diarrhea prevalence pattern.
The important risk factors identified by our Bayesian spatial-temporal modeling provide insights for control and intervention on children diarrhea in Nepal. Special attention should be paid to high risk groups of children and high risk seasons, as well as districts with high risk or increased trend of risk. Effective actions should be implemented to improve sanitation and women's education level. District-specific control planning is recommended for local governments for effective control of children diarrhea in Nepal.
五岁以下儿童腹泻仍然是尼泊尔降低儿童死亡率的一个挑战。了解疾病的时空分布模式和影响因素对于控制和干预至关重要。
从尼泊尔的人口与健康调查和其他公开获取的数据库中提取有关腹泻患病率及其潜在影响因素的数据。应用具有地区特定时空随机效应的贝叶斯逻辑回归模型，以探讨腹泻风险的空间和时间模式，以及风险与潜在影响因素之间的关系。
在尼泊尔的大多数地区，无论是观察到的患病率还是估计的时空效应都显示出 2006 年至 2016 年期间腹泻风险呈下降趋势，但也有一些例外，如阿恰姆和拉苏瓦。患病风险随母亲受教育年限的增加而降低（0.93，95%贝叶斯可信区间（BCI）0.87，0.997）。与春季相比，秋季和冬季腹泻的风险较低。风险随年龄先增加后降低，12-24 个月以下的儿童是最高风险组（1.20，95%BCI 1.04，1.38）。男孩的风险高于女孩（1.24，95%BCI 1.13，1.39）。尽管在 95%BCI 内没有发现卫生改善具有显著意义，但仍有 93.2%的可能性是保护因素。各地区之间没有明显的时空聚类，每个地区都倾向于有自己的时空腹泻流行模式。
我们的贝叶斯时空模型确定的重要风险因素为尼泊尔儿童腹泻的控制和干预提供了思路。应特别关注儿童高风险群体和高风险季节，以及风险较高或风险呈上升趋势的地区。应采取有效行动改善卫生条件和提高妇女教育水平。建议地方政府制定针对特定地区的控制计划，以有效控制尼泊尔儿童腹泻。
