Department of Environmental Health Science and Technology, Jimma University, Jimma, Ethiopia.
Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
Sci Rep. 2020 Jul 3;10(1):10997. doi: 10.1038/s41598-020-67623-0.
Under-five children (U5-children) diarrhea is a significant public health threat, where the World Health Organisation (WHO) reported it as the second leading cause of children's death worldwide. Nearly 1.7 billion cases occur annually with varied temporal and spatial factors. Identification of the spatiotemporal pattern and hotspot areas of U5-children diarrhea can assist targeted intervention and provide an early warning for more effective response measures. This study aimed at examining spatiotemporal variability along with the detection of hotspot areas for U5-children diarrhea in the Bench Maji Zone of southwestern Ethiopia, where resources are limited and cultural heterogeneity is highest. Retrospective longitudinal data of ten years of diarrhea records from January 2008 to December 2017 were used to identify hotspot areas. The incidence rate per 1,000 per year among children was calculated along with seasonal patterns of cases. The spatiotemporal analysis was made using SaTScan version 9.4, while spatial autocorrelations and hotspot identification were generated using ArcGIS 10.5 software. A total of 90,716 U5-children diarrhea cases were reported with an annual incidence rate of 36.1 per 1,000 U5-children, indicating a relative risk (RR) of 1.6 and a log-likelihood ratio (LLR) of 1,347.32 (p < 0.001). The highest incidence of diarrhea illness was recorded during the dry season and showed incidence rate increment from October to February. The risky clusters (RR > 1) were in the districts of Bero, Maji, Surma, Minit Shasha, Guraferda, Mizan Aman Town, and Sheko with annual cases of 127.93, 68.5, 65.12, 55.03, 55.67, 54.14 and 44.97 per 1,000, respectively. The lowest annual cases reported were in the four districts of Shay Bench, South Bench, North Bench, and Minit Goldiya, where RR was less than a unit. Six most likely clusters (Bero, Minit Shasha, Surma, Guraferda, South Bench, and Maji) and one lower RR area (North Bench) were hotspot districts. The U5-children's diarrhea in the study area showed an overall increasing trend during the dry seasons with non-random distribution over space and time. The data recorded during ten years and analyzed with the proper statistical tools helped to identify the hotspot areas with risky seasons where diarrhea could increase.
五岁以下儿童（U5-children）腹泻是一个严重的公共卫生威胁，世界卫生组织（WHO）报告称，这是全球儿童死亡的第二大主要原因。每年几乎有 17 亿例病例，其发生与时间和空间因素有关。识别 U5-children 腹泻的时空变化模式和热点地区可以协助针对性干预，并为更有效的应对措施提供早期预警。本研究旨在探讨埃塞俄比亚西南部本奇马吉地区 U5-children 腹泻的时空变异性，并检测热点地区，该地区资源有限，文化异质性最高。使用 2008 年 1 月至 2017 年 12 月十年的腹泻记录回顾性纵向数据来识别热点地区。计算了每年每 1000 名儿童的发病率，以及病例的季节性模式。使用 SaTScan 版本 9.4 进行时空分析，使用 ArcGIS 10.5 软件生成空间自相关和热点识别。报告了 90716 例 U5-children 腹泻病例，每年发病率为 36.1/1000 U5-children，表明相对风险（RR）为 1.6，对数似然比（LLR）为 1347.32（p < 0.001）。腹泻病发病率最高的是在旱季，发病率从 10 月到 2 月逐月增加。风险聚类（RR > 1）出现在 Bero、Maji、Surma、Minit Shasha、Guraferda、Mizan Aman 镇和 Sheko 区，每年的病例数分别为 127.93、68.5、65.12、55.03、55.67、54.14 和 44.97/1000。报告的最低年度病例数是在 Shay Bench、South Bench、North Bench 和 Minit Goldiya 四个区，RR 小于 1 个单位。最有可能的六个聚类（Bero、Minit Shasha、Surma、Guraferda、South Bench 和 Maji）和一个 RR 较低的区域（North Bench）是热点区。研究区五岁以下儿童腹泻在旱季呈总体上升趋势，空间和时间分布不均。通过十年的记录和适当的统计工具分析，有助于确定风险季节和热点地区，这些地区腹泻可能会增加。
