Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia.
Vector-Borne Diseases Control Programme, Department of Public Health, Ministry of Health, Thimphu, Bhutan.
Sci Rep. 2021 Oct 14;11(1):20422. doi: 10.1038/s41598-021-99137-8.
Pneumonia is one of the top 10 diseases by morbidity in Bhutan. This study aimed to investigate the spatial and temporal trends and risk factors of childhood pneumonia in Bhutan. A multivariable Zero-inflated Poisson regression model using a Bayesian Markov chain Monte Carlo simulation was undertaken to quantify associations of age, sex, altitude, rainfall, maximum temperature and relative humidity with monthly pneumonia incidence and to identify the underlying spatial structure of the data. Overall childhood pneumonia incidence was 143.57 and 10.01 per 1000 persons over 108 months of observation in children aged < 5 years and 5-14 years, respectively. Children < 5 years or male sex were more likely to develop pneumonia than those 5-14 years and females. Each 1 °C increase in maximum temperature was associated with a 1.3% (95% (credible interval [CrI] 1.27%, 1.4%) increase in pneumonia cases. Each 10% increase in relative humidity was associated with a 1.2% (95% CrI 1.1%, 1.4%) reduction in the incidence of pneumonia. Pneumonia decreased by 0.3% (CrI 0.26%, 0.34%) every month. There was no statistical spatial clustering after accounting for the covariates. Seasonality and spatial heterogeneity can partly be explained by the association of pneumonia risk to climatic factors including maximum temperature and relative humidity.
肺炎是不丹发病率排名前十的疾病之一。本研究旨在调查不丹儿童肺炎的时空趋势和危险因素。采用多变量零膨胀泊松回归模型和贝叶斯马尔可夫链蒙特卡罗模拟，定量分析年龄、性别、海拔、降雨量、最高温度和相对湿度与每月肺炎发病率的关系，并确定数据的潜在空间结构。在观察的 108 个月中，<5 岁儿童的总体肺炎发病率为每 1000 人 143.57 例，5-14 岁儿童为 10.01 例。<5 岁的儿童或男性比 5-14 岁的儿童和女性更容易患肺炎。最高温度每升高 1°C，肺炎病例就会增加 1.3%（95%可信区间为 1.27%，1.4%）。相对湿度每增加 10%，肺炎发病率就会降低 1.2%（95%可信区间为 1.1%，1.4%）。每月肺炎发病率下降 0.3%（95%可信区间为 0.26%，0.34%）。在考虑了协变量后，没有发现统计上的空间聚类。季节性和空间异质性部分可以通过肺炎风险与包括最高温度和相对湿度在内的气候因素的关联来解释。
