Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
Department of Global Health Policy, School of International Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
PLoS Negl Trop Dis. 2024 Oct 15;18(10):e0011834. doi: 10.1371/journal.pntd.0011834. eCollection 2024 Oct.
Diarrhoeal diseases cause a heavy burden in developing countries. Although studies have described the seasonality of diarrhoeal diseases, the association of weather variables with diarrhoeal diseases has not been well characterized in resource-limited settings where the burden remains high. We examined short-term associations between ambient temperature, precipitation and hospital visits due to diarrhoea among children in seven low- and middle-income countries.
Hospital visits due to diarrhoeal diseases under 5 years old were collected from seven sites in The Gambia, Mali, Mozambique, Kenya, India, Bangladesh, and Pakistan via the Global Enteric Multicenter Study from December 2007 to March 2011. Daily weather data during the same period were downloaded from the ERA5-Land. We fitted time-series regression models to examine the relationships of daily diarrhoea cases with daily ambient temperature and precipitation. Then, we used meta-analytic tools to examine the heterogeneity between the site-specific estimates.
The cumulative relative risk (RR) of diarrhoea for temperature exposure (95th percentile vs. 1st percentile) ranged from 0.24 to 8.07, with Mozambique and Bangladesh showing positive associations, while Mali and Pakistan showed negative associations. The RR for precipitation (95th percentile vs. 1st percentile) ranged from 0.77 to 1.55, with Mali and India showing positive associations, while the only negative association was observed in Pakistan. Meta-analysis showed substantial heterogeneity in the association between temperature-diarrhoea and precipitation-diarrhoea across sites, with I2 of 84.2% and 67.5%, respectively.
Child diarrhoea and weather factors have diverse and complex associations across South Asia and Sub-Saharan Africa. Diarrhoeal surveillance system settings should be conceptualized based on the observed pattern of climate change in these locations.
腹泻病在发展中国家造成了沉重负担。尽管已有研究描述了腹泻病的季节性，但在资源有限的环境中，天气变量与腹泻病的关联尚未得到很好的描述，而这些地区的负担仍然很高。我们研究了七个低收入和中等收入国家的儿童因腹泻而住院的情况与环境温度、降水之间的短期关联。
通过全球肠道多中心研究，我们于 2007 年 12 月至 2011 年 3 月在冈比亚、马里、莫桑比克、肯尼亚、印度、孟加拉国和巴基斯坦的七个地点收集了 5 岁以下儿童因腹泻而住院的病例。同期的每日天气数据从 ERA5-Land 下载。我们拟合了时间序列回归模型，以研究每日腹泻病例与每日环境温度和降水之间的关系。然后，我们使用荟萃分析工具检查了特定地点估计值之间的异质性。
温度暴露（第 95 百分位与第 1 百分位）的腹泻累积相对风险（RR）范围为 0.24 至 8.07，莫桑比克和孟加拉国呈正相关，而马里和巴基斯坦呈负相关。降水的 RR（第 95 百分位与第 1 百分位）范围为 0.77 至 1.55，马里和印度呈正相关，而巴基斯坦仅呈负相关。荟萃分析表明，温度与腹泻和降水与腹泻之间的关联在各地点之间存在很大的异质性，分别为 84.2%和 67.5%。
南亚和撒哈拉以南非洲地区儿童腹泻病和天气因素之间存在多样化且复杂的关联。腹泻病监测系统的设置应基于这些地区观察到的气候变化模式来构思。
