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The impact of environmental and climatic variation on the spatiotemporal trends of hospitalized pediatric diarrhea in Ho Chi Minh City, Vietnam.

Thompson CN, Zelner JL, Nhu Tdo H, Phan MV, Hoang Le P, Nguyen Thanh H, Vu Thuy D, Minh Nguyen N, Ha Manh T, Van Hoang Minh T, Lu Lan V, Nguyen Van Vinh C, Tran Tinh H, von Clemm E, Storch H, Thwaites G, Grenfell BT, Baker S - Health Place (2015)

Bottom Line: Using all inpatient diarrheal admissions data from three large hospitals within HCMC, we developed a mixed effects regression model to differentiate district-level variation in risk due to environmental conditions from the overarching seasonality of diarrheal disease hospitalization in HCMC.We identified considerable spatial heterogeneity in the risk of all-cause diarrhea across districts of HCMC with low elevation and differential responses to flooding, air temperature, and humidity driving further spatial heterogeneity in diarrheal disease risk.The incorporation of these results into predictive forecasting algorithms will provide a powerful resource to aid diarrheal disease prevention and control practices in HCMC and other similar settings.

View Article: PubMed Central - PubMed

Affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom; The London School of Hygiene & Tropical Medicine, United Kingdom. Electronic address: cthompson@oucru.org.

No MeSH data available.


Related in: MedlinePlus

The citywide monthly relative risk of diarrheal disease across Ho Chi Minh City. The solid line in the figure shows the relative risk (RR) of diarrheal disease, as compared to the population-level intercept in Table 1. The shaded region represents the 95% confidence interval for each of the monthly effects. The dashed line is a guide for assessing statistical significance; monthly effects spanning this line are significantly different from the average rate.
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f0015: The citywide monthly relative risk of diarrheal disease across Ho Chi Minh City. The solid line in the figure shows the relative risk (RR) of diarrheal disease, as compared to the population-level intercept in Table 1. The shaded region represents the 95% confidence interval for each of the monthly effects. The dashed line is a guide for assessing statistical significance; monthly effects spanning this line are significantly different from the average rate.

Mentions: In each year, the relative risk of reported diarrhea at the city level rose rapidly during the final weeks of the year, followed by a peak period lasting from 1 to 2 months. The citywide intercepts for each month of the study are highlighted in Fig. 3. Further, the elevation of each district was strongly related to the reported rate of diarrheal illness (Table 1 and Fig. 4). The RR of a one-meter increase in elevation was 0.95 (95%CI:0.92, 0.97). Therefore, the district with the lowest median elevation (0.32 m) experienced nearly double the risk of the highest district (7.95 m) (RR=0.57, 95%CI:0.31, 0.74). In further models incorporating both elevation and waterway coverage as fixed effects, the influence of waterways was non-significant, although this became significant when elevation was excluded. However, the inverse relationship between average district elevation and the proportion of district area covered by waterways (Pearson's R=−0.59, 95%CI:−0.80, −0.25) suggest that waterway coverage may explain some of the risk associated with lower elevation. Finally, district-level elevation was not associated with distance from CH1 (β=0.07, 95%CI=−2.76, 2.90), suggesting that adjustment for distance to the largest and most centrally located hospital does not confound the effect of elevation.


The impact of environmental and climatic variation on the spatiotemporal trends of hospitalized pediatric diarrhea in Ho Chi Minh City, Vietnam.

Thompson CN, Zelner JL, Nhu Tdo H, Phan MV, Hoang Le P, Nguyen Thanh H, Vu Thuy D, Minh Nguyen N, Ha Manh T, Van Hoang Minh T, Lu Lan V, Nguyen Van Vinh C, Tran Tinh H, von Clemm E, Storch H, Thwaites G, Grenfell BT, Baker S - Health Place (2015)

The citywide monthly relative risk of diarrheal disease across Ho Chi Minh City. The solid line in the figure shows the relative risk (RR) of diarrheal disease, as compared to the population-level intercept in Table 1. The shaded region represents the 95% confidence interval for each of the monthly effects. The dashed line is a guide for assessing statistical significance; monthly effects spanning this line are significantly different from the average rate.
© Copyright Policy - CC BY
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664115&req=5

f0015: The citywide monthly relative risk of diarrheal disease across Ho Chi Minh City. The solid line in the figure shows the relative risk (RR) of diarrheal disease, as compared to the population-level intercept in Table 1. The shaded region represents the 95% confidence interval for each of the monthly effects. The dashed line is a guide for assessing statistical significance; monthly effects spanning this line are significantly different from the average rate.
Mentions: In each year, the relative risk of reported diarrhea at the city level rose rapidly during the final weeks of the year, followed by a peak period lasting from 1 to 2 months. The citywide intercepts for each month of the study are highlighted in Fig. 3. Further, the elevation of each district was strongly related to the reported rate of diarrheal illness (Table 1 and Fig. 4). The RR of a one-meter increase in elevation was 0.95 (95%CI:0.92, 0.97). Therefore, the district with the lowest median elevation (0.32 m) experienced nearly double the risk of the highest district (7.95 m) (RR=0.57, 95%CI:0.31, 0.74). In further models incorporating both elevation and waterway coverage as fixed effects, the influence of waterways was non-significant, although this became significant when elevation was excluded. However, the inverse relationship between average district elevation and the proportion of district area covered by waterways (Pearson's R=−0.59, 95%CI:−0.80, −0.25) suggest that waterway coverage may explain some of the risk associated with lower elevation. Finally, district-level elevation was not associated with distance from CH1 (β=0.07, 95%CI=−2.76, 2.90), suggesting that adjustment for distance to the largest and most centrally located hospital does not confound the effect of elevation.

Bottom Line: Using all inpatient diarrheal admissions data from three large hospitals within HCMC, we developed a mixed effects regression model to differentiate district-level variation in risk due to environmental conditions from the overarching seasonality of diarrheal disease hospitalization in HCMC.We identified considerable spatial heterogeneity in the risk of all-cause diarrhea across districts of HCMC with low elevation and differential responses to flooding, air temperature, and humidity driving further spatial heterogeneity in diarrheal disease risk.The incorporation of these results into predictive forecasting algorithms will provide a powerful resource to aid diarrheal disease prevention and control practices in HCMC and other similar settings.

View Article: PubMed Central - PubMed

Affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom; The London School of Hygiene & Tropical Medicine, United Kingdom. Electronic address: cthompson@oucru.org.

No MeSH data available.


Related in: MedlinePlus