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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.
It is predicted that the integration of climate-based early warning systems into existing action plans will facilitate the timely provision of interventions to diarrheal disease epidemics in resource-poor settings. Diarrhea remains a considerable public health problem in Ho Chi Minh City (HCMC), Vietnam and we aimed to quantify variation in the impact of environmental conditions on diarrheal disease risk across the city. 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
Environmental Drivers of Diarrheal Disease Risk in Ho Chi Minh City, Vietnam
Background: Despite recent advances in hygiene and sanitation, diarrheal disease remains a lead in cause of mortality in children under five. Reducing the global burden of diarrheal disease necessitates further understanding of the drivers of diarrheal disease incidence. Poorly understood
are the impacts of environmental factors on diarrheal disease transmission rates, with rainfall and flooding of particular interest given the role that water plays in spreading fecal contaminants.
Methods: Using a unique dataset collected over six years in Ho Chi Minh City, Vietnam, spatiotemporal
variability in all-cause diarrheal disease incidence was assessed. Rainfall, water level,
humidity, and temperature were evaluated as possible drivers of diarrheal disease incidence. Elevation,
socioeconomic status, imperviousness, and rain runoff were tested for their ability to mediate
the effect of environmental factors on diarrheal disease incidence. Additionally, an epidemic
model was developed to further explore the transmission dynamics of rotavirus, known to cause
a high number of diarrhea hospitalizations in Ho Chi Minh City.
Results: All of the environmental factors evaluated were significantly associated with diarrheal disease incidence during the study period, indicating that environmental fluctuations drive diarrheal disease incidence. Rainfall was negatively associated with diarrhea, whereas flooding was positively associated with diarrhea. Additionally, elevation was found to have a protective effect
against diarrhea. Higher elevation districts experienced fewer diarrhea hospitalizations, suggesting that these districts were less susceptible to diarrheal disease transmission driven by flooding. The significance of these findings is tempered by the suggestion that environmental effects vary by enteropathogen. The results of the epidemic model indicate that rotavirus incidence is driven by
intrinsic seasonality, rather than fluctuations in environmental factors.Conclusions: Targeting environmental drivers of diarrheal disease has the potential to serve as
a meaningful strategy for reducing diarrheal disease incidence. For example, the protective effects
of rainfall and elevation can be replicated through decontamination of aquatic reservoirs and flood-contral effots. At the same time, the widespread prevalence of rotavirus and other enteropathogens with limited susceptibility to environmental factors indicates the importance of
vaccination as a control measure