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IJE Advance Access published online on July 30, 2007
International Journal of Epidemiology, doi:10.1093/ije/dym148
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Published by Oxford University Press on behalf of the International Epidemiological Association.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

Association between climate variability and hospital visits for non-cholera diarrhoea in Bangladesh: effects and vulnerable groups

Masahiro Hashizume1,2,*, Ben Armstrong1, Shakoor Hajat1, Yukiko Wagatsuma3, Abu SG Faruque4, Taiichi Hayashi5 and David A Sack4

1Public and Environmental Health Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
2Research Center for Tropical Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-12-4, Nagasaki City, Nagasaki 852-8523, Japan.
3Department of Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaragi 305-8575, Japan.
4ICDDR,B: Centre for Health and Population Research, Bangladesh, Mohakhali (GPO Box 128, Dhaka 1000) Dhaka 1212, Bangladesh.
5Disaster Prevention Research Institute, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan.

* Corresponding author. Research Center for Tropical Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Sakamoto 1-12-4, Nagasaki City, Nagasaki 852-8523, Japan. E-mail: hashizum{at}nagasaki-u.ac.jp


  Abstract

Background We estimated the effects of rainfall and temperature on the number of non-cholera diarrhoea cases and identified population factors potentially affecting vulnerability to the effect of the climate factors in Dhaka, Bangladesh.

Methods Weekly rainfall, temperature and number of hospital visits for non-cholera diarrhoea were analysed by time-series regression. A Poisson regression model was used to model the relationships controlling for seasonally varying factors other than the weather variables. Modifications of weather effects were investigated by fitting the models separately to incidence series according to their characteristics (sex, age, socio-economic, hygiene and sanitation status).

Results The number of non-cholera diarrhoea cases per week increased by 5.1% (95% CI: 3.3–6.8) for every 10 mm increase above the threshold of 52 mm of average rainfall over lags 0–8 weeks. The number of cases also increased by 3.9% (95% CI: 0.6–7.2) for every 10 mm decrease below the same threshold of rainfall. Ambient temperature was also positively associated with the number of non-cholera diarrhoea cases. There was no evidence for the modification of both ‘high and low rainfall’ effects by individual characteristics, while the effect of temperature was higher amongst those individuals at a lower educational attainment and unsanitary toilet users.

Conclusions The number of non-cholera diarrhoea cases increased both above and below a threshold level with high and low rainfall in the preceding weeks. The number of cases also increased with higher temperature, particularly in those individuals at a lower socio-economic and sanitation status.

Keywords Bangladesh, diarrhoea, non-cholera, rainfall, season, temperature, time-series, weather

Accepted 18 June 2007


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