Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis

Margaret Carrel; Paul Voss; Peter K Streatfield; Mohammad Yunus; Michael Emch

doi:10.1186/1476-069X-9-13

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Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis

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Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis

Margaret Carrel, Paul Voss, Peter K Streatfield, Mohammad Yunus and Michael Emch

Environmental health, Vol.9(1), pp.13-13

03/22/2010

DOI: 10.1186/1476-069X-9-13

PMCID: PMC2856547

PMID: 20307294

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Abstract

Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding. Using a zero inflated negative binomial model, we examine how selected covariates can simultaneously account for household clusters reporting no cholera from those with positive counts as well as distinguishing residential areas with low counts from areas with high cholera counts. Our goal is to examine how residence within or outside a flood protected area interacts with the probability of cholera presence and the effect of flood protection on the magnitude of cholera prevalence. In Matlab, living in a household that is protected from annual monsoon flooding appears to have no significant effect on whether the household experiences cholera, net of other covariates. However, counter-intuitively, among households where cholera is reported, living within the flood protected region significantly increases the number of cholera cases. The construction of dams or other water impoundment strategies for economic or social motives can have profound and unanticipated consequences for waterborne disease. Our results indicate that the construction of a flood control structure in rural Bangladesh is correlated with an increase in cholera cases for residents protected from annual monsoon flooding. Such a finding requires attention from both the health community and from governments and non-governmental organizations involved in ongoing water management schemes.

Bangladesh - epidemiology

Cholera - epidemiology

Cholera - prevention & control

Disaster Planning

Floods

Humans

Regression Analysis

Water Movements

Details

Title: Subtitle: Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis
Creators: Margaret Carrel - University of North Carolina at Chapel Hill
Paul Voss - University of North Carolina at Chapel Hill
Peter K Streatfield - Health and Demographic Surveillance Unit, International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Bangladesh
Mohammad Yunus - Health and Demographic Surveillance Unit, International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Bangladesh
Michael Emch - University of North Carolina at Chapel Hill
Resource Type: Journal article
Publication Details: Environmental health, Vol.9(1), pp.13-13
DOI: 10.1186/1476-069X-9-13
PMID: 20307294
PMCID: PMC2856547
NLM abbreviation: Environ Health
ISSN: 1476-069X
eISSN: 1476-069X
Grant note: R01 TW008066-03 / FIC NIH HHS R24 HD050924 / NICHD NIH HHS
Language: English
Date published: 03/22/2010
Academic Unit: Epidemiology; Interdisciplinary Programs; Geographical and Sustainability Sciences; Internal Medicine
Record Identifier: 9984259631502771

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