Format

Send to

Choose Destination
Am J Epidemiol. 2014 May 15;179(10):1247-54. doi: 10.1093/aje/kwu034. Epub 2014 Apr 15.

Ask when--not just whether--it's a risk: How regional context influences local causes of diarrheal disease.

Abstract

Contemporary epidemiology is enriched when it incorporates ecological concepts about systems and dependencies. With regard to diarrheal disease, the causes of which are many and interacting, the dynamics of within- and between-community disease transmission have distinct components but are also linked in important ways. However, few investigators have studied how regional-scale disease dynamics affect local patterns of diarrheal disease transmission. Characterizing this dependence is important for identifying local- and regional-level transmission pathways. We used data from active surveillance of diarrheal disease prevalence gathered from February 2004 through July 2007 in 21 neighboring Ecuadorian villages to estimate how disease prevalence in spatially and temporally proximate villages modulates the influences of village-level risk and protective factors. We found that the impact of local, village-level interventions such as improved latrines and water treatment can be quite different under conditions of high and low regional disease prevalence. In particular, water treatment was effective only when regional disease prevalence was low, suggesting that person-to-person spread, not waterborne spread, is probably responsible for most between-village transmission in this region. Additional regional-scale data could enhance our understanding of how regional-scale transmission affects local-scale dynamics.

KEYWORDS:

diarrhea; disease transmission; epidemiologic methods; meta-populations; sanitation; surveillance

PMID:
24740889
PMCID:
PMC4010187
DOI:
10.1093/aje/kwu034
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center