Detection of spatial, temporal and spatiotemporal distribution of diarrhea incidence among under-five children in Central Gondar zone, Northwest Ethiopia: a time-series study (2019-2022)

Abstract

Under-five children's diarrhea is a significant public health threat and the World Health Organization (WHO) reported it as the second leading cause of children's death worldwide. In this study area, little is known about the spatiotemporal distribution of under-5 diarrhea incidence. This study was therefore, conducted among all districts in the Central Gondar zone to assess the spatial, temporal, and spatiotemporal variation in diarrhea incidence among under-five children in the Central Gondar zone. The data for children under 5 years of age with diarrhea was obtained from Central Gondar Zone Health Department diarrhea reports from January 2019 to December 2022. All districts were included and geo-coded. The spatial data were created in ArcGIS 10.8.1. Global and local spatial autocorrelation were used to detect hot spots and cold spots. The Poisson model was generated by applying the Kulldorff method in SaTScan™9.6 to analyse the the purely temporal, spatial, and space-time clusters. The study revealed spatial variation of under-5 diarrhea where Gondar City, Gondar Zuria, East Dembia, and Lay Armacho districts were the high-rate spatial clusters during the study period. A year search window for temporal scan statistic identified 01 January 2020-30 December 2021 as risk periods across all districts. Spatiotemporal scan statistics detected high-rate clusters at Gondar City, Gondar Zuria, East Dembia, Lay Armacho, and Alefa between 2019 and 2022. In conclusion, there has been a spatial, temporal, and spatiotemporal variability of under-5 children's diarrhea in the Central Gondar Zone. Interventional and preventive strategies should be developed and given priority to the areas that has been detected as a hotspot in this study to reduce the mortality and morbidity of under 5 children.

Keywords: Diarrhea incidence; Distribution; Spatial; Spatiotemporal; Temporal; Under-5 children.

Fig. 1

Map of central gondar zone, northwest Ethiopia, Ethiopia. The study area map was created by running on Arc Gis version 10.7.1. (https://www.arcgis.com/index.html)

Fig. 2

Yearly trend of diarrhea incidence among under-five children from 2019–2022 in the central Gondar zone, Northwest Ethiopia

Fig. 3

Monthly and yearly variation in diarrhea cases among children under-5 years of age in the Central Gondar Zone, Northwest Ethiopia

Fig. 4

Spatial autocorrelation based on feature locations and attribute values (average cumulative annual diarrhea incidence among under-5children) calculated using the Global Moran’s I statistic across the study area in the Central Gondar Zone, Northwest Ethiopia, January 2019-December 2022

Fig. 5

Graduated color (choropleth) map that depicts density based on the average cumulative annual diarrhea incidence among under-5children per 1000 people at risk in the Central Gondar Zone, Northwest Ethiopia, January 2019- December 2022

Fig. 6

Hotspot detection based on average cumulative annual diarrhea incidence among under-5children in the Central Gondar Zone, Northwest Ethiopia, January 2019-December 2022

Fig. 7

Spatial clustering of Under-5 Diarrhea in the Central Gondar Zone, Northwest Ethiopia, January 2019-December 2022