Spatiotemporal variation of under-5 children diarrhea incidence and associated meteorological factors in central Gondar zone, Northwest Ethiopia. A retrospective time series study

Abstract

Under-5 children's diarrhea is a significant public health threat, and the World Health Organization (WHO) reported that it is the second leading cause of children's death worldwide. In this study area, little is known about the spatiotemporal distribution of under-5 children's diarrhea incidence rates. Therefore, this study was conducted to assess the spatiotemporal variation under-5 diarrhea incidence and associated meteorological factors in the Central Gondar Zone. The data for under-5 diarrhea were obtained from Central Gondar Zone Health Department diarrhea reports from January 2013 to December 2022. Climatic variables were obtained from the West Amhara Meteorological Agency. Every district was covered and given a geocode. The spatial data were created in ArcGIS 10.8.1. Global and local spatial autocorrelation were used to detect hot spots. The Poisson model, which applies the Kulldorff methods and SaTScan™9.6, was used to analyze the purely temporal, spatial, and space-time clusters. Spearman correlation and bivariate and multivariable negative binomial regressions were used to analyze the relationships between under-5 diarrhea cases and climatic factors. This study revealed spatial variation in the incidence of under-5 diarrhea, where Dembia, Gondar Zuria, and Chilga districts and Gondar Zuria, East Dembia, and Lay Armacho districts were high-rate spatial clusters between 2013 and 2018 and between 2019 and 2022, respectively. A temporal scan statistic identified 2014-2016 and 2020-2021 as risk periods across all districts. Spatiotemporal scan statistics revealed high-rate clusters in Dembia, Gondar Zuria, Chilga, Wegera, Alefa, Lay Armacho, and West Belesa between 2013 and 2018, and Gondar City, Gondar Zuria, East Dembia, Lay Armacho, and Alefa between 2019 and 2022. This study also revealed positive correlations between the number of individuals with under-5 diarrhea and the average monthly temperature at 0 and 2 lag months, with values of 1.0209 (1.0034-1.0387) and 1.0202 (1.0022-1.0385), respectively. In addition, there was a negative correlation between the number of under-5 diarrhea events and the average monthly rainfall at 0 and 2 lag months, with values of 0.999 (0.9985-0.9996) and 0.9992 (0.9987-0.9997), respectively. In conclusion, there has been spatiotemporal variability in the incidence of diarrhea in children under-5 years of age in the Central Gondar Zone. The mean monthly temperature and rainfall were positively and negatively related to the incidence of diarrhea in children under-5 years of age. Season-specific intervention strategies should be developed to reduce under-5 morbidity and mortality.

Keywords: Cluster; Spatial; Spatiotemporal; Temporal; Under-5 diarrhea incidence.

Fig. 1

Map of Central Gondar Zone, Northwest Ethiopia, Ethiopia. The study area map was plotted using ArcGIS V. 10.7 software (https://www.arcgis.com/index.html)

Fig. 2

a and b Proportion of under-5 diarrhea patients according to their sex and age respectively in the Central Gondar Zone, Northwest Ethiopia, 2023

Fig. 3

Yearly trend of diarrhea incidence among children under-5 years of age from 2013–2022 in the Central Gondar Zone, Northwest Ethiopia

Fig. 4

Monthly and yearly variation in diarrhea cases among children under-5 years of age in the Central Gondar Zone, Northwest Ethiopia, 2023

Fig. 5

Trends and seasonal variation of diarrhea incidence among children under-5 years of age in the Central Gondar Zone, Northwest Ethiopia, between January 2013 and December 2022

Fig. 6

Spatial autocorrelation based on feature locations and attribute values (average cumulative annual diarrhea incidence among children under-5 years of age calculated via the global Moran’s I statistic across the study area in the Central Gondar Zone, Northwest Ethiopia, January 2013-December 2018

Fig. 7

Graduated color (choropleth) map that depicts the density of diarrhea incidence among children under-5 years of age in Central Gondar Zone, Northwest Ethiopia, from January 2013-December 2018

Fig. 8

Hot spot detection of diarrhea incidence among children under-5 years of age in the Central Gondar Zone, Northwest Ethiopia, January 2013-December 2018

Fig. 9

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

Fig. 10

Graduated color (choropleth) map that depicts the density of diarrhea incidence among children under-5 years of age in Central Gondar Zone, Northwest Ethiopia, from January 2019–to December 2022

Fig. 11

Hotspot detection of diarrhea incidence among children under-5 years of age in the Central Gondar Zone, Northwest Ethiopia, January 2019-December 2022

Fig. 12

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

Fig. 13

Relationships between the 10-year incidence of under-5 diarrhea by month and the 10-year average temperature, average rainfall, and relative humidity in the Central Gondar Zone, 2013–2022