Abstract
Diarrheal diseases are a leading cause of morbidity and mortality in Africa. Although research documents the magnitude and pattern of diarrheal diseases are associated with weather in particular locations, there is limited quantification of this association in sub-Saharan Africa and no studies conducted in Mozambique. Our study aimed to determine whether variation in diarrheal disease was associated with precipitation in Mozambique. In secondary analyses we investigated the associations between temperature and diarrheal disease. We obtained weekly time series data for weather and diarrheal disease aggregated at the administrative district level for 1997–2014. Weather data include modeled estimates of precipitation and temperature. Diarrheal disease counts are confirmed clinical episodes reported to the Mozambique Ministry of Health (n = 7,315,738). We estimated the association between disease counts and precipitation, defined as the number of wet days (precipitation > 1 mm) per week, for the entire country and for Mozambique’s four regions. We conducted time series regression analyses using an unconstrained distributed lag Poisson model adjusted for time, maximum temperature, and district. Temperature was similarly estimated with adjusted covariates. Using a four-week lag, chosen a priori, precipitation was associated with diarrheal disease. One additional wet day per week was associated with a 1.86% (95% CI: 1.05–2.67%), 1.37% (95% CI: 0.70–2.04%), 2.09% (95% CI: 1.01–3.18%), and 0.63% (95% CI: 0.11–1.14%) increase in diarrheal disease in Mozambique’s northern, central, southern, and coastal regions, respectively. Our study indicates a strong association between diarrheal disease and precipitation. Diarrheal disease prevention efforts should target areas forecast to experience increased rainfall. The burden of diarrheal disease may increase with increased precipitation associated with climate change, unless additional health system interventions are undertaken.
Highlights
Sub-Saharan Africa is projected to be affected by climate change [1]
We examined the association between temperature and diarrheal disease
Mozambique is a country situated on the southeastern coast of Africa with a tropical climate characterized by generally hot and rainy summers (November to April), where temperatures in parts of the country may average over 35 ◦ C and cooler and dry winters, and where monthly mean minimum temperatures may drop below 20 ◦ C [20]
Summary
Sub-Saharan Africa is projected to be affected by climate change [1]. Climate variability and change present current and future risks to human health in this region, where many countries have high exposure to climate-related hazards, as well as low capacity to manage the associated risks [2]. Increases in temperature and precipitation intensity are already occurring because of climate change [3] Changes in precipitation and temperature alter the geographic range, pathogenicity, seasonality, and survival of disease-causing pathogens but may increase human exposure and jeopardize the infrastructure necessary to prevent disease transmission [4]. Already of significant concern in sub-Saharan Africa, are amongst a wide range of health outcomes sensitive to weather and climate. Kolstad and Johansson [5] estimated that by the end of the 21st century, climate change might increase the relative risk of diarrhea in Southern Africa by more than 20 percent
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