Abstract
BackgroundThis study investigates the impact of tubewell user density on cholera and shigellosis events in Matlab, Bangladesh between 2002 and 2004. Household-level demographic, health, and water infrastructure data were incorporated into a local geographic information systems (GIS) database. Geographically-weighted regression (GWR) models were constructed to identify spatial variation of relationships across the study area. Zero-inflated negative binomial regression models were run to simultaneously measure the likelihood of increased magnitude of disease events and the likelihood of zero cholera or shigellosis events. The aim of this study was to examine the effect of tubewell density on both the occurrence of diarrheal disease and the magnitude of diarrheal disease incidence.ResultsIn Matlab, households with greater tubewell density were more likely to report zero cholera or shigellosis events. Results for both cholera and shigellosis GWR models suggest that tubewell density effects are spatially stationary and the use of non-spatial statistical methods is appropriate.ConclusionsIncreasing the amount of drinking water available to households through increased density of tubewells contributed to lower reports of cholera and shigellosis events in rural Bangladesh. Our findings demonstrate the importance of tubewell installation and access to groundwater in reducing diarrheal disease events in the developing world.
Highlights
This study investigates the impact of tubewell user density on cholera and shigellosis events in Matlab, Bangladesh between 2002 and 2004
The expected outcome for zero inflated models is that the direction of association between variables observed in the count model will be reversed in the binary model, such that a positive association with increased counts in the count model will be matched by a negative association with zero events in the binary model
Our findings demonstrate the importance of access to clean water in driving diarrheal disease events in the developing world: higher densities of tubewells contribute to lower reports of cholera and shigellosis events
Summary
This study investigates the impact of tubewell user density on cholera and shigellosis events in Matlab, Bangladesh between 2002 and 2004. Diarrheal diseases are endemic in Matlab and across Bangladesh This is due to a number of factors, including natural aquatic environments of diarrheal causative agents, high population density, low socioeconomic status, and limited access to clean water. The installation of tubewells is a primary method for decreasing diarrheal disease incidence, giving Bangladeshis an alternative to drinking contaminated surface water. These tubewells draw water several hundred feet from the underlying aquifer to the surface by hand pumps.
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