Abstract
Background: Previous studies have suggested that extreme weather events, specifically heavy precipitation, are associated with increased risk of infectious disease, including diarrhea. Countries within the Asia Pacific Region (APR) account for a large burden of diarrheal diseases, as access to protected water sources are limited and populations are exposed to heavy monsoon rainfall annually. While prior studies have investigated association between extreme weather events and diarrheal disease in the region, there is a paucity of data regarding how monsoon dynamics (onset, withdrawal, and length) and phases of El Niño Southern Oscillation (ENSO) impacts diarrheal disease burden in high risk countries within the APR region, such as Nepal. Methods: Monthly counts of under-five diarrheal disease cases were collected from 75 districts in Nepal between 2002 and 2014. Monsoon onset and withdrawal dates for the entire country were obtained from Nepal’s Department of Hydrology and Meteorology and Monthly Oceanic Niño Index values were collected from the National Weather Service’s Climate Prediction Center and used to indicate phases of ENSO. A total of 5,379 observations of monthly counts were included in the analysis. Results: There were a total of 7,955,034 under-five diarrheal disease cases during the 2002-2014 period in Nepal. The mean monthly case rate was 2962/100,000 in years with normal monsoon withdrawal, compared to 4854 and 4917/100,000 in years with late and very late withdrawal dates, respectively. Mean monthly case rate of 4958/100,000 was observed during strong La Niña phases compared to 3793/100,000 in ENSO-neutral phases. Geographic variability also appears to impact diarrheal disease risk, as the mean monthly case rate was significantly higher in districts located in the mountainous regions of the country (5259/100,000) than in the plains (3322/100,000) or hilly regions (3621/100,000) Results from further analysis investigating the combined role of monsoon anomaly and ENSO phases will be presented.
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