Abstract
BackgroundLittle is known about the spatiotemporal pattern of bacillary dysentery (BD) in China. This study assessed the geographic distribution and seasonality of BD in China over the past two decades.MethodsData on monthly BD cases in 31 provinces of China from January 1990 to December 2009 obtained from Chinese Center for Disease Control and Prevention, and data on demographic and geographic factors, as well as climatic factors, were compiled. The spatial distributions of BD in the four periods across different provinces were mapped, and heat maps were created to present the seasonality of BD by geography. A cosinor function combined with Poisson regression was used to quantify the seasonal parameters of BD, and a regression analysis was conducted to identify the potential drivers of morbidity and seasonality of BD.ResultsAlthough most regions of China have experienced considerable declines in BD morbidity over the past two decades, Beijing and Ningxia still had high BD morbidity in 2009. BD morbidity decreased more slowly in North-west China than other regions. BD in China mainly peaked from July to September, with heterogeneity in peak time between regions. Relative humidity was associated with BD morbidity and peak time, and latitude was the major predictor of BD amplitude.ConclusionsThe transmission of BD was heterogeneous in China. Improved sanitation and hygiene in North-west China, and better access to clean water and food in the big floating population in some metropolises could be the focus of future preventive interventions against BD. BD control efforts should put more emphasis on those dry areas in summer.
Highlights
Diarrhoea is an important cause of disease burden worldwide, for resource-limited countries and for children under age of five [1,2,3,4]
The maximum and minimum values of bacillary dysentery (BD) morbidity experienced a gradual decrease across the four periods
BD morbidity in most provinces of North-west China (Shaanxi, Gansu, Qinghai and Xinjiang) did not decrease much until the last period (2005–2009), and BD morbidity in Ningxia was consistently high during the 20 years
Summary
Diarrhoea is an important cause of disease burden worldwide, for resource-limited countries and for children under age of five [1,2,3,4]. China has made rapid economic progress in the past decades, and the morbidity and mortality of BD have been declining progressively [8], partially due to the substantially improved water supplies, sanitation and hygiene [9]. It still shoulders a considerable burden of disease from BD [5]. This study used data on the monthly BD cases in 31 provinces of China from 1990–2009 and attempted to: I) explore the geographic distribution of BD in China; II) characterize the seasonality of BD by geography in China; and III) identify the putative drivers of BD morbidity and seasonality. This study assessed the geographic distribution and seasonality of BD in China over the past two decades
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