SaTScan Software Research Articles

Spatial-temporal analysis of cervical cancer screening and social and health indicators in Brazil.

Spatial-temporal analysis of cervical cancer screening and social and health indicators in Brazil.

A novel covariate adjustment method for spatial scan statistics based on outlier removal.

A novel covariate adjustment method for spatial scan statistics based on outlier removal.

Spatial and temporal patterns of foot and mouth disease outbreaks (2011–2022) in cattle export-sourcing areas of southeastern Ethiopia

BackgroundFoot-and-mouth disease (FMD) is a highly contagious viral infection that infects cloven-hoofed animals, including cattle, sheep, goats, swine, and various wildlife species. Ethiopia is found in pool four where Serotype A, Serotype O, SAT1 and SAT2 are endemic. A retrospective study was conducted to analyse the spatial and temporal patterns of FMD outbreaks in export-sourcing areas of Southeastern Ethiopia over 12 years (from January 2011 to December 2022), using reported FMD outbreak data. Geographically, the area extending from Borana to East Shoa, along the main road connecting Moyale to Adama, was identified as the primary FMD outbreak zone within the cattle export-sourcing areas of southeastern Ethiopia.ResultsThe data on Foot-and-mouth disease (FMD) outbreaks over the past twelve years (from January 2011 to December 2022) obtained from the Ministry of Agriculture’s, Ethiopia database were retrieved and analyzed. There were a total of 58,426 cases across 247 outbreaks in 11 zones and 89 districts within the cattle export-sourcing areas of southeastern Ethiopia. On average, there were 20.3 outbreaks per year, with a median of 18 outbreaks annually, corresponding to approximately 4.6 outbreaks per month. The highest incidence occurred in January. The year with the most reported outbreaks was 2011, which had 54 outbreaks, followed by 2020 with 39 outbreaks and 2015 with 30 outbreaks In contrast, there were very few outbreaks recorded in 2014 and 2019. The case fatality rate was 1.02%, and an estimated 4,775,124 cattle were at risk of FMD infection. A time-series decomposition of the FMD outbreak data revealed seasonal trends. The trend analysis indicated that FMD outbreaks occurred in a cycle of two to five years, with peaks observed in 2011, 2012, 2015, and 2021. The incidence of FMD outbreaks varied across different zones, being lowest in the Afder and Gedeo zones and highest in the Arsi zone. An analysis using a space-time permutation probability model within the SaTScan software, with a maximum cluster size of 50%, identified five high-risk clusters and four low-risk clusters that were statistically significant (P < 0.05).ConclusionsThese spatial and temporal cluster analyses highlighted regions and periods with significantly higher-than-expected FMD outbreaks. The spatiotemporal and cluster analysis of FMD outbreaks provides critical insights for prioritizing control, prevention, and prophylactic measures in cattle export-sourcing areas of southeastern Ethiopia.

The Spatiotemporal Epidemiology and Influencing Factor Analysis of Leptospirosis - Anhui Province, China, 2004-2023.

Leptospirosis has historically been a severe public health concern across multiple Chinese provinces. Despite an overall decline in incidence in recent years, the disease continues to exhibit fluctuations and occasionally triggers localized outbreaks. This study aimed to characterize the demographic and spatiotemporal patterns of leptospirosis in Anhui Province - a historically significant epidemic region - from 2004 to 2023, to investigate potential climatic and environmental risk factors, and to identify critical targets for disease prevention and control. Spatiotemporal cluster analysis was conducted using SaTScan software. Spearman correlation analysis was performed using SPSS to examine the short-term lagged effects of rainfall, temperature, and normalized difference vegetation index (NDVI) on leptospirosis incidence in the high-risk counties of Huaiyuan and Jingde. A total of 458 leptospirosis cases were reported across Anhui Province during the 20-year study period. Middle-aged individuals (40-59 years), males, and agricultural workers constituted the primary high-risk populations. Spatiotemporal scanning identified nine adjacent hotspots in southern Anhui during 2004-2012, with a subsequent shift to Huaiyuan County in the northern Huaihe River Basin during 2016-2021. Significant associations were observed between leptospirosis cases and temperature, rainfall, and NDVI in both Huaiyuan and Jingde counties. This study revealed significant spatial heterogeneity, distinct spatiotemporal clustering patterns, and potential climatic and environmental risk factors for leptospirosis in Anhui Province during 2004-2023. These findings provide critical information regarding target regions, high-risk populations, and climatic and environmental factors to inform early warning systems and enhance prevention and control strategies for leptospirosis.

Incidence and spatiotemporal clustering of hepatitis B in China, 2006-2020

Objective: To analyze the incidence and spatiotemporal clustering of hepatitis B in China from 2006 to 2020 and provide reference for hepatitis B prevention and control. Methods: The incidence data of hepatitis B in 31 provinces (autonomous regions and municipalities) from 2006 to 2020 were collected from National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention. The incidence trend analysis was conducted by using software Joinpoint 5.0.2, and the spatiotemporal scan analysis was performed by using software SaTScan 10.1.2. Results: From 2006 to 2020, a total of 1 049 546 cases of acute hepatitis B were reported in China. The average annual reported incidence rate was 5.17/100 000. The reported incidence rate showed a decreasing trend during this period. The incidence decreased from 3.00/100 000 to 0.41/100 000 in age group 0-14 years, from 14.15/100 000 to 3.44/100 000 in age group 15-34 years, and from 6.87/100 000 to 3.72/100 000 in age group ≥35 years, the differences were all significant (all P<0.001). From 2006 to 2020, a total of 10 732 017 cases of chronic hepatitis B were reported in China. The average annual reported incidence rate was 52.85/100 000. The reported incidence of chronic hepatitis B varied in different age groups, which decreased from 11.38/100 000 to 2.18/100 000 in age group 0-14 years, and from 73.17/100 000 to 61.40/100 000 in age group 15-34 years, while increased from 48.07/100 000 to 90.75/100 000 in age group ≥35 years, the differences were all significant (all P<0.05). Spatiotemporal scan analysis indicated that the age of reported acute hepatitis B cases became older over time, and the regions with high-incidence gradually shifted from western China to southwestern China. The overall reported incidence of chronic hepatitis B in those aged ≥35 years showed an upward trend, and the regions with high-incidence were mainly found in coastal area in southeastern China and in southwestern China. Conclusions: From 2006 to 2020, the overall reported incidence of acute hepatitis B in China showed a continuous downward trend, while the reported incidence of chronic hepatitis B in those aged ≥35 years showed an upward trend. It indicated that the need to improve the diagnosis and treatment of chronic hepatitis B in adults in coastal area in southeastern China and southwestern China.

Spatial interpolation and spatiotemporal scanning analysis of human brucellosis in mainland China from 2012 to 2018

Despite the considerable efforts made to address the issue of brucellosis worldwide, its prevalence in dairy products continues to be difficult to estimate and represents a significant public health concern globally. The aim of the present study was to gain a better understanding of the epidemiology of this disease in mainland China. We set out to investigate the annual spatial distribution and potential hotspots of the disease. Data on the incidence rate of brucellosis from 2012 to 2018 was obtained from the China Disease Control and Prevention Information System (CDCIS). ArcGIS 10.6 software was employed to perform kriging interpolation analysis and to create a predictive distribution map for brucellosis. Additionally, SaTScan software was utilized to conduct spatial-temporal scanning analysis to identify potential spatial-temporal changes in the incidence rate of brucellosis in China. There is a seasonal trend in the incidence of brucellosis in China, with higher rates observed during the warm season, particularly peaking in May. The results of the exploratory analysis of kriging data indicate that the average incidence map, generated using the second-order Gaussian semi-variance model with log-kriging interpolation, demonstrates the highest accuracy. Spatial and temporal clustering analyses reveal a primary clustering area centered in Heilongjiang, along with three secondary clustering areas located in Tibet, Shanxi, and Hubei. Additionally, the predictive distribution map for brucellosis in China, along with the analysis of the scanning statistic, indicates that the high-incidence area is situated in the northwest region of mainland China, although there is a noticeable trend of shifting towards the south. There are distinct spatial patterns of brucellosis in China. In high-incidence areas, it is essential to allocate additional resources for prevention and control to effectively contain the spread of brucellosis epidemics. In low-incidence areas, it is vital to promptly identify favorable factors that can help mitigate the occurrence of brucellosis.

Spatial, temporal, and spatiotemporal cluster detection of malaria incidence in Southwest Ethiopia.

Malaria is a major global health hazard, particularly in developing countries such as Ethiopia, where it contributes to high morbidity and mortality rates. According to reports from the South Omo Zone Health Bureau, despite various interventions such as insecticide-treated bed nets and indoor residual spraying, the incidence of malaria has increased in recent years. Therefore, this study aimed to assess the spatial, temporal, and spatiotemporal variation in malaria incidence in the South Omo Zone, Southwest Ethiopia. A retrospective study was conducted using 4 years of malaria data from the South Omo Zone District Health Information Software (DHIS). The incidence rate of malaria per 1,000 people was calculated using Microsoft Excel software. Kulldorff SaTScan software with a discrete Poisson model was used to identify statistically significant spatial, temporal, and spatiotemporal malaria clusters. Graduated color maps depicting the incidence of malaria were generated using ArcGIS 10.7 software. Spatial clusters were identified in the districts of Dasenech (RR = 2.06, p < 0.0001), Hamer (RR = 1.90, p < 0.0001), Salamago (RR = 2.00, p < 0.0001), Bena Tsemay (RR = 1.71, p < 0.0001), Malie (RR = 1.50, p < 0.0001), Nyngatom (RR = 1.91, p < 0.0001) and North Ari (RR = 1.05, p < 0.0001) during the period from 08th July 2019 to 07th July 2023. A temporal cluster was identified as the risk period across all districts between 08th July 2022 and 07th July 2023 (RR = 1.59, p = 0.001). Spatiotemporal clusters were detected in Dasenech (RR = 2.26, p < 0.001) Salamago, (RR = 2.97, p < 0.001) Hamer (RR = 1.95, p < 0.001), Malie (RR = 2.03, p < 0.001), Bena Tsemay (RR = 1.80, p < 0.001), Nyngatom (RR = 2.65, p < 0.001), North Ari (RR = 1.50, p < 0.001), and Jinka town (RR = 1.19, p < 0.001). Significant spatial, temporal, and spatiotemporal clusters in malaria incidence were identified in the South Omo Zone. To better understand the factors contributing to these high-risk areas, further research is needed to explore individual, household, geographical, and climatic factors. Targeted interventions based on these findings could help reduce malaria incidence and associated risks in the region.

Epidemiological characteristics and spatiotemporal distribution of genital herpes in China, 2010-2023

Objective: To understand the epidemiological characteristics and spatiotemporal distribution of genital herpes in China from 2010 to 2023 and provide evidence for the prevention and control of genital herpes. Methods: The reported data of genital herpes cases in 31 provinces (autonomous regions and municipalities) in China from 2010 to 2023 were collected from the National Notifiable Infectious Disease Reporting System of China Information System for Disease Control and Prevention. Software Joinpoint 5.2.0 was used to analyze the epidemiological characteristics of genital herpes, software ArcGIS 10.5 was used for spatial autocorrelation analysis, and software SaTScan 10.2.3 was used for spatiotemporal scanning analysis. Results: The reported incidence rate of genital herpes increased from 1.58/100 000 to 2.00/100 000 in China from 2010 to 2023, with an average annual percentage change of 0.90%. The upward trend of reported incidence rate was significant (t=2.35, P=0.037). There was a positive spatial autocorrelation in the reported incidence of genital herpes with the global Moran's I ranging from 0.36 to 0.51 (all P<0.001). Local spatial autocorrelation analysis showed that the number of hotspots increased from 144 in 2010 to 232 in 2023, mainly distributed in provinces Zhejiang, Guangdong, Guangxi, Chongqing and Hunan. The number of hotspots in of Chongqing, Sichuan, Yunnan and Guizhou increased significantly from 7 to 57. A total of 67 spatiotemporal clusters were detected by spatiotemporal scanning analysis, mainly distributed in Guangdong from 2011 to 2015, in Zhejiang and Fujian from 2015 to 2019, and in Chongqing and Guizhou from 2019 to 2023. Conclusions: From 2010 to 2023, the reported incidence of genital herpes in China showed an upward trend, and there was an obvious spatiotemporal clustering of genital herpes. The distribution of hotspots was basically consistent with the distribution of spatiotemporal clustering areas, mainly distributed in the southeastern coastal area and southwestern region, and the spatiotemporal clustering areas gradually changed from the southeast coastal area to the southwest region.

Geospatial mapping to assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using EDHS 2019: Spatial and geographical weighted regression.

Zero-dose vaccine status refers to a child who has not yet received any childhood vaccines. Globally, zero-dose vaccination status is the major public health problem. In sub-Saharan African countries, among five children, one child did not access the vaccines. The efforts to identify the factors contributing to the zero-dose vaccine have not yet been addressed in Ethiopia. To assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using Ethiopian demographic health survey 2019. A secondary analysis of a cross-sectional study was used among a total of 3208 participants. Stata-14, Arc geographic information system-10.3, and Sat Scan software were used to analyze the data. Moran's I statistic was used to assess the non-random distribution of zero-dose vaccination status. Spatial and geographically weighted regression was used to map the distribution and determinants of zero-dose vaccination status in Ethiopia. The Getis-Ord-statistics and Sat Scan analysis were also used to identify the hot spot area and significant clusters respectively. To identify significant factors, a p-value <0.05 was used. The prevalence of zero-dose vaccination status among children aged 12-35 months old was 16.3% (95%CI, 15%-17.6%). The distribution of zero-dose vaccination status in Ethiopia was not randomly distributed across the area (Moran's I value = 0.4, p<0.001). The hotspot area of zero-dose vaccination status in Ethiopia was located in Afar, Somalia, and the south nations region. The primary cluster was located at 5.479641 N and 42.196835 E within a 405.96 km radius in the Somali region. The highest effect (β, 0.23-0.24) of give birth at home on zero-dose vaccination status was observed in Afar, Somalia, and Tigray, whereas the lowest effect of home delivery (β, 0.21-0.22) was observed in south nations, Gambela, and the western part of Benishangul Gumuz. Additionally, the poor wealth index had the highest effect on zero-dose vaccination status (β, 0.06-0.07) in south nations, Benishangul Gumuz, and the Gambela region, and the lowest effect of the poor wealth index (β, 0.03-0.04) was observed in Somalia and the Afar region. The zero dose child in Ethiopia was low. Geographically, the highest proportion of zero-dose vaccination status among children was in the Somali and Afar regions. Home delivery had the highest and most positive effect on zero-dose vaccination status in Afar, Somalia, and the Tigray region. Additionally, the poor wealth index had the highest and most positive effect in Somalia and the Afar region. Expanding delivery at the health facility and economic empowerment of women are recommended to improve vaccination in Ethiopia.

Spatial distribution and urban-rural disparity of unmet need for family planning among married/in-union women in Ethiopia: a spatial and decomposition analysis.

High unmet need for family planning combined with other factors, such as high early marriage and teenage pregnancy, increases the risk of developing obstetric fistula and other complications. This study aimed to assess spatial distribution and urban-rural disparities of unmet need for family planning among married/in-union women in Ethiopia. The study was conducted on secondary data from a cross-sectional survey that was conducted nationally between September and December 2019 using a two-stage cluster design on a total of 265 enumeration areas. A total weighted sample of 5,349 married/in-union women was included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Finally, multivariable decomposition analysis via a logit model was used to decompose the observed difference in unmet need by the compositional difference and the difference in effects of explanatory variables between places of residence. Spatial distribution of unmet need for family planning was clustered in Ethiopia with a global Moran's I index value of 0.25 (p-value = 0.004). Accordingly, enumeration areas in West Hararge, Arsi, Bale, Gujji, Borena, Jimma, and East Wellega zones of Oromia region, and Gurage, Hadiya, Silte, Gedio, Sidama, Wolaita, Alaba, and Dawro zones of South Nation and Nationality People region, and the southern part of Zone 3 in Afar region were detected as hotspot areas. The decomposition results revealed that there is a significant disparity in unmet need between urban and rural resident women (0.074, p-value < 0.001). Endowment and coefficient factors accounted for the urban-rural disparity, contributing 68.32% and 31.68%, respectively. Household size, husband's opinion of family planning, community acceptance of family planning, woman's age at first sexual intercourse, and the woman's age were key determinants of the urban-rural disparity. The results revealed a significant disparity in the unmet need for family planning based on place of residence, with a clustered spatial distribution across the study area and notable hotspot areas. Thus, targeted interventions should focus on mobilizing resources to high-risk areas and addressing the needs of high-risk groups to reduce the observed variation.

Spatio-temporal distribution characteristics of Oncomelania hupensis snails spread in Suzhou City of Jiangsu Province from 2016 to 2023

To investigate the Oncomelania hupensis snails spread and its spatio-temporal clustering characteristics in Suzhou City, Jiangsu Province from 2016 to 2023, so as to provide insights into precision control of O. hupensis snails in the City. O. hupensis snail surveillance data in Suzhou City from 2016 to 2023 were collected, and the areas of O. hupensis snail spread and areas of emerging and re-emerging snail habitats were retrieved. The spatial distribution characteristics and clustering types and locations of environments with O. hupensis snail spread were investigated using global and local spatial auto correlation analyses with the software ArcGIS 10.7, and the clustering and cluster areas of O. hupensis snail spread were identified in Suzhou City using spatio-temporal scans with the software SaTScan 10.0.2. O. hupensis snail spread covered an area of 677 171 m2 in Suzhou City from 2016 to 2023, including 376 230 m2 emerging snail habitats and 300 941 m2 re-emerging snail habitats. Global spatial autocorrelation analysis showed overall clustering of O. hupensis snail spread in Suzhou City from 2016 to 2023 (Moran's I = 0.066, P = 0.007), and there were spatial clustering of areas with O. hupensis snail spread in 2019 (Moran's I = 0.086, P = 0.001) and 2021 (Moran's I = 0.045, P = 0.003). Local spatial autocorrelation analysis showed clusters of O. hupensis snail spread in Suzhou City from 2016 to 2023, with high-high clusters in Guangfu Township and Dongzhu Street, and the high-high clusters of O. hupensis snail spread were mainly distributed in southwestern Suzhou City. Spatio-temporal scans identified two clusters of areas with O. hupensis snail spread and areas of re-emerging snail habitats in Suzhou City from 2016 to 2023, with large clustering areas found in Guangfu Township, Dongzhu Street, Tong'an Township and Wangting Township [relative risk (RR) = 22.34, log likelihood ratio (LLR) = 163 295.32, P < 0.001] and small clustering areas in Xukou Township, Mudu Township and Xiangshan Street (RR = 2.73, LLR = 921.92, P < 0.001). There was spatial clustering of O. hupensis snail spread in Suzhou City from 2016 to 2023. Improved quality of O. hupensis snail control and intensified management of environments at a high risk of O. hupensis snail spread are recommended in Suzhou City.

Whooping cough – a recurrent epidemic

Abstract Background Whooping cough (WC), or Pertussis, is a vaccine-preventable and highly contagious infectious disease. Although it has a relatively low fatality rate, approximately 13% of reported cases develop secondary bacterial pneumonia. This was because of several recurrent epidemics across Europe in the last decades, with the latest beginning in mid-2023 and still ongoing. The Central Region of Portugal is currently being affected, and this study aims to describe the current epidemic at the regional level. Methods Data from epidemiological inquiries of confirmed and probable cases of WC pertaining to the Central Region of Portugal from January 2020 till April 2024 was gathered from the mandatory report national epidemiological surveillance system (SINAVE). Both a temporal comparison of number of cases and a statistical space-time scan with permutation were conducted (software SaTScan v10.) Results A comparison by month of reported cases shows an increase in cases from September 2023 until December 2023 followed by an exponential increase from January 2024 until April 2024 denoting an ongoing epidemic. In the statistical space-time analysis of 107 reported cases between September 2023 and April 2024, 8 nonsignificant clusters were identified with different locations involved in non-overlapping periods. Conclusions The finding of several unrelated clusters, even though nonsignificant, during a short time period indicates that Pertussis transmission is ongoing at the local level probably through asymptomatic or barely symptomatic cases that act as reservoirs. Clinicians must hold a high clinical suspicion for a timely diagnosis, treatment and report and health authorities must reinforce control measures to limit the spread of this disease. Key messages • Pertussis remains a disease of significant concern recurrent outbreaks across Europe show that public health local authorities have an important role in timely management of cases and outbreaks. • Local level transmission and intervention may play a pivotal role in the epidemiologic dynamic of Pertussis.

Adherence to IMCI guidelines for key symptoms in Ethiopian children: A 2021-2022 national service provision survey.

The Health Services Provision Assessment in Ethiopia (SPA-ET) is a survey that generates data on the availability and quality of health services in Ethiopia. Despite the presence of integrated management of childhood illness guidelines in healthcare settings, there has been inadequate exploration or assessment of how effectively and consistently health professionals follow the guidelines. This study aims to identify factors influencing healthcare worker adherence to the integrated management of childhood illness guidelines to identify spatial clusters. The data for this study were gathered from the Service Provision Assessment (SPA) survey in Ethiopia, which was conducted nationwide from August 11, 2021, to February 4, 2022. It included a total of 788 health professionals who assessed sick children experiencing at least one of the three main childhood illness symptoms: fever, cough, or diarrhea. We employed STATA version 16 for data analysis, utilizing cross-tabulations to explore relationships between variables and logistic regression modeling to identify factors influencing adherence. To account for the hierarchical structure of the health survey data, we employed multilevel logistic regression. Model selection was based on comparison parameters including the Bayesian Information Criterion (BIC) and Akaike Information Criterion (AIC). We computed adjusted odds ratios with 95% confidence intervals, and statistical significance was determined at a significance level of p < 0.05. The rate of adherence to the integrated management of childhood illness guideline was 33% (95% CI: 29.70%, 36.26%). The analysis revealed several factors influencing adherence to IMCI protocols. child's age (being ≥24 months) [aOR = 0.66, 95% CI: (0.45, 0.87)], facility type (health center) [aOR = 2.61, 95% CI: (1.84, 3.37)], place of residency (being rural) [aOR = 0.54, 95% CI: (0.38, 0.77)], and care provider's qualification (health officer) [aOR = 1.71, 95% CI: (1.18, 2.48)] were all statistically significant. Moreover, the primary cluster is situated in the west Oromia region, with a central focus at coordinates (7.982108 N, 36.203355 E) and extends to a radius of 78.28 km. This study confirms a low adherence rate (33%) among health professionals in Ethiopia to the IMCI guideline for assessing the three main symptoms of sick children. The study identified child's age, facility type, academic qualification, and place of residence as crucial factors correlated with adherence rate. Furthermore, 5 secondary clusters (hotspot areas) were identified using SaTScan software. To address the higher protocol refusal, interventional plan needs to be based on academic qualification of care provider, facility type, age of child and place of residency. Moreover, interventions to reduce non-adherence to IMCI guidelines should be location-tailored based on identified hotspot areas to restore guidelines adherence equality.

Space-time scanning statistics in the prediction and evaluation of dengue epidemic clusters

Space-time scanning statistics in the prediction and evaluation of dengue epidemic clusters

Spatiotemporal distribution of newly diagnosed echinococcosis patients in Qinghai Province from 2016 to 2022

To investigate the spatiotemporal distribution characteristics and potential influencing factors of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, so as to provide insights into the formulation of the echinococcosis control strategy in Qinghai Province. The number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases, number of registered dogs and number of stray dogs were captured from the annual reports of echinococcosis control program in Qinghai Province from 2016 to 2022, and the detection of newly diagnosed echinococcosis cases was calculated. The number of populations, precipitation, temperature, wind speed, sunshine hours, average altitude, number of year-end cattle stock, number of year-end sheep stock, gross domestic product (GDP) per capita, and number of village health centers in each county (district) of Qinghai Province were captured from the Qinghai Provincial Statistical Yearbook, and county-level electronic maps in Qinghai Province were downloaded from the National Platform for Common Geospatial Information Services. The software ArcGIS 10.8 was used to map the distribution of newly diagnosed echinococcosis cases in Qinghai Province, and the spatial autocorrelation analysis of newly diagnosed echinococcosis cases was performed. In addition, the spacetime scan analyses of number of individuals screened for echinococcosis, number of newly diagnosed echinococcosis cases and geographical coordinates in Qinghai Province were performed with the software SaTScan 10.1.2, and the spatial stratified heterogeneity of the detection of newly diagnosed echinococcosis cases was investigated with the software GeoDetector. A total of 6 569 426 residents were screened for echinococcosis in Qinghai Province from 2016 to 2022, and 5 924 newly diagnosed echinococcosis cases were found. The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline over years from 2016 to 2022 (χ2 = 11.107, P < 0.01), with the highest detection in Guoluo Tibetan Autonomous Prefecture in 2017 (82.12/105). There were spatial clusters in the detection of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2018 (Moran's I = 0.34 to 0.65, all Z values > 1.96, all P values < 0.05), and the distribution of newly diagnosed echinococcosis cases appeared random distribution from 2019 to 2022 (Moran's I = -0.09 to 0.04, all Z values < 1.96, all P values > 0.05). Local spatial autocorrelation analysis showed high-high clusters and low-low clusters in the detection of new diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022, and space-time scan analysis showed that the first most likely cluster areas of newly diagnosed echinococcosis cases in Qinghai Province from 2016 to 2022 were mainly distributed in Yushu Tibetan Autonomous Prefecture and Guoluo Tibetan Autonomous Prefecture. GeoDetector-based analysis of the driving factors for the spatial stratified heterogeneity of detection of newly diagnosed echinococcosis cases in Qinghai Province showed that average altitude, number of village health centers, number of cattle and sheep stock, GDP per capita, annual average sunshine hours, and annual average temperature had a strong explanatory power for the spatial distribution of newly diagnosed echinococcosis cases, with q values of 0.630, 0.610, 0.600, 0.590, 0.588, 0.537 and 0.526, respectively. The detection of newly diagnosed echinococcosis cases appeared a tendency towards a decline in Qinghai Province over years from 2016 to 2022, showing spatial clustering. Targeted control measures are required in cluster areas of newly diagnosed echinococcosis cases for further control of the disease.

Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis.

The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.

Spatial variations and determinants of receiving cash and food from the productive safety net program among households in Ethiopia: spatial clustering and multilevel analyses.

There is a global struggle with food insecurity and undernutrition among women, and Ethiopia has been particularly impacted by these issues. To address this challenge, Ethiopia has implemented a cash and food safety net program over many years. However, there is limited information available regarding the program's factors and spatial distributions, with no recent national evidence from Ethiopia. Consequently, the objective of this study is to investigate the spatial clustering and determinants of the Productive Safety Net Program (PSNP) in Ethiopia. This study utilized data from the Ethiopian Demographic and Health Survey. The sample included 8,570 weighted households. Given the hierarchical nature of the data, a multilevel logistic regression model was employed to identify factors influencing the outcome variable. Geographical clusters of individuals receiving assistance from the PSNP were examined using SaTScan software and the Bernoulli model, along with the Kulldorff methods. The nationwide distribution of the program beneficiaries was visualized using ArcGIS version 10.8. Variables were considered statistically significant if their p-value was <0.05. The overall coverage of the PSNP was 13.54% [95% confidence interval (CI): 12.84-14.29] among households in Ethiopia. The study revealed that people from richer households adjusted odds ratio [AOR = 0.46 (95% CI: (0.33, 0.64))], those from the richest households [AOR = 0.26 (95% CI:(0.17,0.41))], and those with educated household heads [AOR = 0.45 (95% CI:(0.28, 0.71))] have a lower likelihood of utilizing the PSNP compared to their counterparts. Conversely, a unit increase in household heads' age [AOR = 1.02 (95% CI:(1.01, 1.02))] and family size [AOR = 1.05 (95% CI:1.021.10)] showed a higher likelihood of joining the PSNP, respectively. Household heads who have joined community health insurance [AOR = 3.21 (95% CI:(2.58, 4.01))] had significantly higher odds of being included in the PSNP than their counterparts. Heads who belong to a community with a high poverty level [AOR = 2.68 (95% CI:(1.51, 4.79))] and community health insurance [AOR = 2.49 (95% CI:(1.51, 4.11))] showed more inclination to utilize the PSNP compared to their counterparts. PSNP was judged to have a low implementation status based on the findings gathered regarding it. We found factors such as age, sex, region, wealth, education, family size, regions, and health insurance to be statistically significant. Therefore, encouraging women empowerment, community-based awareness creation, and coordination with regional states is advisable.

Uncovering wastewater treatment plants as possible sources of legionellosis clusters through spatial statistics approach and environmental analysis.

Wastewater treatment plants (WWTPs) are suspected reservoirs of Legionella pneumophila (Lp). The required aeration and mixing steps lead to the emission and dispersion of bioaerosols potentially harboring Lp. The aim of the project is to evaluate municipal WWTPs as a possible source of legionellosis through the statistical analysis of case clusters. A space-time scanning statistical method was implemented in SaTScan software to identify and analyze WWTPs located within and close to spatiotemporal clusters of legionellosis detected in Quebec between 2016 and 2020. In parallel, WWTPs were ranked according to their pollutant load, flow rate and treatment type. These parameters were used to evaluate the WWTP susceptibility to generate and disperse bioaerosols. Results show that 37 of the 874 WWTPs are located inside a legionellosis cluster study zone, including six of the 40 WWTPs ranked most susceptible. In addition, two susceptible WWTPs located within an extended area of 2.5km from the study zone (2.5-km buffer) were included, for a total of 39 WWTPs. The selected 39 WWTPs were further studied to document proximity of population, dominant wind direction, and surrounding water quality. Samples collected from the influent and the effluent of six selected WWTPs revealed the presence of Legionella spp. in 92.3% of the samples. Lp and Lp serogroupg 1 (Lp sg1) were detected below the limit of quantification in 69% and 46% of the samples, respectively. The presence of Legionella in wastewater and the novel statistical approach presented here provides information to the public health authorities regarding the investigation of WWTPs as a possible source of Legionella exposure, sporadic cases, and clusters of legionellosis.

Spatial distribution and determinants of Early sexual initiation in Ethiopia

Introduction: Early sexual initiation has negative health, social, and economic consequences for both women and future generations. The trend of early sexual initiation is increasing globally, leading to higher rates of sexually transmitted diseases and unplanned pregnancies. Ethiopia has been challenged various disasters that makes women vulnerable and position them at heightened risk of early sexual initiation in the last four years. The spatial patterns and factors of early sexual initiation in the post-conflict-post pandemic settings is not well understood. Hence this research aimed at mapping Spatial Patterns and identifying determinant factors in the Post-COVID-Post-Conflict Settings.MethodsThe study was conducted on secondary data from the PMA 2021 cross-sectional survey which conducted nationally from November 2021 to January 2022 which is in the post pandemic and post-war period. Total weighted sample of 6,036 reproductive age women were included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Multilevel logistic regression model was used to estimate the effects of independent variables on early sexual initiation at individual and community level factors. Adjusted odds ratio with the 95% confidence interval was reported to declare the strength and statistical significance of the association.ResultThe spatial distribution of early sexual initiation was clustered in Ethiopia with a global Moran’s I index value of 0.09 and Z-score 6.01 (p-value < 0.001).Significant hotspots were detected in East Gojjam zone of Amhara region, Bale, Arsi, West Hararge, East Wellega and Horo Gudru Wellega zones of Oromia region. The odds of having early sexual initiation was higher in women with primary education (AOR = 1.23, 95%CI: 1.03, 1.47), secondary or above education (AOR = 4.36, 95%CI: 3.49, 5.44), Women aged 26 to 25 (AOR = 1.91, 95%CI: 1.61, 2.26), women aged 36 to 49(AOR = 1.51, 95%CI: 1.24, 1.84). However, there was a significant lower likelihood of early sexual initiation in rural resident women (AOR = 0.53, 95%CI: 0.35, 0.81) and women living in 5 to 7 family size (AOR = 0.79, 95%CI: 0.68, 0.92), and more than 7 members (AOR = 0.63, 95%CI: 0.49, 0.81).ConclusionsThe spatial distribution of early sexual initiation was clustered in Ethiopia. Interventions should be taken to eliminate the observed variation by mobilizing resources to high-risk areas. Policies and interventions targeted to this problem may also take the identified associated factors into account for better results.

Spatiotemporal pattern and suitable areas analysis of equine influenza in global scale (2005-2022).

Equine influenza (EI) is a severe infectious disease that causes huge economic losses to the horse industry. Spatial epidemiology technology can explore the spatiotemporal distribution characteristics and occurrence risks of infectious diseases, it has played an important role in the prevention and control of major infectious diseases in humans and animals. For the first time, this study conducted a systematic analysis of the spatiotemporal distribution of EI using SaTScan software and investigated the important environmental variables and suitable areas for EI occurrence using the Maxent model. A total of 517 occurrences of EI from 2005 to 2022 were evaluated, and 14 significant spatiotemporal clusters were identified. Furthermore, a Maxent model was successfully established with high prediction accuracy (AUC = 0.920 ± 0.008). The results indicated that annual average ultraviolet radiation, horse density, and precipitation of the coldest quarter were the three most important environmental variables affecting EI occurrence. The suitable areas for EI occurrence are widely distributed across all continents, especially in Asia (India, Mongolia, and China) and the Americas (Brazil, Uruguay, USA, and Mexico). In the future, these suitable areas will expand and move eastward. The largest expansion is predicted under SSP126 scenarios, while the opposite trend will be observed under SSP585 scenarios. This study presents the spatial epidemiological characteristics of EI for the first time. The results could provide valuable scientific insights that can effectively inform prevention and control strategies in regions at risk of EI worldwide.