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Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh

Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh
Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh

Background

Respiratory infections continue to be a public health threat, particularly to young children in developing countries. Understanding the geographic patterns of diseases and the role of potential risk factors can help improve future mitigation efforts. Toward this goal, this paper applies a spatial scan statistic combined with a zero-inflated negative-binomial regression to re-examine the impacts of a community-based treatment program on the geographic patterns of acute lower respiratory infection (ALRI) mortality in an area of rural Bangladesh. Exposure to arsenic-contaminated drinking water is also a serious threat to the health of children in this area, and the variation in exposure to arsenic must be considered when evaluating the health interventions.
Methods

ALRI mortality data were obtained for children under 2 years old from 1989 to 1996 in the Matlab Health and Demographic Surveillance System. This study period covers the years immediately following the implementation of an ALRI control program. A zero-inflated negative binomial (ZINB) regression model was first used to simultaneously estimate mortality rates and the likelihood of no deaths in groups of related households while controlling for socioeconomic status, potential arsenic exposure, and access to care. Next a spatial scan statistic was used to assess the location and magnitude of clusters of ALRI mortality. The ZINB model was used to adjust the scan statistic for multiple social and environmental risk factors.
Results

The results of the ZINB models and spatial scan statistic suggest that the ALRI control program was successful in reducing child mortality in the study area. Exposure to arsenic-contaminated drinking water was not associated with increased mortality. Higher socioeconomic status also significantly reduced mortality rates, even among households who were in the treatment program area.
Conclusion

Community-based ALRI interventions can be effective at reducing child mortality, though socioeconomic factors may continue to influence mortality patterns. The combination of spatial and non-spatial methods used in this paper has not been applied previously in the literature, and this study demonstrates the importance of such approaches for evaluating and improving public health intervention programs
1476-072X
1-13
Jochem, Warren
ef65df67-4364-4438-92e9-f93ceedb8da1
Razzaque, Abdur
60edf3ab-16be-4db2-a9c3-5268eb0c7a76
Root, Elisabeth Dowling
1d7dc4f2-fcb8-40e5-9822-c0a8f960ce2f
Jochem, Warren
ef65df67-4364-4438-92e9-f93ceedb8da1
Razzaque, Abdur
60edf3ab-16be-4db2-a9c3-5268eb0c7a76
Root, Elisabeth Dowling
1d7dc4f2-fcb8-40e5-9822-c0a8f960ce2f

Jochem, Warren, Razzaque, Abdur and Root, Elisabeth Dowling (2016) Effects of health intervention programs and arsenic exposure on child mortality from acute lower respiratory infections in rural Bangladesh. International Journal of Health Geographics, 15 (1), 1-13. (doi:10.1186/s12942-016-0061-9).

Record type: Article

Abstract


Background

Respiratory infections continue to be a public health threat, particularly to young children in developing countries. Understanding the geographic patterns of diseases and the role of potential risk factors can help improve future mitigation efforts. Toward this goal, this paper applies a spatial scan statistic combined with a zero-inflated negative-binomial regression to re-examine the impacts of a community-based treatment program on the geographic patterns of acute lower respiratory infection (ALRI) mortality in an area of rural Bangladesh. Exposure to arsenic-contaminated drinking water is also a serious threat to the health of children in this area, and the variation in exposure to arsenic must be considered when evaluating the health interventions.
Methods

ALRI mortality data were obtained for children under 2 years old from 1989 to 1996 in the Matlab Health and Demographic Surveillance System. This study period covers the years immediately following the implementation of an ALRI control program. A zero-inflated negative binomial (ZINB) regression model was first used to simultaneously estimate mortality rates and the likelihood of no deaths in groups of related households while controlling for socioeconomic status, potential arsenic exposure, and access to care. Next a spatial scan statistic was used to assess the location and magnitude of clusters of ALRI mortality. The ZINB model was used to adjust the scan statistic for multiple social and environmental risk factors.
Results

The results of the ZINB models and spatial scan statistic suggest that the ALRI control program was successful in reducing child mortality in the study area. Exposure to arsenic-contaminated drinking water was not associated with increased mortality. Higher socioeconomic status also significantly reduced mortality rates, even among households who were in the treatment program area.
Conclusion

Community-based ALRI interventions can be effective at reducing child mortality, though socioeconomic factors may continue to influence mortality patterns. The combination of spatial and non-spatial methods used in this paper has not been applied previously in the literature, and this study demonstrates the importance of such approaches for evaluating and improving public health intervention programs

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More information

Accepted/In Press date: 20 August 2016
e-pub ahead of print date: 1 September 2016
Published date: 3 September 2016
Organisations: WorldPop, Geography & Environment

Identifiers

Local EPrints ID: 399979
URI: https://eprints.soton.ac.uk/id/eprint/399979
ISSN: 1476-072X
PURE UUID: 862002cc-edcb-41c8-abd3-badb4ef54e42

Catalogue record

Date deposited: 15 Sep 2016 10:50
Last modified: 09 Dec 2019 19:28

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