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1. Quantifying the effects of anomalies of temperature, precipitation, and surface water storage on diarrhea risk in Taiwan

   https://doi.org/10.4178/epih.e2023024  

   Andhikaputra, Gerry; Sharma, Ayushi; Sapkota, Amir; He, Hao; Lin, Yu-Kai; Deng, Li-Wen; Wang, Yu-Chun (February 2023, Epidemiology and Health)

   Objectives: Diarrheal disease continues to be a significant cause of morbidity and mortality. We investigated how anomalies in monthly average temperature, precipitation, and surface water storage (SWS) impacted bacterial, and viral diarrhea morbidity in Taiwan between 2004 and 2015. Methods: A multivariate analysis using negative binomial generalized estimating equations was employed to quantify age- and cause-specific cases of diarrhea associated with anomalies in temperature, precipitation, and SWS. Results: Temperature anomalies were associated with an elevated rate of all-cause infectious diarrhea at a lag of 2 months, with the highest risk observed in the under-5 age group (incidence rate ratio [IRR]=1.03, 95% CI, 1.01-1.07). Anomalies in SWS were associated with increased viral diarrhea rates, with the highest risk observed in the under-5 age group at a 2-month lag (IRR= 1.27; 95% CI: 1.14, 1.42) and a lesser effect at a 1-month lag (IRR=1.18; 95% CI, 1.06-1.31). Furthermore, cause-specific diarrheal diseases were significantly affected by extreme weather events in Taiwan. Both extremely cold and hot conditions were associated with an increased risk of all-cause infectious diarrhea regardless of age, with IRRs ranging from 1.03 (95% CI, 1.02-1.12) to 1.18 (95% CI, 1.16-1.40).Conclusions: The risk of all-cause infectious diarrhea was significantly associated with average temperature anomalies in the population aged under 5 years. Viral diarrhea was significantly associated with anomalies in SWS. Therefore, we recommend strategic planning and early warning systems as major solutions to improve resilience against climate change. 

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2. Effects of Climatic Factors on Diarrheal Diseases among Children below 5 Years of Age at National and Subnational Levels in Nepal: An Ecological Study

   https://doi.org/10.3390/ijerph19106138  

   Dhimal, Meghnath; Bhandari, Dinesh; Karki, Khem B.; Shrestha, Srijan Lal; Khanal, Mukti; Shrestha, Raja Ram; Dahal, Sushma; Bista, Bihungum; Ebi, Kristie L.; Cissé, Guéladio; et al (May 2022, International Journal of Environmental Research and Public Health)

   Introduction: The incidence of diarrhea, a leading cause of morbidity and mortality in low-income countries such as Nepal, is temperature-sensitive, suggesting it could be associated with climate change. With climate change fueled increases in the mean and variability of temperature and precipitation, the incidence of water and food-borne diseases are increasing, particularly in sub-Saharan Africa and South Asia. This national-level ecological study was undertaken to provide evidence linking weather and climate with diarrhea incidence in Nepal. Method: We analyzed monthly diarrheal disease count and meteorological data from all districts, spanning 15 eco-development regions of Nepal. Meteorological data and monthly data on diarrheal disease were sourced, respectively, from the Department of Hydrology and Meteorology and Health Management Information System (HMIS) of the Government of Nepal for the period from 2002 to 2014. Time-series log-linear regression models assessed the relationship between maximum temperature, minimum temperature, rainfall, relative humidity, and diarrhea burden. Predictors with p-values < 0.25 were retained in the fitted models. Results: Overall, diarrheal disease incidence in Nepal significantly increased with 1 °C increase in mean temperature (4.4%; 95% CI: 3.95, 4.85) and 1 cm increase in rainfall (0.28%; 95% CI: 0.15, 0.41). Seasonal variation of diarrheal incidence was prominent at the national level (11.63% rise in diarrheal cases in summer (95% CI: 4.17, 19.61) and 14.5% decrease in spring (95% CI: −18.81, −10.02) compared to winter season). Moreover, the effects of temperature and rainfall were highest in the mountain region compared to other ecological regions of Nepal. Conclusion: Our study provides empirical evidence linking weather factors and diarrheal disease burden in Nepal. This evidence suggests that additional climate change could increase diarrheal disease incidence across the nation. Mountainous regions are more sensitive to climate variability and consequently the burden of diarrheal diseases. These findings can be utilized to allocate necessary resources and envision a weather-based early warning system for the prevention and control of diarrheal diseases in Nepal. 

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3. Exposure to Ambient Heat and Risk of Spontaneous Abortion: A Case–Crossover Study

   https://doi.org/10.1097/EDE.0000000000001774  

   Wesselink, Amelia K; Gause, Emma L; Spangler, Keith D; Hystad, Perry; Kirwa, Kipruto; Willis, Mary D; Wellenius, Gregory A; Wise, Lauren A (November 2024, Epidemiology)

   Background:Few epidemiologic studies have examined the association of ambient heat with spontaneous abortion, a common and devastating pregnancy outcome. Methods:We conducted a case–crossover study nested within Pregnancy Study Online, a preconception cohort study (2013–2022). We included all participants reporting spontaneous abortion (N = 1,524). We defined the case window as the 7 days preceding the event and used time-stratified referent selection to select control windows matched on calendar month and day of week. Within each 7-day case and control window, we measured the mean, maximum, and minimum of daily maximum outdoor air temperatures. We fit splines to examine nonlinear relationships across the entire year and conditional logistic regression to estimate odds ratios (ORs) and 95% confidence interval (CI) of spontaneous abortion with increases in temperature during the warm season (May–September) and decreases during the cool season (November–March). Results:We found evidence of a U-shaped association between outdoor air temperature and spontaneous abortion risk based on year-round data. When restricting to warm season events (n = 657), the OR for a 10-percentile increase in the mean of lag 0–6 daily maximum temperatures was 1.1 (95% CI: 0.96, 1.2) and, for the maximum, 1.1 (95% CI: 0.99, 1.2). The OR associated with any extreme heat days (>95th county-specific percentile) in the preceding week was 1.2 (95% CI: 0.95, 1.5). Among cool season events (n = 615), there was no appreciable association between lower temperatures and spontaneous abortion risk. Conclusion:Our study provides evidence of an association between high outdoor temperatures and the incidence of spontaneous abortion. 

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4. El Niño-Southern oscillation and under-5 diarrhea in Botswana

   https://doi.org/10.1038/s41467-019-13584-6  

   Heaney, Alexandra K.; Shaman, Jeffrey; Alexander, Kathleen A. (December 2019, Nature Communications)

   Abstract Childhood diarrheal disease causes significant morbidity and mortality in low and middle-income countries, yet our ability to accurately predict diarrhea incidence remains limited. El Niño-Southern Oscillation (ENSO) has been shown to affect diarrhea dynamics in South America and Asia. However, understanding of its effects in sub-Saharan Africa, where the burden of under-5 diarrhea is high, remains inadequate. Here we investigate the connections between ENSO, local environmental conditions, and childhood diarrheal disease in Chobe District, Botswana. Our results demonstrate that La Niña conditions are associated with cooler temperatures, increased rainfall, and higher flooding in the Chobe region during the rainy season. In turn, La Niña conditions lagged 0–5 months are associated with higher than average incidence of under-5 diarrhea in the early rainy season. These findings demonstrate the potential use of ENSO as a long-lead prediction tool for childhood diarrhea in southern Africa. 

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5. Land use impacts on parasitic infection: a cross-sectional epidemiological study on the role of irrigated agriculture in schistosome infection in a dammed landscape

   https://doi.org/10.1186/s40249-021-00816-5  

   Lund, Andrea J.; Rehkopf, David H.; Sokolow, Susanne H.; Sam, M. Moustapha; Jouanard, Nicolas; Schacht, Anne-Marie; Senghor, Simon; Fall, Assane; Riveau, Gilles; De Leo, Giulio A.; et al (December 2021, Infectious Diseases of Poverty)

   null (Ed.)

   Abstract Background Water resources development promotes agricultural expansion and food security. But are these benefits offset by increased infectious disease risk? Dam construction on the Senegal River in 1986 was followed by agricultural expansion and increased transmission of human schistosomes. Yet the mechanisms linking these two processes at the individual and household levels remain unclear. We investigated the association between household land use and schistosome infection in children. Methods We analyzed cross-sectional household survey data ( n  = 655) collected in 16 rural villages in August 2016  across demographic, socio-economic and land use dimensions, which were matched to Schistosoma haematobium ( n  = 1232) and S. mansoni ( n  = 1222) infection data collected from school-aged children. Mixed effects regression determined the relationship between irrigated area and schistosome infection presence and intensity. Results Controlling for socio-economic and demographic risk factors, irrigated area cultivated by a household was associated with an increase in the presence of S. haematobium infection (odds ratio [ OR ] = 1.14; 95% confidence interval [95% CI ]: 1.03–1.28) but not S. mansoni infection ( OR  = 1.02; 95% CI : 0.93–1.11). Associations between infection intensity and irrigated area were positive but imprecise ( S. haematobium: rate ratio [ RR ] = 1.05; 95% CI : 0.98–1.13, S. mansoni : RR  = 1.09; 95% CI : 0.89–1.32). Conclusions Household engagement in irrigated agriculture increases individual risk of S. haematobium but not S. mansoni infection. Increased contact with irrigated landscapes likely drives exposure, with greater impacts on households relying on agricultural livelihoods. 

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