Malaria Infection Has Spatial,Temporal, and Spatiotemporal Heterogeneity in Unstable Malaria Transmission Areas in Northwest Ethiopia

Background

Malaria elimination requires successful nationwide control efforts. Detecting the spatiotemporal distribution and mapping high-risk areas are useful to effectively target pockets of malaria endemic regions for interventions.

Objective

The aim of the study was to identify patterns of malaria distribution by space and time in unstable malaria transmission areas in northwest Ethiopia.

Methods

Data were retrieved from the monthly reports stored in the district malaria offices for the period between 2003 and 2012. Eighteen districts in the highland and fringe malaria areas were included and geo-coded for the purpose of this study. The spatial data were created in ArcGIS10 for each district. The Poisson model was used by applying Kulldorff methods using the SaTScan™ software to analyze the purely temporal, spatial and space-time clusters of malaria at a district levels.

Results

The study revealed that malaria case distribution has spatial, temporal, and spatiotemporal heterogeneity in unstable transmission areas. Most likely spatial malaria clusters were detected at Dera, Fogera, Farta, Libokemkem and Misrak Este districts (LLR =197764.1, p<0.001). Significant spatiotemporal malaria clusters were detected at Dera, Fogera, Farta, Libokemkem and Misrak Este districts (LLR=197764.1, p<0.001) between 2003/1/1 and 2012/12/31. A temporal scan statistics identified two high risk periods from 2009/1/1 to 2010/12/31 (LLR=72490.5, p<0.001) and from 2003/1/1 to 2005/12/31 (LLR=26988.7, p<0.001).

Conclusion

In unstable malaria transmission areas, detecting and considering the spatiotemporal heterogeneity would be useful to strengthen malaria control efforts and ultimately achieve elimination.     

Spatial Analysis of Childhood Cancer: A Case/Control Study

BackgroundChildhood cancer was the leading cause of death among children aged 1-14 years for 2012 in Spain. Leukemia has the highest incidence, followed by tumors of the central nervous system (CNS) and lymphomas (Hodgkin lymphoma, HL, and Non-Hodgkin’s lymphoma, NHL). Spatial distribution of childhood cancer cases has been under concern with the aim of identifying potential risk factors.ObjectiveThe two objectives are to study overall spatial clustering and cluster detection of cases of the three main childhood cancer causes, looking to increase etiological knowledge.MethodsWe ran a case-control study. The cases were children aged 0 to 14 diagnosed with leukemia, lymphomas (HL and NHL) or CNS neoplasm in five Spanish regions for the period 1996-2011. As a control group, we used a sample from the Birth Registry matching every case by year of birth, autonomous region of residence and sex with six controls. We geocoded and validated the address of the cases and controls. For our two objectives we used two different methodologies. For the first, for overall spatial clustering detection, we used the differences of K functions from the spatial point patterns perspective proposed by Diggle and Chetwynd and the second, for cluster detection, we used the spatial scan statistic proposed by Kulldorff with a level for statistical significance of 0.05.ResultsWe had 1062 cases of leukemia, 714 cases of CNS, 92 of HL and 246 of NHL. Accordingly we had 6 times the number of controls, 6372 controls for leukemia, 4284 controls for CNS, 552 controls for HL and 1476 controls for NHL. We found variations in the estimated empirical D(s) for the different regions and cancers, including some overall spatial clustering for specific regions and distances. We did not find statistically significant clusters.ConclusionsThe variations in the estimated empirical D(s) for the different regions and cancers could be partially explained by the differences in the spatial distribution of the population; however, according to the literature, we cannot discard environmental hazards or infections agents in the etiology of these cancers.     

Etiology of Childhood Infectious Diarrhea in a Developed Region of China: Compared to Childhood Diarrhea in a Developing Region and Adult Diarrhea in a Developed Region

In China, great differences in economy, social characteristics and hygiene exist between developing and developed regions. A comparative study of infectious diarrhea between two regions was needed. Three groups of diarrheal patients were collected: children ≤5 year-olds from Beijing (developed region) and Henan Province (developing region), and adults over 18 year-olds from Beijing. A questionnaire was used to survey and feces samples were examined for 16 enteropathogens. We enrolled 1422 children and 1047 adults from developed region and 755 children from developing region. Virus positive rates were 32.98% for children and 23.67% for adults in developed region. The most prevalent pathogen for children was rotavirus whereas for adults was norovirus. Bacterial isolation rates were 13.92% for children from developed region, while 29.14% for children from the developing regions. For the greatest difference, Shigella accounted for 50.79% and was the dominant pathogen in the developing region, whereas in the developed region it was only 1.45%. There was no significant relationship between the local levels of development with diarrheogenic Escherichia coli (DEC) categories. But it was seen the notable differences between the population with different age: enteropathogenic E.coli (EPEC) and enteroaggregative E.coli (EAggEC) were the primary classes of DEC in children from both regions, whereas it was enterotoxigenic E.coli (ETEC) in adults. The symptoms of Shigella and Salmonella infection, such as bloody stools, white blood cells (WBC) and red blood cells (RBC) positivity and fever were similar in children, which may lead to the misidentification. Yersinia enterocolitica and shiga toxin-producing E.coli (STEC) infections were firstly reported in Beijing. There was a large difference in etiology of bacterial diarrhea between children in developing and developed regions of China.     

Prevalence and Associated Factors of Hypertension: A Crossectional Community Based Study in Northwest Ethiopia

Background

Hypertension, being the root cause of many of the body sytem and organs failure, remains to be a major public health challenge globally. Though the problem is huge in both developed and developing countries, data are scarce in developing countries like Ethiopia. Therefore, this study was aimed to determine the magnitude and associated factors of hypertension in North West Ethiopia.

Methods

A cross-sectional survey was conducted on adults aged 35 years and above in the rural and urban communities of Dabat district and Gondar town in 2012. The data were collected using the WHO STEPwise strategy. Hypertension was defined as having a Systolic blood pressure of ≥140 mmHg and/ or a Diastolic BP of ≥ 90mmHg or a reported use of anti-hypertensive medications for raised blood pressure. Prevalence was computed with a 95% confidence interval. Selected risk factors were assessed using a biviarete logistic regression.

Results

A total of 2200 participants were included in the study. The median age (±SD) was 47 (±12.4) years. The overall prevalence of hypertension was found to be 27.9% [95% CI 26.0, 29.8], with the proportion in the urban and rural residents being 30.7% and 25.3% respectively. The prevalence of hypertension was 29.3% for women and 26.3% for men. Out of the 598 hypertensive patients 241 (40.3%) had blood pressure measurements, and 99 (16.6%) had known hypertension and were on treatment. The proportion of systolic and diastolic hypertension in this subgroup of adults was 133(6.2%). The multivariable logistic regression analysis showed older age (AOR = 1.06; 1.05, 1.07), raised fasting glucose (AOR = 1.01; 1.001, 1.01), alcohol consumption (AOR = 1.71; 1.24, 2.36), and raised BMI (AOR =1.07; 1.04, 1.10) were significantly associated with hypertension.

Conclusion

The prevalence of hypertension was considerably higher in rural areas than previously reported. The health system needs to develop strategies to increase the reach of relevant screening and diagnostic services to both rural and urban populations.     

Statistical Analysis of Spatial Point Processes: A Soft-Core Model and Cross-Correlations of Marks

This paper suggests correlation characteristics for marked point processes with two marks for each point and describes statistical methods for their estimation. Its use is demonstrated by means of an example, where the points are locations of pine saplings, and the marks are their heights and ages. Furthermore, a soft-core point process model is presented. It is shown that a pattern of sites of beadlet anemones on a rock has a pair-correlation function and intensity which can be very well approximated by the model.     

Quantitative Analysis of Burden of Infectious Diarrhea Associated with Floods in Northwest of Anhui Province,China: A Mixed Method Evaluation

Background

Persistent and heavy rainfall in the upper and middle Huaihe River of China brought about severe floods during the end of June and July 2007. However, there has been no assessment on the association between the floods and infectious diarrhea. This study aimed to quantify the impact of the floods in 2007 on the burden of disease due to infectious diarrhea in northwest of Anhui Province.

Methods

A time-stratified case-crossover analysis was firstly conducted to examine the relationship between daily cases of infectious diarrhea and the 2007 floods in Fuyang and Bozhou of Anhui Province. Odds ratios (ORs) of the flood risk were quantified by conditional logistic regression. The years lived with disability (YLDs) of infectious diarrhea attributable to floods were then estimated based on the WHO framework of the calculating potential impact fraction in the Burden of Disease study.

Results

A total of 197 infectious diarrheas were notified during the exposure and control periods in the two study areas. The strongest effect was shown with a 2-day lag in Fuyang and a 5-day lag in Bozhou. Multivariable analysis showed that floods were significantly associated with an increased risk of the number cases of infectious diarrhea (OR = 3.175, 95%CI: 1.126–8.954 in Fuyang; OR = 6.754, 95%CI: 1.954–23.344 in Bozhou). Attributable YLD per 1000 of infectious diarrhea resulting from the floods was 0.0081 in Fuyang and 0.0209 in Bozhou.

Conclusions

Our findings confirm that floods have significantly increased the risks of infectious diarrhea in the study areas. In addition, prolonged moderate flood may cause more burdens of infectious diarrheas than severe flood with a shorter duration. More attention should be paid to particular vulnerable groups, including younger children and elderly, in developing public health preparation and intervention programs. Findings have significant implications for developing strategies to prevent and reduce health impact of floods.     

Spatial Variation in Lesser Prairie-Chicken Demography: A Sensitivity Analysis of Population Dynamics and Management Alternatives

ABSTRACT The lesser prairie-chicken (Tympanuchus pallidicinctus) is currently considered a candidate for protection under the Endangered Species Act. To identify potential limiting factors for lesser prairie-chicken populations, we developed an age-based matrix model of lesser prairie-chicken population dynamics to compare the relative importance of components of reproduction and survival, and determine if various management alternatives stabilize or increase rates of population change. We based our analyses on an intensive 6-year population study from which demographic rates were estimated for each age class in Kansas. We used deterministic models and elasticity values to identify parameters predicted to have the greatest effect on the rate of population change (λ) at 2 study sites. Last, we used life-stage simulation analysis to simulate various management alternatives. Lambda was <1 for both populations (site 1: λ = 0.54, site 2: λ = 0.74). However, we found differences in sensitivity to nest success and chick survival between populations. The results of the simulated management scenarios complemented the lower-level elasticity analysis and indicated the relative importance of female survival during the breeding season compared with winter. If management practices are only capable of targeting a single demographic rate, changes to either nest success or chick survival had the greatest impact on λ at site 1 and 2, respectively. Management that simultaneously manipulated both nest success and chick survival was predicted to have a greater effect on λ than changes in survival of adult females. In practice, our demographic analyses indicate that effective management should be based on habitat conservation measures to increase components of fecundity.     

Spatial Distribution of Podoconiosis in Relation to Environmental Factors in Ethiopia: A Historical Review

Background

An up-to-date and reliable map of podoconiosis is needed to design geographically targeted and cost-effective intervention in Ethiopia. Identifying the ecological correlates of the distribution of podoconiosis is the first step for distribution and risk maps. The objective of this study was to investigate the spatial distribution and ecological correlates of podoconiosis using historical and contemporary survey data.

Methods

Data on the observed prevalence of podoconiosis were abstracted from published and unpublished literature into a standardized database, according to strict inclusion and exclusion criteria. In total, 10 studies conducted between 1969 and 2012 were included, and data were available for 401,674 individuals older than 15 years of age from 229 locations. A range of high resolution environmental factors were investigated to determine their association with podoconiosis prevalence, using logistic regression.

Results

The prevalence of podoconiosis in Ethiopia was estimated at 3.4% (95% CI 3.3%–3.4%) with marked regional variation. We identified significant associations between mean annual Land Surface Temperature (LST), mean annual precipitation, topography of the land and fine soil texture and high prevalence of podoconiosis. The derived maps indicate both widespread occurrence of podoconiosis and a marked variability in prevalence of podoconiosis, with prevalence typically highest at altitudes >1500 m above sea level (masl), with >1500 mm annual rainfall and mean annual LST of 19–21°C. No (or very little) podoconiosis occurred at altitudes <1225 masl, with annual rainfall <900 mm, and mean annual LST of >24°C.

Conclusion

Podoconiosis remains a public health problem in Ethiopia over considerable areas of the country, but exhibits marked geographical variation associated in part with key environmental factors. This is work in progress and the results presented here will be refined in future work.     

Household Water Chlorination Reduces Incidence of Diarrhea among Under-Five Children in Rural Ethiopia: A Cluster Randomized Controlled Trial

Background

Household water treatment has been advocated as a means of decreasing the burden of diarrheal diseases among young children in areas where piped and treated water is not available. However, its effect size, the target population that benefit from the intervention, and its acceptability especially in rural population is yet to be determined. The objective of the study was to assess the effectiveness of household water chlorination in reducing incidence of diarrhea among children under-five years of age.

Method

A cluster randomized community trial was conducted in 36 rural neighborhoods of Eastern Ethiopia. Households with at least one child under-five years of age were included in the study. The study compared diarrhea incidence among children who received sodium hypochlorite (liquid bleach) for household water treatment and children who did not receive the water treatment. Generalized Estimation Equation model was used to compute adjusted incidence rate ratio and the corresponding 95% confidence interval.

Result

In this study, the incidence of diarrhea was 4.5 episodes/100 person week observations in the intervention arm compared to 10.4 episodes/100 person week observations in the control arm. A statistically significant reduction in incidence of diarrhea was observed in the intervention group compared to the control (Adjusted IRR = 0.42, 95% CI 0.36–0.48).

Conclusion

Expanding access to household water chlorination can help to substantially reduce child morbidity and achieve millennium development goal until reliable access to safe water is achieved.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01376440","term_id":"NCT01376440"}}NCT01376440     

A Computer Programme Package for the Statistical Analysis of Spatial Point Processes in a Square

A computer programme for the statistical analysis of point data in a square is described. Several tests for randomness of the distribution of points are possible. The most comprehensive of these are comparisons of the empirical distributions of the inter-point and closest neighbour distances with their respective expected distributions under complete randomness, and tests based on Ripley' L function; using these, significant aggregation or regularity can be identified. It is also possible to calculate statistics of properties (“attributes”) associated with each spatial point, as well as to compare statistics for sub-areas of the experimental square. Several measures of spatial autocorrelation are available, amongst them correlograms and variograms. The programme can also find the tesselation of the study area and correlate tile properties with the point attributes. The procedures are illustrated by references to the spatial distribution and mound heights of Trinevitermes trinervoides on a study area in South Africa. Although the programme was developed specifically for application in entomology, it could be used to analyse data from many other disciplines.     

爱玉子花的变异类型及其相关统计分析

该文报道了爱玉子（Ficusawkeotsang）花序中存在变异花的现象,并通过花序解剖观测及数据统计分析方法,研究比较雌、雄花序中变异花的类型、不同品系的花序变异率以及单花序中变异花的数量,了解变异花发育过程、变异花与传粉小蜂之间的相互关系,以及变异花对爱玉子产量造成的影响。结果表明：爱玉子变异花在形态上有单生与伞形花序状2种类型,雌花序中的变异花分布在雌花区和退化花区：雄花序中的变异花均生长在瘿花区。雌花序中伞形花序状的A型变异花影响传粉小蜂对正常雌花的授粉,与正常雌花争夺养分和生长空间从而影响正常雌花的生长发育,大量A型变异花的存在使未授粉的雌花序延迟凋落或挂树不落,造成养分流失。雌性品系太和6、太7、W13、乐野8、日野20和大洋Z106的花序中A型变异花数量较多,对产量有一定的影响。除A型外的其它类型的变异花,由于数量少且结构简单,或发育后熟,对传粉小蜂的传粉、产卵以及花序的发育、成熟没有显著影响。无论是雌性品系还是雄性品系,以扦插苗繁殖方式形成的植株,其花序变异率高于以实生苗繁殖方式形成的植株。以上研究结果为高产优质爱玉子品系的选育提供了一定的依据,且对于爱玉子的栽培和推广有着重要的指导意义。     

爱玉子花的变异类型及其相关统计分析

该文报道了爱玉子(Ficus awkeotsang)花序中存在变异花的现象, 并通过花序解剖观测及数据统计分析方法, 研究比较雌、雄花序中变异花的类型、不同品系的花序变异率以及单花序中变异花的数量, 了解变异花发育过程、变异花与传粉小蜂之间的相互关系, 以及变异花对爱玉子产量造成的影响。结果表明: 爱玉子变异花在形态上有单生与伞形花序状2种类型, 雌花序中的变异花分布在雌花区和退化花区; 雄花序中的变异花均生长在瘿花区。雌花序中伞形花序状的A型变异花影响传粉小蜂对正常雌花的授粉, 与正常雌花争夺养分和生长空间从而影响正常雌花的生长发育, 大量A型变异花的存在使未授粉的雌花序延迟凋落或挂树不落, 造成养分流失。雌性品系太和6、太7、W13、乐野8、日野20和大洋Z106的花序中A型变异花数量较多, 对产量有一定的影响。除A型外的其它类型的变异花, 由于数量少且结构简单, 或发育后熟, 对传粉小蜂的传粉、产卵以及花序的发育、成熟没有显著影响。无论是雌性品系还是雄性品系, 以扦插苗繁殖方式形成的植株, 其花序变异率高于以实生苗繁殖方式形成的植株。以上研究结果为高产优质爱玉子品系的选育提供了一定的依据, 且对于爱玉子的栽培和推广有着重要的指导意义。     

Variation in reaction norms: Statistical considerations and biological interpretation

Analysis of reaction norms, the functions by which the phenotype produced by a given genotype depends on the environment, is critical to studying many aspects of phenotypic evolution. Different techniques are available for quantifying different aspects of reaction norm variation. We examine what biological inferences can be drawn from some of the more readily applicable analyses for studying reaction norms. We adopt a strongly biologically motivated view, but draw on statistical theory to highlight strengths and drawbacks of different techniques. In particular, consideration of some formal statistical theory leads to revision of some recently, and forcefully, advocated opinions on reaction norm analysis. We clarify what simple analysis of the slope between mean phenotype in two environments can tell us about reaction norms, explore the conditions under which polynomial regression can provide robust inferences about reaction norm shape, and explore how different existing approaches may be used to draw inferences about variation in reaction norm shape. We show how mixed model‐based approaches can provide more robust inferences than more commonly used multistep statistical approaches, and derive new metrics of the relative importance of variation in reaction norm intercepts, slopes, and curvatures.     

Drift or Selection: A Statistical Test of Gene Frequency Variation over Generations

The method used by Fisher and Ford (1947) to study the spread of a gene in a natural population has been modified to analyze the variation in allele frequencies from generation to generation in a common experimental procedure. A further analysis has been developed that is more sensitive to directional trends in the allele frequency over generations, and its use in detecting the action of directional selection on gene frequency at a locus is discussed. The power of each of these statistical tests is calculated for a number of cases, and the tests are applied to sets of isozyme data from Drosophila pseudoobscura and Zea mays.     

Detecting Associations between Early-Life DDT Exposures and Childhood Growth Patterns: A Novel Statistical Approach

It has been hypothesized that environmental exposures at key development periods such as in utero play a role in childhood growth and obesity. To investigate whether in utero exposure to endocrine-disrupting chemicals, dichlorodiphenyltrichloroethane (DDT) and its metabolite, dichlorodiphenyldichloroethane (DDE), is associated with childhood physical growth, we took a novel statistical approach to analyze data from the CHAMACOS cohort study. To model heterogeneity in the growth patterns, we used a finite mixture model in combination with a data transformation to characterize body mass index (BMI) with four groups and estimated the association between exposure and group membership. In boys, higher maternal concentrations of DDT and DDE during pregnancy are associated with a BMI growth pattern that is stable until about age five followed by increased growth through age nine. In contrast, higher maternal DDT exposure during pregnancy is associated with a flat, relatively stable growth pattern in girls. This study suggests that in utero exposure to DDT and DDE may be associated with childhood BMI growth patterns, not just BMI level, and both the magnitude of exposure and sex may impact the relationship.     

Statistical Analysis of Secondary Sex Ratio Variation in Sable Martes zibellina L.

The secondary sex ratio in sable Martes zibellina L. maintained in captivity was estimated for the first time ever. The data obtained at the Pushkin pedigree breeding farm (Moscow oblast) in 1982 through 1987 were analyzed. In total, 1705 litters of 418 females were examined. The total frequency of male births (P^ was 0.527 ± 0.007; the 95% confidence interval of P^ (the probability of birth of a male) was within the limits 0.513 p 0.541, and the deviation from the expected 1 : 1 ratio was statistically significant. No effect of parental age and litter size on the number of male progeny was found. This may indicate a small influence of the parental hormonal and immunological status on sex ratio, which was reported in many other mammal species including those related to sable. Apparently, there is an evolutionary mechanism underlying the stable excess of males in sable litters.     

Knowledge,Attitudes and Practices Related to Visceral Leishmaniasis in Rural Communities of Amhara State: A Longitudinal Study in Northwest Ethiopia

Background

In the northwest of Ethiopia, at the South Gondar region, there was a visceral leishmaniasis (VL) outbreak in 2005, making the disease a public health concern for the regional health authorities ever since. The knowledge on how the population perceives the disease is essential in order to propose successful control strategies.

Methodology/Principal findings

Two surveys on VL knowledge, attitudes and practices were conducted at the beginning (May 2009) and at the end (February 2011) of a VL longitudinal study carried out in rural communities of Libo Kemkem and Fogera, two districts of the Amhara Regional State. Results showed that VL global knowledge was very low in the area, and that it improved substantially in the period studied. Specifically, from 2009 to 2011, the frequency of proper knowledge regarding VL signs and symptoms increased from 47% to 71% (p<0.0001), knowledge of VL causes increased from 8% to 25% (p<0.0001), and knowledge on VL protection measures from 16% to 55% (p<0.0001). Moreover, the improvement observed in VL knowledge was more marked among the families with no previous history of VL case. Finally, in 2011 more than 90% of the households owned at least an impregnated bed net and had been sprayed, and attitudes towards these and other protective measures were very positive (over 94% acceptance for all of them).

Conclusions/Significance

In 2009 the level of knowledge regarding VL was very low among the rural population of this area, although it improved substantially in the study period, probably due to the contribution of many actors in the area. VL patients and relatives should be appropriately informed and trained as they may act as successful health community agents. VL risk behavioural patterns are subject to change as attitudes towards protective measures were very positive overall.