Diarrheal Diseases in Rural Bangladesh: Spatial-Temporal Patterns, Risk Factors and Pathogen Detection

Diarrheal diseases are still a leading cause of child mortality in less developed countries. In the past three decades, in an effort to reduce the transmission of diarrheal diseases, millions of tubewells have been installed as a way to provide safe drinking water in Bangladesh. However, this effort may have been counterproductive since widespread arsenic contamination has been found in groundwater. Thus, there is a reason to rethink the use of tubewells and to assess risk factors related to diarrheal disease in Bangladesh. This study primarily focused on 142 villages of Matlab, a rural area in Bangladesh, using datasets collected through a local health surveillance system to explore the spatiotemporal patterns of diarrheal disease and its relevant risk factors. First, a geographic information system (GIS) and spatial statistics were used to illustrate the occurrence and spatial-temporal clusters of diarrhea (including community childhood diarrhea data and hospital data on diarrhea caused by rotavirus and Shigella). Second, the study determined the relationship between diarrheal disease among children under five and identified several important risk factors, such as tubewell access, depth and arsenic levels. Additionally, simple and rapid concentration methods were developed and evaluated to detect adenovirus, a common etiologic pathogen of diarrhea in water. The study attempted to answer the following questions: What are the trends and spatial patterns of diarrheal diseases? Are tubewells protective against diarrheal diseases? Does arsenic mitigation by well switching raise the risk of diarrheal disease among children? The results obtained from this study provide some useful information to help policy-makers implement relevant scientific measures for diarrhea reduction and arsenic mitigation. The concentration methods developed in this study are applicable to monitor pathogens in water in Bangladesh and worldwide