Elsevier

Public Health

Volume 131, February 2016, Pages 20-26
Public Health

Original Research
Daily temperature change in relation to the risk of childhood bacillary dysentery among different age groups and sexes in a temperate city in China

https://doi.org/10.1016/j.puhe.2015.10.011Get rights and content

Highlights

  • This study attempts to investigate the relationship between mean temperature and childhood BD in a temperate city of China.

  • Different lagged effect of mean temperature on childhood BD exists among different age-group and gender.

  • As the climatic conditions become more and more harsh, children aged 0–5 years and female children were more at risk of developing bacillary dysentery.

  • Different lagged effect of mean temperature on childhood bacillary dysentery exists among different age-group and gender.

Abstract

Background

In recent years, many studies have found that ambient temperature is significantly associated with bacillary dysentery (BD). However, there is limited evidence on the relationship between temperature and childhood BD in temperate areas.

Objectives

To investigate the relationship between daily mean temperature (MT) and childhood BD in China.

Methods

Data on daily MT and childhood BD between 2006 and 2012 were collected from the Bureau of Meteorology and the Centre for Disease Control and Prevention in Hefei, Anhui Province, China. A Poisson generalized linear regression model combined with a distributed lag non-linear model was used to analyse the effects of temperature on childhood BD across different age and sex subgroups.

Results

An increase in temperature was significantly associated with childhood BD, and each 1 °C increase corresponded to an increase of 1.58% [95% confidence interval (CI) 0.46–2.71%] in the number of cases of BD. Children aged 0–5 years and girls were particularly sensitive to the effects of temperature.

Conclusions

High temperatures may increase the risk of childhood BD in Hefei. Children aged 0–5 years and girls appear to be particularly sensitive to the effects of high temperature.

Introduction

Bacillary dysentery (BD) is mainly caused by Shigella. Common clinical manifestations include fever, chills, abdominal pain and diarrhoea after an incubation period of one or two days.1 BD is mainly spread through the faecal–oral route and person-to-person contacts. BD epidemics are common among overcrowded populations with poor sanitation. Previous studies have found that trends in BD transmission show significant seasonality, and its incidence peaks in summer and autumn.2, 3, 4

In recent decades, although the incidence of BD has declined considerably in developing countries,5 the considerable burden of BD is still a great public health concern in impoverished areas.6, 7, 8 Globally, BD remains an important cause of mortality among children aged <5 years, especially in China.8, 9 According to the National Notifiable Diseases of China, the number of cases of BD reached almost 0.19 million, with an incidence of 138.2 per million, in 2013 and approximately 85% of cases occur in summer and autumn.10, 11 The burden of childhood BD has been reported to be much greater than the burden of other age groups (>14 years),12, 13, 14 suggesting that research into childhood BD would be of more practical significance.

Many individual, social and environmental factors are associated with the occurrence of BD.15 In northeast China, Huang et al. found that climatic factors (including temperature, evaporation, precipitation and relative humidity) were positively correlated with cases of BD.11 Associations between mean and maximum temperatures and BD have also been observed in Taiwan.16 Available evidence strongly suggests that children are more susceptible to BD, while few studies to date have focused on assessing the impact of temperature on BD among children, and little is known about whether the relationship between temperature and childhood BD varies by age and sex.

The incidence of BD in China is high, which can be largely attributable to the extremely high population mobility and high population density. Adverse effects of mean temperature (MT) on BD may exist in different areas with various socio-economic statuses, population characteristics and weather conditions. As such, an eastern inland city of China (Hefei) was selected as the study site. This study attempted to address the following research issues using a Poisson generalized linear regression model combined with a distributed lag non-linear model (DLNM):17

  • What is the relationship between daily MT and childhood BD?

  • Which subgroups are more vulnerable to the effects of MT on BD?

  • Is there a delayed effect of MT on childhood BD?

Section snippets

Setting

Hefei, the capital city of Anhui Province, is located in the east of China (31°52′ N, 117°17′ E) (see Fig. 1). The city has an area of 11,408 km2, a population of approximately 7.61 million, and 18.1% of the population are aged 0–14 years.18 Hefei has a typical subtropical humid monsoon climate, with hot summers and mild winters.

Data collection

Daily data on BD morbidity in children (aged 0–14 years) between 2006 and 2012 were collected from Hefei Centre for Disease Control and Prevention. Age (0–5 years and

Results

Over the study period (2006–2012), 6511 cases of BD occurred in Hefei. Table 1 shows the summary statistics for childhood BD and climatic variables in the study area. There were 5560 cases of BD in children aged 0–5 years. The average number of daily BD cases was 5.1 (range 0–15). The average values for maximum, mean and minimum temperature were 21.3 °C (range −1.8–38.8 °C), 16.7 °C (range −5.1 °C–34.0 °C) and 13.0 °C (range −11.2–30.6 °C), respectively. The average values for RH and

Discussion

The purpose of this study was to investigate the relationship between MT and childhood BD. Several notable findings were observed. First, there was a significant relationship between MT and childhood BD, particularly in children aged 0–5 years, boys and girls. Second, the longest lagged effects of MT on BD differed between age and sex groups (lag of 7, 6, 3, 4 and 7 days for children aged 0–14 years, children aged 0–5 years, children aged 6–14 years, boys and girls, respectively). Third, the

Ethical approval

Ethical approval was obtained from the Ethic Review Board of Anhui Medical University.

Funding

This research was funded by Anhui Natural Science Fund (NO.1408085MH159).

Competing interests

None declared.

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