title: Diarrheal disease risk in rural Bangladesh decreases as tubewell density increases: a zero-inflated and geographically weighted analysis.
abstract: BACKGROUND
  This study investigates the impact of tubewell user density on cholera and shigellosis events in Matlab, Bangladesh between 2002 and 2004. Household-level demographic, health, and water infrastructure data were incorporated into a local geographic information systems (GIS) database. Geographically-weighted regression (GWR) models were constructed to identify spatial variation of relationships across the study area. Zero-inflated negative binomial regression models were run to simultaneously measure the likelihood of increased magnitude of disease events and the likelihood of zero cholera or shigellosis events. The aim of this study was to examine the effect of tubewell density on both the occurrence of diarrheal disease and the magnitude of diarrheal disease incidence.
  
  
  RESULTS
  In Matlab, households with greater tubewell density were more likely to report zero cholera or shigellosis events. Results for both cholera and shigellosis GWR models suggest that tubewell density effects are spatially stationary and the use of non-spatial statistical methods is appropriate.
  
  
  CONCLUSIONS
  Increasing the amount of drinking water available to households through increased density of tubewells contributed to lower reports of cholera and shigellosis events in rural Bangladesh. Our findings demonstrate the importance of tubewell installation and access to groundwater in reducing diarrheal disease events in the developing world.
authors.affiliation: Department of Geography, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Carrel
authors.forename: Veronica
authors.initials: V
authors.lastname: Escamilla
authors.forename: Jane
authors.initials: J
authors.lastname: Messina
authors.forename: Sophia
authors.initials: S
authors.lastname: Giebultowicz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Winston
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yunus
authors.forename: P Kim
authors.initials: PK
authors.lastname: Streatfield
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003967:Diarrhea / Q000453:epidemiology*; D060766:Drinking Water / Q000382:microbiology*; D005843:Geography; D006801:Humans; D011159:Population Surveillance; D012044:Regression Analysis; D012424:Rural Population; D060986:Water Wells
chemical_list: D060766:Drinking Water