title: The impact of environmental and climatic variation on the spatiotemporal trends of hospitalized pediatric diarrhea in Ho Chi Minh City, Vietnam.
abstract: It is predicted that the integration of climate-based early warning systems into existing action plans will facilitate the timely provision of interventions to diarrheal disease epidemics in resource-poor settings. Diarrhea remains a considerable public health problem in Ho Chi Minh City (HCMC), Vietnam and we aimed to quantify variation in the impact of environmental conditions on diarrheal disease risk across the city. Using all inpatient diarrheal admissions data from three large hospitals within HCMC, we developed a mixed effects regression model to differentiate district-level variation in risk due to environmental conditions from the overarching seasonality of diarrheal disease hospitalization in HCMC. We identified considerable spatial heterogeneity in the risk of all-cause diarrhea across districts of HCMC with low elevation and differential responses to flooding, air temperature, and humidity driving further spatial heterogeneity in diarrheal disease risk. The incorporation of these results into predictive forecasting algorithms will provide a powerful resource to aid diarrheal disease prevention and control practices in HCMC and other similar settings.
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom; The London School of Hygiene & Tropical Medicine, United Kingdom. Electronic address: cthompson@oucru.org.
authors.forename: Corinne N
authors.initials: CN
authors.lastname: Thompson
authors.affiliation: Robert Wood Johnson Foundation Health and Society Scholars Program, 701A Knox Hall, Columbia University, New York, NY 10027, USA. Electronic address: jlz2115@columbia.edu.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Zelner
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam. Electronic address: nhutdh@oucru.org.
authors.forename: Tran Do Hoang
authors.initials: Tdo H
authors.lastname: Nhu
authors.affiliation: Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom. Electronic address: mp21@sanger.ac.uk.
authors.forename: My Vt
authors.initials: MV
authors.lastname: Phan
authors.affiliation: Children's Hospital 1, Ho Chi Minh City, Vietnam. Electronic address: drphuc.ph1@gmail.com.
authors.forename: Phuc
authors.initials: P
authors.lastname: Hoang Le
authors.affiliation: Children's Hospital 1, Ho Chi Minh City, Vietnam. Electronic address: hungnt@oucru.org.
authors.forename: Hung
authors.initials: H
authors.lastname: Nguyen Thanh
authors.affiliation: Children's Hospital 1, Ho Chi Minh City, Vietnam. Electronic address: duongvt@oucru.org.
authors.forename: Duong
authors.initials: D
authors.lastname: Vu Thuy
authors.affiliation: Children's Hospital 2, Ho Chi Minh City, Vietnam. Electronic address: mngocnd2@yahoo.com.
authors.forename: Ngoc
authors.initials: N
authors.lastname: Minh Nguyen
authors.affiliation: Children's Hospital 2, Ho Chi Minh City, Vietnam. Electronic address: manhtuanzu@yahoo.com.
authors.forename: Tuan
authors.initials: T
authors.lastname: Ha Manh
authors.affiliation: Children's Hospital 2, Ho Chi Minh City, Vietnam. Electronic address: vanhmt@oucru.org.
authors.forename: Tu
authors.initials: T
authors.lastname: Van Hoang Minh
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Electronic address: drluvi@yahoo.com.vn.
authors.forename: Vi
authors.initials: V
authors.lastname: Lu Lan
authors.affiliation: Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Electronic address: chaunvv@oucru.org.
authors.forename: Chau
authors.initials: C
authors.lastname: Nguyen Van Vinh
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom. Electronic address: hientt@oucru.org.
authors.forename: Hien
authors.initials: H
authors.lastname: Tran Tinh
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, NJ, USA. Electronic address: emmiliese.von.clemm@gmail.com.
authors.forename: Emmiliese
authors.initials: E
authors.lastname: von Clemm
authors.affiliation: Brandenburg University of Technology, Cottbus, Germany. Electronic address: harry.storch@gmail.com.
authors.forename: Harry
authors.initials: H
authors.lastname: Storch
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom. Electronic address: gthwaites@oucru.org.
authors.forename: Guy
authors.initials: G
authors.lastname: Thwaites
authors.affiliation: Department of Ecology and Evolutionary Biology, Princeton University, NJ, USA; RAPIDD Program, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA. Electronic address: grenfell@princeton.edu.
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Grenfell
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, United Kingdom; The London School of Hygiene & Tropical Medicine, United Kingdom. Electronic address: sbaker@oucru.org.
authors.forename: Stephen
authors.initials: S
authors.lastname: Baker
mesh_terms: D002648:Child; D003967:Diarrhea / Q000453:epidemiology*; D004777:Environment; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D012621:Seasons; D014744:Vietnam / Q000453:epidemiology
keywords: Climate change; Diarrhea; Environment; Mixed effects; Spatial risk