title: Health at the Sub-catchment Scale: Typhoid and Its Environmental Determinants in Central Division, Fiji.
abstract: The impact of environmental change on transmission patterns of waterborne enteric diseases is a major public health concern. This study concerns the burden and spatial nature of enteric fever, attributable to Salmonella Typhi infection in the Central Division, Republic of Fiji at a sub-catchment scale over 30-months (2013-2015). Quantitative spatial analysis suggested relationships between environmental conditions of sub-catchments and incidence and recurrence of typhoid fever. Average incidence per inhabited sub-catchment for the Central Division was high at 205.9/100,000, with cases recurring in each calendar year in 26% of sub-catchments. Although the numbers of cases were highest within dense, urban coastal sub-catchments, the incidence was highest in low-density mountainous rural areas. Significant environmental determinants at this scale suggest increased risk of exposure where sediment yields increase following runoff. The study suggests that populations living on large systems that broaden into meandering mid-reaches and floodplains with alluvial deposition are at a greater risk compared to small populations living near small, erosional, high-energy headwaters and small streams unconnected to large hydrological networks. This study suggests that anthropogenic alteration of land cover and hydrology (particularly via fragmentation of riparian forest and connectivity between road and river networks) facilitates increased transmission of typhoid fever and that environmental transmission of typhoid fever is important in Fiji.
authors.affiliation: Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia. apjenkins22@gmail.com.
authors.forename: Aaron Peter
authors.initials: AP
authors.lastname: Jenkins
authors.affiliation: Wildlife Conservation Society, Suva, Fiji.
authors.forename: Stacy
authors.initials: S
authors.lastname: Jupiter
authors.affiliation: Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
authors.forename: Ute
authors.initials: U
authors.lastname: Mueller
authors.affiliation: Fiji National University, Suva, Fiji.|Murdoch Childrens Research Institute, Parkville, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Jenney
authors.affiliation: Wildlife Conservation Society, Suva, Fiji.
authors.forename: Gandercillar
authors.initials: G
authors.lastname: Vosaki
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia.
authors.forename: Varanisese
authors.initials: V
authors.lastname: Rosa
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia.
authors.forename: Alanieta
authors.initials: A
authors.lastname: Naucukidi
authors.affiliation: Murdoch Childrens Research Institute, Parkville, Australia.|London School of Hygiene and Tropical Medicine, London, England.
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.affiliation: University of Melbourne, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Strugnell
authors.affiliation: Fiji Ministry of Health and Medical Services, Suva, Fiji.
authors.forename: Mike
authors.initials: M
authors.lastname: Kama
authors.affiliation: Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
authors.forename: Pierre
authors.initials: P
authors.lastname: Horwitz
mesh_terms: D005367:Fiji; D006801:Humans; D011634:Public Health; D018570:Risk Assessment; D045483:Rivers; D012485:Salmonella typhi; D014435:Typhoid Fever / Q000453:epidemiology*
keywords: catchment; environmental determinants; incidence; recurrence; typhoid