Background: Climate change in Ethiopia is already evident in a number of ways.. Climate variability as a result of climate change will be one of the public health challenges to control infectious diseases in the future, particularly in the low income communities of sub-Saharan Africa.
Objective: the aim of this study was to investigate the effect of climate variability on childhood diarrhea and identify high risk periods of diarrheal diseases.
Methods: The study was conducted in all districts located in three Zones (Awi, West and East Gojjam) of Amhara Region in northwestern parts of Ethiopia. Monthly childhood diarrhea cases for 24 months (from July 2013 to June 2015) reported to each district health office from the routine surveillance system were used for the study. Climate variability (temperature, rainfall and humidity) for each district was extracted from satellite precipitation estimates and global atmospheric reanalysis. The space-time permutation scan statistic was used to identify high risk periods of childhood diarrhea. A time-series negative binomial regression was used to investigate the relationship between cases of childhood diarrhea and climate variables. Statistical analyses were conducted using SaTScan program and StataSE v. 12.
Results: a total of 217,734 cases of childhood diarrhea were reported during the study period. The monthly average incidence rate of childhood diarrhea was 11.4 per 1000 (95%CI 10.8-12.0) with significant variation between males [12.5 per 1000 (95%CI 11.9 to 13.2)] and females [10.2 per 1000 (95%CI 9.6 to 10.8)]. The space-time permutation scan statistic identified the most likely high risk period of childhood diarrhea between March and June 2014 located in Huletej Enese district of East Gojjam Zone. The center of the high risk period was at 11.080369 N, 37.534226 E and its radius was 0 km. In this most likely high risk period, 4,838 observed cases occurred during a 4-month period when 1830.9 cases were expected to occur. Multivariable negative binomial regression results show that monthly average temperature and monthly average rainfall were positively associated with the rate of childhood diarrhea, whereas the relative humidity was negatively associated with the rate of childhood diarrhea.
Conclusions: This study found that the most likely high risk period is in the beginning of the dry season. Climatic factors have an association with the occurrence of childhood diarrhea. Therefore, childhood diarrhea prevention and control strategy should consider local weather variations to improve programs on childhood diarrhea.
Key words: Childhood diarrhea, Space-time risk analysis, Climatic risk factors
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