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Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach

BACKGROUND: The climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to...

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Autores principales: Lee, Tristan Taylor, Dalvie, Mohamed Aqiel, Röösli, Martin, Merten, Sonja, Kwiatkowski, Marek, Mahomed, Hassan, Sweijd, Neville, Cissé, Guéladio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10436439/
https://www.ncbi.nlm.nih.gov/pubmed/37596648
http://dx.doi.org/10.1186/s40249-023-01127-7
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author Lee, Tristan Taylor
Dalvie, Mohamed Aqiel
Röösli, Martin
Merten, Sonja
Kwiatkowski, Marek
Mahomed, Hassan
Sweijd, Neville
Cissé, Guéladio
author_facet Lee, Tristan Taylor
Dalvie, Mohamed Aqiel
Röösli, Martin
Merten, Sonja
Kwiatkowski, Marek
Mahomed, Hassan
Sweijd, Neville
Cissé, Guéladio
author_sort Lee, Tristan Taylor
collection PubMed
description BACKGROUND: The climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to gain a more holistic understanding of the relationship between diarrhoea in young children and climate variability in a system stressed by water scarcity. METHODS: Using a mixed-methods approach, we explored diarrhoeal disease incidence in children under 5 years between 2010 to 2019 in Cape Town, primarily in the public health system through routinely collected diarrhoeal incidence and weather station data. We developed a negative binomial regression model to understand the relationship between temperature, precipitation, and relative humidity on incidence of diarrhoea with dehydration. We conducted in-depth interviews with stakeholders in the fields of health, environment, and human development on perceptions around diarrhoea and health-related interventions both prior to and over the drought, and analysed them through the framework method. RESULTS: From diarrhoeal incidence data, the diarrhoea with dehydration incidence decreased over the decade studied, e.g. reduction of 64.7% in 2019 [95% confidence interval (CI): 5.5–7.2%] compared to 2010, with no increase during the severe drought period. Over the hot dry diarrhoeal season (November to May), the monthly diarrhoea with dehydration incidence increased by 7.4% (95% CI: 4.5–10.3%) per 1 °C increase in temperature and 2.6% (95% CI: 1.7–3.5%) per 1% increase in relative humidity in the unlagged model. Stakeholder interviews found that extensive and sustained diarrhoeal interventions were perceived to be responsible for the overall reduction in diarrhoeal incidence and mortality over the prior decade. During the drought, as diarrhoeal interventions were maintained, the expected increase in incidence in the public health sector did not occur. CONCLUSIONS: We found that that diarrhoeal incidence has decreased over the last decade and that incidence is strongly influenced by local temperature and humidity, particularly over the hot dry season. While climate change and extreme weather events especially stress systems supporting vulnerable populations such as young children, maintaining strong and consistent public health interventions helps to reduce negative health impacts. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40249-023-01127-7.
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spelling pubmed-104364392023-08-19 Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach Lee, Tristan Taylor Dalvie, Mohamed Aqiel Röösli, Martin Merten, Sonja Kwiatkowski, Marek Mahomed, Hassan Sweijd, Neville Cissé, Guéladio Infect Dis Poverty Research Article BACKGROUND: The climate of southern Africa is expected to become hotter and drier with more frequent severe droughts and the incidence of diarrhoea to increase. From 2015 to 2018, Cape Town, South Africa, experienced a severe drought which resulted in extreme water conservation efforts. We aimed to gain a more holistic understanding of the relationship between diarrhoea in young children and climate variability in a system stressed by water scarcity. METHODS: Using a mixed-methods approach, we explored diarrhoeal disease incidence in children under 5 years between 2010 to 2019 in Cape Town, primarily in the public health system through routinely collected diarrhoeal incidence and weather station data. We developed a negative binomial regression model to understand the relationship between temperature, precipitation, and relative humidity on incidence of diarrhoea with dehydration. We conducted in-depth interviews with stakeholders in the fields of health, environment, and human development on perceptions around diarrhoea and health-related interventions both prior to and over the drought, and analysed them through the framework method. RESULTS: From diarrhoeal incidence data, the diarrhoea with dehydration incidence decreased over the decade studied, e.g. reduction of 64.7% in 2019 [95% confidence interval (CI): 5.5–7.2%] compared to 2010, with no increase during the severe drought period. Over the hot dry diarrhoeal season (November to May), the monthly diarrhoea with dehydration incidence increased by 7.4% (95% CI: 4.5–10.3%) per 1 °C increase in temperature and 2.6% (95% CI: 1.7–3.5%) per 1% increase in relative humidity in the unlagged model. Stakeholder interviews found that extensive and sustained diarrhoeal interventions were perceived to be responsible for the overall reduction in diarrhoeal incidence and mortality over the prior decade. During the drought, as diarrhoeal interventions were maintained, the expected increase in incidence in the public health sector did not occur. CONCLUSIONS: We found that that diarrhoeal incidence has decreased over the last decade and that incidence is strongly influenced by local temperature and humidity, particularly over the hot dry season. While climate change and extreme weather events especially stress systems supporting vulnerable populations such as young children, maintaining strong and consistent public health interventions helps to reduce negative health impacts. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s40249-023-01127-7. BioMed Central 2023-08-18 /pmc/articles/PMC10436439/ /pubmed/37596648 http://dx.doi.org/10.1186/s40249-023-01127-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Lee, Tristan Taylor
Dalvie, Mohamed Aqiel
Röösli, Martin
Merten, Sonja
Kwiatkowski, Marek
Mahomed, Hassan
Sweijd, Neville
Cissé, Guéladio
Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach
title Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach
title_full Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach
title_fullStr Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach
title_full_unstemmed Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach
title_short Understanding diarrhoeal diseases in response to climate variability and drought in Cape Town, South Africa: a mixed methods approach
title_sort understanding diarrhoeal diseases in response to climate variability and drought in cape town, south africa: a mixed methods approach
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10436439/
https://www.ncbi.nlm.nih.gov/pubmed/37596648
http://dx.doi.org/10.1186/s40249-023-01127-7
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