Protection from annual flooding is correlated with increased cholera prevalence in Bangladesh: a zero-inflated regression analysis

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  • Carrel, Margaret
    • Affiliation: College of Arts and Sciences, Department of Geography
  • Voss, Paul
    • Affiliation: Odum Institute for Research in Social Science
  • Streatfield, Peter K
    • Other Affiliation: Health and Demographic Surveillance Unit, International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh
  • Yunus, Mohammad
    • Other Affiliation: Health and Demographic Surveillance Unit, International Center for Diarrheal Disease Research, Bangladesh, Mohakhali, Dhaka 1212, Bangladesh
  • Emch, Michael
    • Affiliation: College of Arts and Sciences, Department of Geography
Abstract
  • Abstract Background Alteration of natural or historical aquatic flows can have unintended consequences for regions where waterborne diseases are endemic and where the epidemiologic implications of such change are poorly understood. The implementation of flood protection measures for a portion of an intensely monitored population in Matlab, Bangladesh, allows us to examine whether cholera outcomes respond positively or negatively to measures designed to control river flooding. Methods Using a zero inflated negative binomial model, we examine how selected covariates can simultaneously account for household clusters reporting no cholera from those with positive counts as well as distinguishing residential areas with low counts from areas with high cholera counts. Our goal is to examine how residence within or outside a flood protected area interacts with the probability of cholera presence and the effect of flood protection on the magnitude of cholera prevalence. Results In Matlab, living in a household that is protected from annual monsoon flooding appears to have no significant effect on whether the household experiences cholera, net of other covariates. However, counter-intuitively, among households where cholera is reported, living within the flood protected region significantly increases the number of cholera cases. Conclusions The construction of dams or other water impoundment strategies for economic or social motives can have profound and unanticipated consequences for waterborne disease. Our results indicate that the construction of a flood control structure in rural Bangladesh is correlated with an increase in cholera cases for residents protected from annual monsoon flooding. Such a finding requires attention from both the health community and from governments and non-governmental organizations involved in ongoing water management schemes.
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  • Article
Rights statement
  • In Copyright
Rights holder
  • Margaret Carrel et al.; licensee BioMed Central Ltd.
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Journal title
  • Environmental Health
Journal volume
  • 9
Journal issue
  • 1
Page start
  • 13
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1476-069X
Bibliographic citation
  • Environmental Health. 2010 Mar 22;9(1):13
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • August 23, 2012

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