Short-term associations of diarrhoeal diseases in children with temperature and precipitation in seven low- and middle-income countries from Sub-Saharan Africa and South Asia in the Global Enteric Multicenter Study
Authors: Hossain Nasif , Madaniyazi Lina , Ng Chris Fook Sheng , Nasrin Dilruba , Seposo Xerxes Tesoro , Chua Paul L.C. , Pan Rui , Faruque Abu Syed Golam , Hashizume Masahiro 
Published: December 2023

ABSTRACTBackgroundDiarrhoeal diseases cause a heavy burden in developing countries. Although studies have described the seasonality of diarrhoeal diseases, the association of weather variables with diarrhoeal diseases has not been well characterized in resource-limited settings where the burden remains high. We examined short-term associations between weather and hospital visits due to diarrhoea among children in seven low- and middle-income countries.MethodologyHospital visits due to diarrhoeal diseases in under 5 years old were collected from seven sites in The Gambia, Mali, Mozambique, Kenya, India, Bangladesh, and Pakistan via the Global Enteric Multicenter Study, from December 2007 to March 2011. Daily weather data during the same period were downloaded from the –ERA5-Land. We fitted time-series regression models to examine the relationships of daily diarrhoea cases with daily ambient temperature and precipitation. To account for between-site variability, we used a multivariate random-effects meta-regression model.Principal findingsThe relative risk (RR) of diarrhoea with temperature exposure ranged from 0.24 to 8.07, with Mozambique and Bangladesh showing positive associations, while Mali and Pakistan showing negative associations. The RR for precipitation ranged from 0.77 to 1.55, with Mali and India showing positive associations, while the only negative association was observed in Pakistan. Meta-analysis showed substantial heterogeneity in the association’s temperature–diarrhoea and precipitation– diarrhoea across sites, withI2of 84.2% and 67.5%, respectively.ConclusionsChild diarrhea and weather factors have diverse and complex associations across South Asia and Sub-Saharan Africa, influenced by pathogens, treatment, and nutrition. Diarrhoeal surveillance system settings should be conceptualized based on the observed pattern of climate change in these locations.Author SummaryDiarrhoeal diseases remain a significant public health concern, particularly in low- and middle- income nations, and understanding the environmental factors that influence their occurrence is crucial for effective prevention and management strategies. Here, we study the weather factors, such as temperature and precipitation, that could influence the prevalence of diarrhoeal diseases in children. We found that higher temperatures were associated with an increased risk of diarrhoea in some regions. Increased precipitation was associated with a higher incidence of diarrhoea in some sites. In certain sites, diarrhoeal cases decreased with rising temperatures and precipitation. We believe that these findings may offer insights into the climate and geographic patterns of childhood diarrhoea. Such insights are crucial for developing targeted and efficient public health interventions to reduce the burden of diarrhoeal diseases. Furthermore, weather- related variables can play a significant role in driving child diarrhoea, making it imperative to identify the conditions associated with these patterns to enhance our understanding of the complex interplay between environmental factors and the prevalence of this disease.