Assessing the effect of climate factors on childhood diarrhoea burden in Kathmandu, Nepal.
This study was undertaken to assess the effect of climate variability on diarrhoeal disease burden among children under 5 years of age living in Kathmandu, Nepal. The researchers sought to predict future risk of childhood diarrhoea under different climate change scenarios to advance the evidence base available to public health decision-makers, and the Nepalese infection control division, in planning for climate impacts. A time series study was conducted using the monthly case count of diarrhoeal disease (2003-2013) among children under 5 years of age living in Kathmandu, Nepal. A quasi Poisson generalised linear equation with distributed lag linear model was fitted to estimate the lagged effect of monthly maximum temperature and rainfall on childhood diarrhoea. The environmental framework of comparative risk assessment was used to assess the environmental burden of diarrhoea within this population. A total of 219,774 cases of diarrhoeal disease were recorded during the study period with a median value of 1286 cases per month. The results of a regression model revealed that the monthly count of diarrhoea cases increased by 8.1% (RR: 1.081; 95% CI: 1.02-1.14) per 1 °C increase in maximum temperature above the monthly average recorded within that month. Similarly, rainfall was found to have significant effect on the monthly diarrhoea count, with a 0.9% (RR; 1.009; 95% CI: 1.004-1.015) increase in cases for every 10 mm increase in rainfall above the monthly cumulative value recorded within that month. It was estimated that 7.5% (95% CI: 2.2%-12.5%) of the current burden of diarrhoea among children under 5 years of age could be attributed to climatic factors (maximum temperature), and projected that 1357 (UI: 410-2274) additional cases of childhood diarrhoea could be climate attributable by the year 2050 under low-risk scenario (0.9 °C increase in maximum temperature). It is estimated that there exists a significant association (p < 0.05) between childhood diarrhoea and an increase in maximum temperature and rainfall in Kathmandu, Nepal. The findings of this study may inform the conceptualization and design of early warning systems for the prediction and control of childhood diarrhoea, based upon the observed pattern of climate change in Kathmandu.