Spatial, temporal, and spatiotemporal analysis of under-five diarrhea in Southern Ethiopia.

Background: Despite improvements in prevention efforts, childhood diarrhea remains a public health concern. However, there may be substantial variation influenced by place, time, and season. Description of diarrheal clusters in time and space and understanding seasonal patterns can improve surveillance and management. The present study investigated the spatial and seasonal distribution and purely spatial, purely temporal, and space-time clusters of childhood diarrhea in Southern Ethiopia.

Methods: The study was a retrospective analysis of data from the Health Management Information System (HMIS) under-five diarrheal morbidity reports from July 2011 to June 2017 in Sidama Zone. Annual diarrhea incidence at district level was calculated. Incidence rate calculation and seasonal trend analysis were performed. The Kulldorff SaTScan software with a discrete Poisson model was used to identify statistically significant special, temporal, and space-time diarrhea clusters. ArcGIS 10.1 was used to plot the maps.

Results: A total of 202,406 under-five diarrheal cases with an annual case of 5822 per 100,000 under-five population were reported. An increasing trend of diarrhea incidence was observed over the 6 years with seasonal variation picking between February and May. The highest incidence rate (135.8/1000) was observed in the year 2016/17 in Boricha district. One statistically significant most likely spatial cluster (Boricha district) and six secondary clusters (Malga, Hulla, Aleta Wondo, Shebedino, Loka Abaya, Dale, and Wondogenet) were identified. One statistically significant temporal cluster (LLR = 2109.93, p  < 0.001) during December 2013 to May 2015 was observed in all districts. Statistically significant spatiotemporal primary hotspot was observed in December 2012 to January 2015 in Malga district with a likelihood ratio of 1214.67 and a relative risk of 2.03. First, second, third, and fourth secondary hotspots occurred from January 2012 to May 2012 in Loka Abaya, December 2011 in Bursa, from March to April 2014 in Gorchie, and March 2012 in Wonsho districts.

Conclusion: Childhood diarrhea was not distributed randomly over space and time and showed an overall increasing trend of seasonal variation peaking between February and May. The health department and other stakeholders at various levels need to plan targeted interventional activities at hotspot seasons and areas to reduce morbidity and mortality.