Diarrhoeal Diseases in Children under five years Exhibits space-time disparities and priority areas for control interventions in Rwanda

Abstract

Background: The Diarrhoeal diseases remain to be a public health concern despite the existence of preventive measures and developing are the most affected. It affects more children under five years compared to the rest of the population. The burden of childhood diarrhoea varies with geographical area and time bound. A part from this variation, the link between climate change and diarrhoea among children under five years has not been well understood. This study aims to determine the trends, spatial temporal and seasonal characteristics of diarrhoea diseases among Rwandan children under five years using routine Health Management Information System (HMIS) data from 2014 to 2018.Methods: This was an ecological study using retrospective data analysis. Incidence were used to examine the trend, and excess hazard was assessed to determine the risk and likelihood for the occurrence of cases. Retrospective Discrete Poisson model was used to identify spatial, temporal and spatial-temporal clusters of diarrhoea. Linear regression was used to assess relationship between climatology variables and the occurrence of diarrhoea. Results: In total, 1,012,827 new diarrhoeal diseases episodes were reported during 2014-2018 with an annual incidence rate of 12,669/100,000 children under five years. Excess risk was noticed in 12/30 (40%) of country’s districts (RR>1). Most significant spatial clusters of diarrhoea were observed in the northern province (RR=1.66, p<001). We found a statistically significant positive and negative relationship between diarrhoeal disease, and temperature and rainfall respectively (p<0.001). Increase in one millimeter of rainfall was associated with decrease of 14 cases of diarrhoea while increase of one degree Celsius of temperature was associated with an increase of 17 diarrhoea cases.Conclusion: More districts were remarked with risk of diarrhoea which require targeted control intervention. Furthermore, significant association between diarrhoea case and climate dynamics was observed. This call for the public attention to climate changes which affect health especially children aged less than five years