The hidden factors of regional prevalence of intussusception in children under two years: Interdisciplinary examination using exploratory geostatistical analysis

Abstract

Both developed and developing countries carry a large burden of pediatric intussusception. Epidemiological studies conducted so far have highlighted the huge difference in the regional prevalence of intussusception cases. Through the lens of interdisciplinary exploratory geospatial analysis this manuscript attempts to relook at the regional prevalence data reported from the hospital based sentinel surveillance. The objectives of this study are to see the geospatial pattern of the hospital confirmed childhood intussusception, to check the geospatial pattern of cases and assessment of the potential reasons behind the existing geospatial pattern. Study utilizes address information of the cases documented in the INCLEN’s intussusception surveillance study (n 2221) conducted in between 2010 and 2017 after removing the personal identifiers. Majority of cases were concentrated in geographical clusters (Moran’s- I index 0.071 at the statistically significant (p value < 0.0010) Z score of 16.147. Out of the 2221 locations (residence of children with intussusception) across the country, 14 locations (6 in Kerala and 8 in Tamil Nadu) emerged as the hotspots (95% CI). Geostatistical analysis at the granular scale indicated that the 67% of the reported cases resided within < 50 km distance from the hospitals and average distance travelled by the patients to the sentinel hospital site was ~ 47 kms (CI 95%: min1km- max 378 km). The potential cause of the higher caseloads from a few sentinel sites were facility preference. We recommend designing community based surveillance studies for building better understanding of the incidence and epidemiological burden of intussusception.