Socio-epidemiological and land cover risk factors for melioidosis in Kedah, Northern Malaysia.
Adult
Aged
Burkholderia pseudomallei
/ isolation & purification
Case-Control Studies
Demography
Diabetes Complications
Ethnicity
Female
Humans
Incidence
Malaysia
/ epidemiology
Male
Melioidosis
/ epidemiology
Middle Aged
Occupational Exposure
Retrospective Studies
Risk Factors
Sex Factors
Socioeconomic Factors
Spatial Analysis
Tertiary Care Centers
Topography, Medical
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
03
07
2018
accepted:
13
02
2019
revised:
28
03
2019
pubmed:
19
3
2019
medline:
23
4
2019
entrez:
19
3
2019
Statut:
epublish
Résumé
Melioidosis, a fatal infectious disease caused by Burkholderia pseudomallei, is increasingly diagnosed in tropical regions. However, data on risk factors and the geographic epidemiology of the disease are still limited. Previous studies have also largely been based on the analysis of case series data. Here, we undertook a more definitive hospital-based matched case-control study coupled with spatial analysis to identify demographic, socioeconomic and landscape risk factors for bacteremic melioidosis in the Kedah region of northern Malaysia. We obtained patient demographic and residential information and clinical presentation and medical history data from 254 confirmed melioidosis cases and 384 matched controls attending Hospital Sultanah Bahiyah (HSB), the main tertiary hospital of Alor Setar, the capital city of Kedah, during the period between 2005 and 2011. Crude and adjusted odds ratios employing conditional logistic regression analysis were used to assess if melioidosis in this region is related to risk factors connected with socio-demographics, various behavioural characteristics, and co-occurring diseases. Spatial clusters of cases were determined using a continuous Poisson model as deployed in SaTScan. A land cover map in conjunction with mapped case data was used to determine disease-land type associations using the Fisher's exact test deploying simulated p-values. Crude and adjusted odds ratios indicate that melioidosis in this region is related to gender (males), race, occupation (farming) and co-occurring chronic diseases, particularly diabetes. Spatial analyses of disease incidence, however, showed that disease risk and geographic clustering of cases are related strongly to land cover types, with risk of disease increasing non-linearly with the degree of human modification of the natural ecosystem. These findings indicate that melioidosis represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of the coupled human and natural variables that govern disease transmission in endemic communities.
Sections du résumé
BACKGROUND
Melioidosis, a fatal infectious disease caused by Burkholderia pseudomallei, is increasingly diagnosed in tropical regions. However, data on risk factors and the geographic epidemiology of the disease are still limited. Previous studies have also largely been based on the analysis of case series data. Here, we undertook a more definitive hospital-based matched case-control study coupled with spatial analysis to identify demographic, socioeconomic and landscape risk factors for bacteremic melioidosis in the Kedah region of northern Malaysia.
METHODOLOGY/PRINCIPAL FINDINGS
We obtained patient demographic and residential information and clinical presentation and medical history data from 254 confirmed melioidosis cases and 384 matched controls attending Hospital Sultanah Bahiyah (HSB), the main tertiary hospital of Alor Setar, the capital city of Kedah, during the period between 2005 and 2011. Crude and adjusted odds ratios employing conditional logistic regression analysis were used to assess if melioidosis in this region is related to risk factors connected with socio-demographics, various behavioural characteristics, and co-occurring diseases. Spatial clusters of cases were determined using a continuous Poisson model as deployed in SaTScan. A land cover map in conjunction with mapped case data was used to determine disease-land type associations using the Fisher's exact test deploying simulated p-values. Crude and adjusted odds ratios indicate that melioidosis in this region is related to gender (males), race, occupation (farming) and co-occurring chronic diseases, particularly diabetes. Spatial analyses of disease incidence, however, showed that disease risk and geographic clustering of cases are related strongly to land cover types, with risk of disease increasing non-linearly with the degree of human modification of the natural ecosystem.
CONCLUSIONS/SIGNIFICANCE
These findings indicate that melioidosis represents a complex socio-ecological public health problem in Kedah, and that its control requires an understanding and modification of the coupled human and natural variables that govern disease transmission in endemic communities.
Identifiants
pubmed: 30883550
doi: 10.1371/journal.pntd.0007243
pii: PNTD-D-18-01040
pmc: PMC6438580
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0007243Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Clin Infect Dis. 1999 Aug;29(2):408-13
pubmed: 10476750
Intern Med J. 2002 Apr;32(4):143-8
pubmed: 11951925
Trans R Soc Trop Med Hyg. 1992 Nov-Dec;86(6):683-5
pubmed: 1287945
Trop Med Int Health. 2004 Nov;9(11):1167-74
pubmed: 15548312
Clin Microbiol Rev. 2005 Apr;18(2):383-416
pubmed: 15831829
J Postgrad Med. 2005 Apr-Jun;51(2):140-5
pubmed: 16006713
Stat Med. 2006 May 30;25(10):1768-97
pubmed: 16220518
Med J Malaysia. 2005 Dec;60(5):599-605
pubmed: 16515111
Med J Malaysia. 2005 Dec;60(5):606-13
pubmed: 16515112
Clin Infect Dis. 2007 Aug 1;45(3):308-14
pubmed: 17599307
Stat Methods Med Res. 2009 Feb;18(1):7-26
pubmed: 18562396
Med Clin North Am. 2008 Nov;92(6):1473-91, xii
pubmed: 19061763
PLoS Negl Trop Dis. 2009;3(1):e364
pubmed: 19156200
Emerg Infect Dis. 2009 Oct;15(10):1645-7
pubmed: 19861063
Epidemiol Infect. 2010 Sep;138(9):1346-52
pubmed: 20092666
Am J Trop Med Hyg. 2010 Jun;82(6):1113-7
pubmed: 20519609
BMC Infect Dis. 2010 Oct 21;10:302
pubmed: 20964837
Trop Biomed. 2010 Dec;27(3):517-24
pubmed: 21399594
PLoS Negl Trop Dis. 2012 Jan;6(1):e1488
pubmed: 22303489
PLoS Negl Trop Dis. 2013;7(2):e2072
pubmed: 23437412
Asia Pac J Public Health. 2015 Mar;27(2):123-35
pubmed: 25524952
J Infect Dis. 1989 May;159(5):890-9
pubmed: 2708842
Ann Glob Health. 2015 Nov-Dec;81(6):851-62
pubmed: 27108152
Trop Med Infect Dis. 2018 Feb 27;3(1):null
pubmed: 30274422
Diabetes. 1974 Jan;23(1):9-15
pubmed: 4809622
Ann Intern Med. 1995 Dec 15;123(12):952-4
pubmed: 7486493
Southeast Asian J Trop Med Public Health. 1993 Sep;24(3):425-35
pubmed: 7512752
Trans R Soc Trop Med Hyg. 1995 Jan-Feb;89(1):41-3
pubmed: 7538233