Application of landscape epidemiology to assess potential public health risk due to poor sanitation

Clear identification of areas vulnerable to waterborne diseases is essential for protecting community health. This is particularly important in developing countries where unsafe disposal of domestic wastewater and limited potable water supply pose potential public health risks. However, data paucity can be a compounding issue. Under these circumstances, landscape epidemiology can be applied as a resource efficient approach for mapping potential disease risk areas associated with poor sanitation. However, in order to realise the full potential offered by this approach, an in-depth understanding of the impact of different classes of an explanatory variable on a target disease and the validity of hotspot analysis using limited datasets is needed. Accordingly, this research study focused on typhoid and diarrhoea incidence with respect to different classes of elevation, flood inundation, land use, soil permeability, population density and rainfall as explanatory variables. An integrated methodology consisting of hot spot analysis and Poisson regression was employed to map potential disease risk areas. The study findings confirmed the significant differences in the influence exerted by the various classes of an explanatory variable in relation to a target disease. The results also confirmed the feasibility of the hotspot analysis for identifying areas vulnerable to the target diseases using a limited dataset. The study outcomes are expected to contribute to creating an in-depth understanding of the relationship between disease prevalence and associated landscape factors for the delineation of disease risk zones in the context of data paucity.