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Geospatial methodology for determining the regional prevalence of hospital-reported childhood intussusception in
Shikha Dixit1, Manoja Kumar Das2, Durga Chitra Ramadugu1
1The INCLEN Trust International, New Delhi, India.
Insights
Pediatric intussusception cases in India show significant geographic clustering, with most cases concentrated near sentinel hospitals. This pattern is driven by factors like easy access and referral preferences, suggesting a need for community-based surveillance.
Area of Science:
- Pediatric epidemiology
- Geospatial analysis
- Public health surveillance
Background:
- Pediatric intussusception presents a significant global health burden, with notable regional variations in incidence.
- Sentinel site surveillance has been instrumental in identifying these incidence differences.
Purpose of the Study:
- To geospatially map childhood intussusception cases in India.
- To identify spatial patterns, including clustering and dispersion.
- To investigate potential causes for observed epidemiological patterns.
Main Methods:
- Geospatial analysis of 2221 hospital-confirmed pediatric intussusception cases across India.
- Moran's I statistic and Z-score analysis to assess spatial autocorrelation.
- Hotspot analysis to identify geographical clusters.
- Analysis of patient residence proximity to sentinel hospitals.
Main Results:
- Significant positive spatial clustering of intussusception cases was observed across India (Moran's I = 0.071, p < 0.0010).
- Fourteen distinct hotspots were identified in Kerala and Tamil Nadu.
- 67% of cases resided within 50 km of sentinel hospitals, with an average travel distance of 47 km.
Conclusions:
- Geographic clustering of pediatric intussusception in India is strongly associated with proximity to sentinel hospitals.
- Easy access to healthcare facilities and referral patterns are key drivers of this clustering.
- Community-based surveillance studies are recommended to better understand disease prevalence and epidemiology.
Abstract:
Both developed and developing countries carry a large burden of pediatric intussusception. Sentinel site surveillance-based studies have highlighted the difference in the regional incidence of intussusception. The objectives of this manuscript were to geospatially map the locations of hospital-confirmed childhood intussusception cases reported from sentinel hospitals, identify clustering and dispersion, and reveal the potential causes of the underlying pattern. Geospatial analysis revealed positive clustering patterns, i.e., a Moran's I of 0.071 at a statistically significant (p value < 0.0010) Z score of 16.14 for the intussusception cases across India (cases mapped n = 2221), with 14 hotspots in two states (Kerala = 6 and Tamil Nadu = 8) at the 95% CI. Granular analysis indicated that 67% of the reported cases resided < 50 km from the sentinel hospitals, and the average travel distance to the sentinel hospital from the patient residence was calculated as 47 km (CI 95% min 1 km-max 378 km). Easy access and facility referral preferences were identified as the main causes of the existing clustering pattern of the disease. We recommend designing community-based surveillance studies to improve the understanding of the prevalence and regional epidemiological burden of the disease.
