Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation
We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and dif...
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| Veröffentlicht in: | The American journal of tropical medicine and hygiene 2014-11, Vol.91 (5), p.1023-1028 |
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| container_title | The American journal of tropical medicine and hygiene |
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| creator | Nygren, Benjamin L Blackstock, Anna J Mintz, Eric D |
| description | We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation. |
| doi_str_mv | 10.4269/ajtmh.14-0331 |
| format | Article |
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Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation.</description><identifier>ISSN: 0002-9637</identifier><identifier>EISSN: 1476-1645</identifier><identifier>DOI: 10.4269/ajtmh.14-0331</identifier><identifier>PMID: 25200265</identifier><language>eng</language><publisher>United States: The American Society of Tropical Medicine and Hygiene</publisher><subject>Area Under Curve ; Cholera - epidemiology ; Drinking Water - microbiology ; Endemic Diseases ; Food Contamination ; Food Microbiology ; Foodborne Diseases - epidemiology ; Humans ; Infant ; Infant Mortality ; Logistic Models ; Sanitation - methods ; Sensitivity and Specificity ; Water Microbiology ; World Health Organization</subject><ispartof>The American journal of tropical medicine and hygiene, 2014-11, Vol.91 (5), p.1023-1028</ispartof><rights>The American Society of Tropical Medicine and Hygiene.</rights><rights>The American Society of Tropical Medicine and Hygiene 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c420t-b4d79aadea35883c6a5ade81adc0b698a4c754834958a6427a4a93dddf4002d13</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228869/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228869/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25200265$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nygren, Benjamin L</creatorcontrib><creatorcontrib>Blackstock, Anna J</creatorcontrib><creatorcontrib>Mintz, Eric D</creatorcontrib><title>Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation</title><title>The American journal of tropical medicine and hygiene</title><addtitle>Am J Trop Med Hyg</addtitle><description>We evaluated World Health Organization (WHO) national water and sanitation coverage levels and the infant mortality rate as predictors of endemic cholera in the 5-year period following water and sanitation coverage estimates using logistic regression, receiver operator characteristic curves, and different definitions of endemicity. Each was a significant predictors of endemic cholera at P < 0.001. Using a value of 250 for annual cases reported in 3 of 5 years, a national water access level of 71% has 65% sensitivity and 65% specificity in predicting endemic cholera, a sanitation access level of 39% has 63% sensitivity and 62% specificity, and an infant mortality rate of 65/1,000 has 67% sensitivity and 69% specificity. Our findings reveal the tradeoff between sensitivity and specificity for these predictors of endemic cholera and highlight the substantial uncertainty in the data. More accurate global surveillance data will enable more precise characterization of the benefits of improved water and sanitation.</description><subject>Area Under Curve</subject><subject>Cholera - epidemiology</subject><subject>Drinking Water - microbiology</subject><subject>Endemic Diseases</subject><subject>Food Contamination</subject><subject>Food Microbiology</subject><subject>Foodborne Diseases - epidemiology</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant Mortality</subject><subject>Logistic Models</subject><subject>Sanitation - methods</subject><subject>Sensitivity and Specificity</subject><subject>Water Microbiology</subject><subject>World Health Organization</subject><issn>0002-9637</issn><issn>1476-1645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkb1PHDEQxa0oKFxIyrTIZZol_lqvlwIpOgWChEQDtTVnz-WMdu3D9oGo-Nez7AFKqtHo_ebN2I-Qb5ydKKH7H3BXx80JVw2Tkn8gC6463XCt2o9kwRgTTa9ld0g-l3LHGDeC80_kULRiknS7IM_LTRowA4VK6wapy6mUnMCX07mHUpILUEOKdIX1ETFSjB7H4Kh7G42exhmBgYJzWAqtiYZxm9MDevoIFTMtaZcnaaYLxFDniS_kYA1Dwa-v9Yjcnv-6Wf5urq4vLpc_rxqnBKvNSvmuB_AIsjVGOg3t1BgO3rGV7g0o17XKSNW3BrQSHSjopfd-raaHei6PyNned7tbjegdxpphsNscRshPNkGw_ysxbOyf9GCVEMbofjL4_mqQ0_0OS7VjKA6HASKmXbG8E4J30wFiQps9uv9MXL-v4cy-hGbn0CxX9iW0iT_-97Z3-i0l-ReoU5eh</recordid><startdate>20141101</startdate><enddate>20141101</enddate><creator>Nygren, Benjamin L</creator><creator>Blackstock, Anna J</creator><creator>Mintz, Eric D</creator><general>The American Society of Tropical Medicine and Hygiene</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7U2</scope><scope>C1K</scope><scope>F1W</scope><scope>H95</scope><scope>H97</scope><scope>L.G</scope><scope>M7N</scope><scope>5PM</scope></search><sort><creationdate>20141101</creationdate><title>Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation</title><author>Nygren, Benjamin L ; 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| subjects | Area Under Curve Cholera - epidemiology Drinking Water - microbiology Endemic Diseases Food Contamination Food Microbiology Foodborne Diseases - epidemiology Humans Infant Infant Mortality Logistic Models Sanitation - methods Sensitivity and Specificity Water Microbiology World Health Organization |
| title | Cholera at the crossroads: the association between endemic cholera and national access to improved water sources and sanitation |
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