Dataset Information

Socio-epidemiological and land cover risk factors for melioidosis in Kedah, Northern Malaysia.

ABSTRACT: 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.

SUBMITTER: Abu Hassan MR

PROVIDER: S-EPMC6438580 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Socio-epidemiological and land cover risk factors for melioidosis in Kedah, Northern Malaysia.

Abu Hassan Muhammad Radzi MR Aziz Norasmidar N Ismail Noraini N Shafie Zainab Z Mayala Benjamin B Donohue Rose E RE Pani Subhada Prasad SP Michael Edwin E

PLoS neglected tropical diseases 20190318 3

<h4>Background</h4>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 ...[more]

PMID: 30883550

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Project description:Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case-control study was conducted at a tertiary hospital. Cases were adult (aged ? 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case-control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73-13.81), injection drug use (AOR = 6.60, 95% CI: 3.66-12.43), imprisonment (AOR = 4.58, 95% CI: 1.62-16.40), tattooing (AOR = 3.73, 95% CI: 1.37-12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16-3.69), piercing (AOR = 1.71, 95% CI: 1.04-2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06-3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.

Project description:Tropical mountain ecosystems are threatened by land use pressures, compromising their capacity to provide ecosystem services. Although local patterns and interactions among anthropogenic and biophysical factors shape these socio-ecological systems, the analysis of landscape changes and their driving forces is often qualitative and sector oriented. Using the Driver-Pressure-State-Impact-Response (DPSIR) framework, we characterized land use land cover (LULC) dynamics using Markov chain probabilities by elevation and geographic settings and then integrated them with a variety of publicly available geospatial and temporal data into a Generalized Additive Model (GAM) to evaluate factors driving such landscape dynamics in a sensitive region of the northern Ecuadorian Andes. In previous agricultural land located at lower elevations to the east of the studied territory, we found a significant expansion of floriculture (13 times) and urban areas (25 times), reaching together almost 10% of the territory from 1990 to 2014. Our findings also revealed an unexpected trend of páramo stability (0.75-0.90), but also a 40% reduction of montane forests, with the lowest probability (<0.50) of persistence in the elevation band of 2800-3300 m; agricultural land is replacing this LULC classes at higher elevation. These trends highlight the increasing threat of permanently losing the already vulnerable native mountain biodiversity. GAMs of socio-economic factors, demographic, infrastructure variables, and environmental parameters explained between 21 to 42% of the variation of LULC transitions observed in the study region, where topographic factors was the main drivers of change. The conceptual and methodological approach of our findings demonstrate how dynamic patterns through space and time and their explanatory drivers can assist local authorities and decision makers to improve sustainable resource land management in vulnerable landscapes such as the tropical Andes in northern Ecuador.

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Project description:BackgroundMelioidosis is a tropical infectious disease associated with significant mortality due to early onset of sepsis.ObjectiveWe sought to review case reports of melioidosis from Malaysia.MethodsWe conducted a computerized search of literature resources including PubMed, OVID, Scopus, MEDLINE and the COCHRANE database to identify published case reports from 1975 to 2015. We abstracted information on clinical characteristics, exposure history, comorbid conditions, management and outcome.ResultsOverall, 67 cases were reported with 29 (43%) deaths; the median age was 44 years, and a male preponderance (84%) was noted. Forty-one cases (61%) were bacteremic, and fatal septic shock occurred in 13 (19%) within 24-48 hours of admission; nine of the 13 cases were not specifically treated for melioidosis as confirmatory evidence was available only after death. Diabetes mellitus (n = 36, 54%) was the most common risk factor. Twenty-six cases (39%) had a history of exposure to contaminated soil/water or employment in high-risk occupations. Pneumonia (n = 24, 36%) was the most common primary clinical presentation followed by soft tissue abscess (n = 22, 33%). Other types of clinical presentations were less common-genitourinary (n = 5), neurological (n = 5), osteomyelitis/septic arthritis (n = 4) and skin (n = 2); five cases had no evidence of a focus of infection. With regard to internal foci of infection, abscesses of the subcutaneous tissue (n = 14, 21%) was the most common followed by liver (18%); abscesses of the spleen and lung were the third most common (12% each). Seven of 56 males were reported to have prostatic abscesses. Mycotic pseudoaneurysm occurred in five cases. Only one case of parotid abscess was reported in an adult. Of the 67 cases, 13 were children (≤ 18 years of age) with seven deaths; five of the 13 were neonates presenting primarily with bronchopneumonia, four of whom died. Older children had a similar presentation as adults; no case of parotid abscess was reported among children.ConclusionsThe clinical patterns of cases reported from Malaysia are consistent for the most part from previous case reports from South and Southeast Asia with regard to common primary presentations of pneumonia and soft tissue abscesses, and diabetes as a major risk factor. Bacteremic melioidosis carried a poor prognosis and septic shock was strong predictor of mortality. Differences included the occurrence of: primary neurological infection was higher in Malaysia compared to reports outside Malaysia; internal foci of infection such as abscesses of the liver, spleen, prostate, and mycotic pseudoaneurysms were higher than previously reported in the region. No parotid abscess was reported among children. Early recognition of the disease is the cornerstone of management. In clinical situations of community-acquired sepsis and/or pneumonia, where laboratory bacteriological confirmation is not possible, empirical treatment with antimicrobials for B. pseudomallei is recommended.

Dataset Information

Socio-epidemiological and land cover risk factors for melioidosis in Kedah, Northern Malaysia.

Publications

Socio-epidemiological and land cover risk factors for melioidosis in Kedah, Northern Malaysia.

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