Spatial and Space time Clustering of Diarrhoeal Cases among Under-Five Children in Karkala, Karnataka: A Geo-Spatial Analysis

Globally, India tops by contributing the maximum number of diarrhoeal fatality and accounts for 13% of all deaths/year in children under-five years. Forecasting the path and spread of diarrhoea) disease is critical due to its multi-factorial cause, which needs robust spatial analysis and experiential investigations of communicable disease. Objectives: A retrospective longitudinal study was conducted in Karkala taluk of the Udupi district of Karnataka state, India, to investigate purely spatial, purely temporal, and space-time clusters of diarrhoea among underfive children using a geographic information system (GIS). Methods: The data on diarrhoea among under-five children was collected for three years, i.e. from April 1, 2015, to March 31, 2018, at the district health office. A total of forty-nine village data were obtained and about 3894 under-five childhood diarrhoea were reported during the study period. Results: The analysis of the spatial cluster using SatScan software for three years in the study area identified eight high-risk areas (p <= 0.0001), covering twenty-one villages. The most likely spatiotemporal cluster region was located at the northern Karkala, and the most-at-risk period was April 1, 2016, to September 30, 2017 (LI,R=114.67 and p-value <0.00001). The analysis of purely temporal cluster showed that one most likely cluster happened in all villages (LLR=73.89, p<0.001) from April 1, 2017, to March 3, 2018. Conclusion: The prevention, control and health promotional activities can be planned using advanced spatial statistical methods. The spatial information will help the program planners to have horizontal and vertical equity.