Spatiotemporal variation of hand-foot-mouth disease in relation to socioecological factors: A multiple-province analysis in Vietnam.

BACKGROUND:Hand-foot-and-mouth disease (HFMD) is a significant public health issue in Asia-pacific countries. Numerous studies have examined the relationship between socio-ecological factors and HFMD however the research findings were inconsistent. This study examined the association between socio-ecologic factors and HFMD in multiple provinces across Vietnam. METHODS:We applied a spatial autoregressive model using a Bayesian framework to examine the relationship between HFMD and socio-demographic factors. We used a Generalized Linear Model (GLD) with Poisson family to examine the province-specific association between monthly HFMD and climatic factors while controlling for spatial lag, seasonality and long-term trend of HFMD. Then, we used a random-effect meta-analysis to generate pooled effect size of climate-HFMD association for regional and country scale. RESULTS:One percent increase in newborn breastfed within 1h of birth, households with permanent houses, and households accessed to safe water resulted in 1.57% (95% CI: -2.25, -0.93), 0.96% (-1.66, -0.23), and 1.13% (-2.16, -0.18) reduction in HFMD incidence, respectively. At the country-level, HFMD increased 7% (RR: 1.07; 95%CI: 1.052-1.088) and 3.1% (RR: 1.031, 95%CI: 1.024-1.039) for 1°C increase in monthly temperature above 26°C and 1% increase in monthly humidity above 76%. Whereas, HFMD decreased 3.1% associated with 1mm increase in monthly cumulative rainfalls. The climate-HFMD relationship was varied by regions and provinces across the country. CONCLUSIONS:The findings reflect an important implication for the climate change adaptation strategies and public-health decision, of which development of weather-based early warning systems should be considered to strengthen communicable disease prevention system.