Modeling spatiotemporal domestic wastewater variability: Implications for measuring treatment efficiency.

Continuously measuring the efficiency of wastewater treatment plants is crucial to progress in sanitation management. Regulations for decentralized wastewater treatment plants (WWTP) can include rudimentary specifications for sporadic sampling, unencouraging continuous monitoring, and missing crucial domestic wastewater (DW) variability, especially in low- and middle-income countries. However, few studies have focused on modeling and understanding spatiotemporal DW variability. We developed and calibrated an agent-based model (ABM) to understand spatial and temporal DW variability, its role in estimated WWTP efficiency, and provide recommendations to improve sampling regulations. We simulated DW variability at various spatial and temporal resolutions in Santa Ana Atzcapotzaltongo, Mexico, focusing on chemical oxygen demand (COD) and total suspended solids (TSS). The model results show that DW variability increases at higher spatiotemporal resolutions. Without a proper understanding of DW variability, treatment efficiency can be overestimated or underestimated by as much as 25% from sporadic sampling. Sensor measurements at 6-min intervals over 3 hours are recommended to overcome uncertainty resulting from temporal variability during heavy drinking water demand in the morning. Reporting of sewage catchment areas, population sizes, and sampling times and intervals is recommended to compare WWTP efficiencies to overcome uncertainty resulting from spatiotemporal variability. The proposed model is a useful tool for understanding DW variability. It can be used to estimate the impact of spatiotemporal variability when measuring WWTP efficiencies, support improvements to sampling regulations for decentralized sanitation, and alternatively for designing and operating WWTPs.

An ecological study of chronic kidney disease in five Mesoamerican countries: associations with crop and heat.

BACKGROUND: Mesoamerica is severely affected by an epidemic of Chronic Kidney Disease of non-traditional origin (CKDnt), an epidemic with a marked variation within countries. We sought to describe the spatial distribution of CKDnt in Mesoamerica and examine area-level crop and climate risk factors. METHODS: CKD mortality or hospital admissions data was available for five countries: Mexico, Guatemala, El Salvador, Nicaragua and Costa Rica and linked to demographic, crop and climate data. Maps were developed using Bayesian spatial regression models. Regression models were used to analyze the association between area-level CKD burden and heat and cultivation of four crops: sugarcane, banana, rice and coffee. RESULTS: There are regions within each of the five countries with elevated CKD burden. Municipalities in hot areas and much sugarcane cultivation had higher CKD burden, both compared to equally hot municipalities with lower intensity of sugarcane cultivation and to less hot areas with equally intense sugarcane cultivation, but associations with other crops at different intensity and heat levels were not consistent across countries. CONCLUSION: Mapping routinely collected, already available data could be a first step to identify areas with high CKD burden. The finding of higher CKD burden in hot regions with intense sugarcane cultivation which was repeated in all five countries agree with individual-level studies identifying heavy physical labor in heat as a key CKDnt risk factor. In contrast, no associations between CKD burden and other crops were observed.

Spatial analysis of HIV-TB co-clustering in Uganda.

BACKGROUND: Tuberculosis (TB) is the leading cause of death for individuals infected with Human immunodeficiency virus (HIV). Conversely, HIV is the most important risk factor in the progression of TB from the latent to the active status. In order to manage this double epidemic situation, an integrated approach that includes HIV management in TB patients was proposed by the World Health Organization and was implemented in Uganda (one of the countries endemic with both diseases). To enable targeted intervention using the integrated approach, areas with high disease prevalence rates for TB and HIV need to be identified first. However, there is no such study in Uganda, addressing the joint spatial patterns of these two diseases. METHODS: This study uses global Moran's index, spatial scan statistics and bivariate global and local Moran's indices to investigate the geographical clustering patterns of both diseases, as individuals and as combined. The data used are TB and HIV case data for 2015, 2016 and 2017 obtained from the District Health Information Software 2 system, housed and maintained by the Ministry of Health, Uganda. RESULTS: Results from this analysis show that while TB and HIV diseases are highly correlated (55-76%), they exhibit relatively different spatial clustering patterns across Uganda. The joint TB/HIV prevalence shows consistent hotspot clusters around districts surrounding Lake Victoria as well as northern Uganda. These two clusters could be linked to the presence of high HIV prevalence among the fishing communities of Lake Victoria and the presence of refugees and internally displaced people camps, respectively. The consistent cold spot observed in eastern Uganda and around Kasese could be explained by low HIV prevalence in communities with circumcision tradition. CONCLUSIONS: This study makes a significant contribution to TB/HIV public health bodies around Uganda by identifying areas with high joint disease burden, in the light of TB/HIV co-infection. It, thus, provides a valuable starting point for an informed and targeted intervention, as a positive step towards a TB and HIV-AIDS free community.

Establishing spatially-enabled health registry systems using implicit spatial data pools: case study - Uganda.

BACKGROUND: Spatial epidemiological analyses primarily depend on spatially-indexed medical records. Some countries have devised ways of capturing patient-specific spatial details using ZIP codes, postcodes or personal numbers, which are geocoded. However, for most resource-constrained African countries, the absence of a means to capture patient resident location as well as inexistence of spatial data infrastructures makes capturing of patient-level spatial data unattainable. METHODS: This paper proposes and demonstrates a creative low-cost solution to address the issue. The solution is based on using interoperable web services to capture fine-scale locational information from existing "spatial data pools" and link them to the patients' information. RESULTS: Based on a case study in Uganda, the paper presents the idea and develops a prototype for a spatially-enabled health registry system that allows for fine-level spatial epidemiological analyses. CONCLUSION: It has been shown and discussed that the proposed solution is feasible for implementation and the collected spatially-indexed data can be used in spatial epidemiological analyses to identify hotspot areas with elevated disease incidence rates, link health outcomes to environmental exposures, and generally improve healthcare planning and provisioning.

Proposing and investigating PCAMARS as a novel model for NO2 interpolation.

Effective measurement of exposure to air pollution, not least NO2, for epidemiological studies along with the need to better management and control of air pollution in urban areas ask for precise interpolation and determination of the concentration of pollutants in nonmonitored spots. A variety of approaches have been developed and used. This paper aims to propose, develop, and test a spatial predictive model based on multivariate adaptive regression splines (MARS) and principle component analysis (PCA) to determine the concentration of NO2 in Tehran, as a case study. To increase the accuracy of the model, spatial data (population, road network and point of interests such as petroleum stations and green spaces) and meteorological data (including temperature, pressure, wind speed and relative humidity) have also been used as independent variables, alongside air quality measurement data gathered by the monitoring stations. The outputs of the proposed model are evaluated against reference interpolation techniques including inverse distance weighting, thin plate splines, kriging, cokriging, and MARS3. Interpolation for 12 months showed better accuracies of the proposed model in comparison with the reference methods.

Spatial Analysis of Ambient Air Pollution and Cardiovascular Disease (CVD) Hospitalization Across Sweden.

The associations of multiple pollutants and cardiovascular disease (CVD) morbidity, and the spatial variations of these associations have not been nationally studied in Sweden. The main aim of this study was, thus, to spatially analyze the associations between ambient air pollution (black carbon, carbon monoxide, particulate matter (both <10 µm and <2.5 µm in diameter) and Sulfur oxides considered) and CVD admissions while controlling for neighborhood deprivation across Sweden from 2005 to 2010. Annual emission estimates across Sweden along with admission records for coronary heart disease, ischemic stroke, atherosclerotic and aortic disease were obtained and aggregated at Small Areas for Market Statistics level. Global associations were analyzed using global Poisson regression and spatially autoregressive Poisson regression models. Spatial non-stationarity of the associations was analyzed using Geographically Weighted Poisson Regression. Generally, weak but significant associations were observed between most of the air pollutants and CVD admissions. These associations were non-homogeneous, with more variability in the southern parts of Sweden. Our study demonstrates significant spatially varying associations between ambient air pollution and CVD admissions across Sweden and provides an empirical basis for developing healthcare policies and intervention strategies with more emphasis on local impacts of ambient air pollution on CVD outcomes in Sweden.

Predictive risk mapping of human leptospirosis using support vector machine classification and multilayer perceptron neural network.

Leptospirosis is a zoonotic disease found wherever human is in direct or indirect contact with contaminated water and environment. Considering the increasing number of cases of this disease in the northern part of Iran, identifying areas characterized by high disease incidence risk can help policy-makers develop strategies to prevent its further spread. This study presents an approach for generating predictive risk maps of leptospirosis using spatial statistics, environmental variables and machine learning. Moran's I demonstrated that the distribution of leptospirosis cases in the study area in Iran was highly clustered. Pearson's correlation analysis was conducted to examine the type and strength of relationships between climate and topographical factors and incidence of the disease. To handle the complex and nonlinear problems involved, machine learning based on the support vector machine classification algorithm and multilayer perceptron neural network was exploited to generate annual and monthly predictive risk maps of leptospirosis distribution. Performance of both models was evaluated using receiver operating characteristic curve and Kappa coefficient. The output results demonstrated that both models are adequate for the prediction of the probability of leptospirosis incidence.