Abstract
The impact of environmental change on transmission patterns of waterborne enteric diseases is a major public health concern. This study concerns the burden and spatial nature of enteric fever, attributable to Salmonella Typhi infection in the Central Division, Republic of Fiji at a sub-catchment scale over 30-months (2013–2015). Quantitative spatial analysis suggested relationships between environmental conditions of sub-catchments and incidence and recurrence of typhoid fever. Average incidence per inhabited sub-catchment for the Central Division was high at 205.9/100,000, with cases recurring in each calendar year in 26% of sub-catchments. Although the numbers of cases were highest within dense, urban coastal sub-catchments, the incidence was highest in low-density mountainous rural areas. Significant environmental determinants at this scale suggest increased risk of exposure where sediment yields increase following runoff. The study suggests that populations living on large systems that broaden into meandering mid-reaches and floodplains with alluvial deposition are at a greater risk compared to small populations living near small, erosional, high-energy headwaters and small streams unconnected to large hydrological networks. This study suggests that anthropogenic alteration of land cover and hydrology (particularly via fragmentation of riparian forest and connectivity between road and river networks) facilitates increased transmission of typhoid fever and that environmental transmission of typhoid fever is important in Fiji.
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Acknowledgments
Particular thanks to Professor John Crump for being consistently supportive of this work, Dawit Mulholland, Namrata Prasad, Steven Lee and Joe Vitayaki for help in the field; Johnathon Boeyen for assistance with GIS techniques and mapping and Professor John Lowry for helpful suggestions. Additional thanks to Jacqui Coombes for statistical assistance and the Fiji Health Sector Support Program and UNICEF for funding components of this work. The work was conducted while the senior author was in receipt of an Australian Postgraduate Research Award, and while Horwitz, Mueller and Jupiter were in receipt of a collaborative Developmental Research Grant from Edith Cowan University and Wildlife Conservation Society.
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Jenkins, A.P., Jupiter, S., Mueller, U. et al. Health at the Sub-catchment Scale: Typhoid and Its Environmental Determinants in Central Division, Fiji. EcoHealth 13, 633–651 (2016). https://doi.org/10.1007/s10393-016-1152-6
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DOI: https://doi.org/10.1007/s10393-016-1152-6