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Exploring the Spatial Pattern of Animal Bites in Iran (2021-2022)
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The rabies virus, which belongs to the genus Lyssavirus, the family Rhabdoviridae, is the causative agent of rabies, a contagious, deadly, and progressive neurological infection. This illness is commonly distributed worldwide and affects all warm-blooded animals. Regarding the zoonotic aspects of rabies, the prevalence of rabies was investigated in this study. Over 2 years, 188 samples were examined via the direct fluorescent antibody test (DFAT) and mouse inoculation test (MIT) techniques by using brain tissue samples. Our findings showed that 73.94% of samples were rabies positive. The highest number of samples belonged to cows and dogs, respectively. The positivity rate in cows was 71.88%, followed by dogs with a 57.78% infection rate. These findings suggested that despite the heavy monitoring protocols in Iran, rabies is still a prevalent disease, and it is advised that vaccinations and screening programs should be carried out more frequently with heavier observation.
Dog bites are a major cause for transmission of rabies virus to humans. Pakistan ranks fifth among most rabies affected countries in the world. There are a few regional (ecological) studies that investigate factors that explain geographic disparities in incidence of dog bite injuries. The main objective of this research was to document findings of spatial exploratory data analysis of incidence of reported cases of dog bite in Punjab province of Pakistan (2016-2019). In addition, we have quantified the association between incidence of dog bites and a set of selected socio-economic and demographic variables. District-wise data about reported cases of dog bite from 2016 to 2019 were used to map annual crude incidence per 100000 of population. There was an obvious spatial variation in incidence of dog bites but there was no evidence of spatial autocorrelation. The risk of dog bite attacks was relatively higher in districts with low human population density (per sq. km), poor literacy rate, more rural population (% of total population), and lower median nighttime lights.
Understanding dynamics of free-roaming dog (FRD) population is critical for planning and implementation of dog population management programs. FRD population size estimation as well as dynamic modeling of dog population under different female dog neutering interventions were investigated in order to determine the most appropriate animal birth control approach. We performed population size estimate of dogs using sight-resight surveys by photography in a randomly selected 25 blocks of the city and all the suburbs of greater Kerman area. Main demographic features were characterized and the dog density distribution was mapped. A dynamic model was developed to predict free-roaming dog population variations after 5 and 10 years. Different scenarios based on 10, 30, 50, 60 and 70% female dog sterilization were considered to predict the effects of animal birth control measures. Free roaming dog population was estimated at 6781 dogs (65.3% males) in Kerman and suburbs with several major population hotspots. Analysis of the dog locations within the city showed that the largest proportion of the dogs were observed in the vacant lots (46.2%). Modeling predictions indicated that, in the absence of management, the free-roaming dog population could increase from a baseline of 6781 to 13,665 dogs (2.02 fold increase) in 5 years and to 19,376 dogs in 10 years (2.86 fold increase). Using a population dynamics model, we simulated five neutering coverages to explore the impact of female neutering on free-roaming dog population size. The 5-year projections of the model have shown that 50% annual female dog sterilization significantly reduced free-roaming dog population by 0.44 comparing to the baseline population. Findings of the present study improve our knowledge on the nature and extent of dog population dynamics in Iran. Effective population control and selection of the most appropriate neutering interventions require a comprehensive knowledge of the characteristics and dynamics of FRD population.
Canine rabies poses a significant risk to humans and animals in Nigeria. However, the lack of reliable tools to evaluate the performance of existing canine rabies control programs to inform public health policy decisions poses a severe obstacle. We obtained canine rabies surveillance data from the National Veterinary Research Institute (NVRI) and supplemented these data with rabies diagnoses reported in the published studies from Nigeria. To uncover contextual factors (i.e., environmental and sociodemographic) associated with canine rabies evidence at the Local Government Area (LGA) level, we classified LGAs in Nigeria into four categories based on evidence availability (i.e., LGAs with NVRI data or published studies, both, or no evidence). We described the geographical and temporal variation in coverage. We fitted a multinomial regression model to examine the association between LGA level canine rabies evidence and potential sociodemographic and ecological determinants of canine rabies evidence. The effective annual testing during the 19 years was less than one dog/100,000 Nigerian resident-year. Our results showed that 58% of Nigerian LGAs (450/774) had not been targeted by the existing national rabies surveillance or studies on rabies, including ten states capitals with high human populations. While 16% (122/774) of Nigerian LGAs concentrated in Taraba, Adamawa, and Abia had canine rabies evidence from published studies, none of these LGAs was represented in the NVRI rabies surveillance data. We also observed an increasing trend in rabies evidence over time towards the eastern part of Nigeria. Our multinomial regression model indicated that education level, poverty, population density, land use and temperature were significantly associated with canine rabies evidence at the LGA level. This study underscores the value of combining canine rabies evidence from different sources to better understand the current disease situation for targeted intervention.
Background
Rabies is one of the oldest zoonosis viral diseases, which still remains as one of the most important threats to public health in the 21st century.
Methods
This cross-sectional study examined epidemiologic features of all 33,996 cases of persons bitten by animals and referred to the rabies prophylaxis centers in Golestan province between March 2017 and March 2020. Factors included demographic information of the victim (age, gender, and occupation), type of invasive animals (dog, cat, and other types), time of bite (year, month, and hour), place of residence (urban or rural), and injury and treatment statuses. We also obtained national and provincial animal bite incidence data for all of Iran and for Golestan province for the longer interval 2013–2020 to examine broader time trends. We used SPSS version 19, QGIS version 3.1, and Excel 2013 to generate frequency distributions and descriptive statistics.
Results
The incidence rates of animal bites in Golestan province and Iran as a whole both increased smoothly. The latest incidence rate of animal bites in Golestan was 652 per 100,000 people, almost three times the overall national figure for 2020. Most cases of animal bites (67.6%) occurred in rural areas, and 36% of the victims aged under 19 years old. Dog and cat bites accounted for the great majority of cases (89% and 8%, respectively). The highest rate of animal bites was reported in the spring (30.8%). The lower limb was the most commonly bitten area in these individuals (64.6%). Of note, 87% of the cases received incomplete prophylactic post-exposure treatment, and 18% received immunoglobulin.
Conclusion
The increasing rates of animal bites in the study area as well as the higher rate compared to the national average indicates the need for further review of animal bite control programs.
Rabies is a vaccine-preventable fatal zoonotic disease. Uganda, through the veterinary surveillance system at National Animal Disease Diagnostics and Epidemiology Centre (NADDEC), captures animal bites (a proxy for rabies) on a monthly basis from districts. We established trends of incidence of animal bites and corresponding post-exposure prophylactic anti-rabies vaccination in humans (PEP), associated mortality rates in humans, spatial distribution of animal bites, and pets vaccinated during 2013–2017. We reviewed rabies surveillance data at NADDEC from 2013–2017. The surveillance system captures persons reporting bites by a suspected rabid dog/cat/wild animal, human deaths due to suspected rabies, humans vaccinated against rabies, and pets vaccinated. Number of total pets was obtained from the Uganda Bureau of Statistics. We computed incidence of animal bites and corresponding PEP in humans, and analyzed overall trends, 2013–2017. We also examined human mortality rates and spatial distribution of animal bites/rabies and pets vaccinated against rabies. We identified 8,240 persons reporting animal bites in Uganda during 2013–2017; overall incidence of 25 bites/ 100,000population. The incidence significantly decreased from 9.2/100,000 in 2013 to 1.3/100,000 in 2017 (OR = 0.62, p = 0.0046). Of the 8,240 persons with animal bites, 6,799 (82.5%) received PEP, decreasing from 94% in 2013 to 71% in 2017 (OR = 0.65, p<0.001). Among 1441 victims, who reportedly never received PEP, 156 (11%) died. Western region had a higher incidence of animal bites (37/100,000) compared to other regions. Only 5.6% (124,555/2,240,000) of all pets in Uganda were vaccinated. There was a decline in the reporting rate (percentage of annual district veterinary surveillance reports submitted monthly to Commissioner Animal Health by districts) of animal bites. While reported animal bites by districts decreased in Uganda, so did PEP among humans. Very few pets received anti-rabies vaccine. Evaluation of barriers to complete reporting may facilitate interventions to enhance surveillance quality. We recommended improved vaccination of pets against rabies, and immediate administration of exposed humans with PEP.
There is no abstract available.
Background:
Animal bite due to the risk of rabies is a major public health problem. Rabies is of great importance because of fatalities and economic damage.
Objective:
This study was conducted to investigate the epidemiological patterns of animal bite in Najaf Abad during the years of 2012 to 2017.
Methods:
This is a cross-sectional study. All records (4,104) were registered in the registration offices of animal bites during the years of 2012 to 2017 at the rabies treatment centres of Najafabad by census method. Demographic characteristics, animal type and sometime clinical patterns of the wounded were examined.
Results:
The mean age of the injured was 31.28 ± 15.28 years. Of the 4,104 injured, 3648 (88%) were male and the rest of them were women. In terms of residential area, 3645 people (88%) were in urban areas and the rest were in rural areas in the place of occurrence of bites. Most cases of animal biting occurred in dogs (70.9%) and then cat (24.3%). The most affected part was 51% with shoulder and hand. In this study, the incidence of animal bites is estimated as 100,000 people per year in Najaf Abad in in 2012 it was 206.4, with an increasing trend to 212.9 in 2019 (P < 0.001).
Conclusion:
The results of the study showed that most cases of animal bites were related to dogs, urban areas and male sex variables. The incidence of animal bites was also increasing. Due to the importance of this disease and its financial losses, it is recommended that prevention methods should be used to control stray dogs, vaccination of domesticated dogs and to raise awareness of the people.
Background:
Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013-2017.
Methods:
In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics.
Results:
In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55-45.66 per100000 populations during 2013-2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years' time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times.
Conclusion:
The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.
Background:
Rabies is a fatal disease that still kills 2-6 people a year in Iran. A meta-analysis was conducted in order to generate accurate data on animal bite exposure, and to estimate the incidence of animal bite across the country.
Materials and methods:
Major national and international electronic databases were searched using the keywords "animal bite," rabies, prevalence, incidence, and Iran. Web of Knowledge, PubMed, Scopus, Ovid, and ScienceDirect were used as international databases, and the national databases included Science Information Database, MagIran, and IranDoc. Descriptive cross-sectional studies addressing the incidence of animal bite were selected and screened by two authors, and pre-specified data were extracted. The population of provinces or cities of studies was extracted from the Statistical Centre of Iran. The overall incidence of animal bite in Iran was estimated using a random-effects model with 95% confidence interval (CI). Study quality was assessed using the STROBE recommended checklist.
Results:
A total of 34 studies were selected for the meta-analysis out of 1215 retrieved studies. The number of animal bites in the studies during 1993-2013 was 230,019 cases. The overall estimated incidence rate of animal bite in Iran was 13.20/1000 (95%, CI 12.10, 14.30) and the mean age of people was 26.23 (SD = 5.02) year. The incidence rate of animal bite among males (14.90/1000) was much higher than females (4.55/1000), and was higher in rural areas (17.45/1000) compared with urban areas (4.35/1000). The incident rate was highest among students compared with other reported occupations. The incidence rate of dogs was 10.40/1000 followed by cats, cows, wolves, jackals, and foxes. Domestic animals had a higher incidence rate than stray and wild animals. The incidence rate of animal bite during spring was 4.90/1000; however, the incidence rate in other seasons had no significant difference. In the retrieved studies, the highest incidence rate of animal bite was found in the West Azerbaijan Province (146.83/1000).
Conclusion:
The current study is the first comprehensive analysis of the published animal bite studies in Iran. Accurate data on animal bite incidence may lead to more effective policy-decisions towards more efficient resource allocation to primary health care for reducing rabies case. Such information is a primary and major necessity for rabies control program in the country. Animal bite reduction can significantly minimize the risk of rabies infection, thereby reducing public health costs for the expensive post-exposure treatment.
Background
In the absence of accurate data on trends and the burden of human rabies infection in developing countries, animal bite injuries provide useful information to bridge that gap. Rabies is one of the most deadly infectious diseases, with a case fatality rate approaching 100%. Despite availability of effective prevention and control strategies, rabies still kills 50,000 to 60,000 people worldwide annually, the majority of whom are in the developing world. We describe trends and geographical distribution of animal bite injuries (a proxy of potential exposure to rabies) and deaths due to suspected human rabies in Uganda from 2001 to 2015.
Methods
We used 2001–2015 surveillance data on suspected animal bite injuries, collected from health facilities in Uganda. To describe annual trends, line graphs were used and linear regression tested significance of observed trends at P<0.05. We used maps to describe geographical distribution of animal bites by district.
Results
A total of 208,720 cases of animal bite injuries were reported. Of these, 27% were in Central, 22% in Eastern, 27% in Northern and 23% in Western regions. Out of 48,720 animal bites between 2013 and 2015, 59% were suffered by males and 81% were persons aged above 5 years. Between 2001 and 2015, the overall incidence (per 100,000 population) of animal bites was 58 in Uganda, 76 in Northern, 58 in Central, 53 in Western and 50 in Eastern region. From 2001 to 2015, the annual incidence (per 100,000 population) increased from 21 to 47 (P = 0.02) in Central, 27 to 34 (P = 0.04) in Eastern, 23 to 70 (P = 0.01) in Northern and 16 to 46 (P = 0.001) in Western region. A total of 486 suspected human rabies deaths were reported, of which 29% were reported from Eastern, 28% from Central, 27% from Northern and 17% from Western region.
Conclusion
Animal bite injuries, a potential exposure to rabies infection, and mortality attributed to rabies infection are public health challenges affecting all regions of Uganda. Eliminating rabies requires strengthening of rabies prevention and control strategies at all levels of the health sector. These strategies should utilize the “One Health” approach with strategic focus on strengthening rabies surveillance, controlling rabies in dogs and ensuring availability of post exposure prophylaxis at lower health facilities.
Background
The incidence of canine rabies cases in El Salvador has decreased in the last decade since the establishment of intense control programs, such as massive vaccination campaigns implemented by the Ministry of Health. Socioeconomic crises in recent years have limited the access to certain areas across the country and have impacted surveillance and prevention campaigns, which places the country at risk for a resurgence of canine rabies.We aimedto describe the spatiotemporal patterns of canine rabies and its association with critical social factors in El Salvador from 2005 to 2014.
Method
We included 459 cases of canine rabies. Several socioeconomic, demographic, and surveillance variables were modeled using a Poisson regression to evaluate their associations with the incidence of canine rabies. Spatial scan statistics were adjusted or unadjusted with covariates and applied to identify statistically significant clusters of canine rabies. Finally, a canine rabies risk map was created.
Results
A positive association and higher risk of canine rabies were found for low poverty zones, where it is suspected that urban slums contribute to ongoing rabies transmission (RR = 7.74). Violence had a negative association with rabies (RR = 0.663), which is likely due to reporting bias. Significant clusters were identified in all five epidemiological regions, and the Eastern region had the highest risk (RR = 50.62). The influences of the selected variables in cluster detection were confirmed by the adjusted analysis. Higher-risk townships were distributed from the Western to the Eastern regions of the country.
Conclusion
Social factors are determinants of rabies in El Salvador and play a major role in national spatial patterns of the disease. There are high-risk areas for canine rabies across the country, and there were two persistent rabies foci during the study period. Examining the role of social factors can provide better insight into rabies in vulnerable countries, and socioeconomic factors can be key elements in developing better policies and interventions for rabies control.
Background: Despite the progress made, animal bites and rabies are one of the important health problems in the country. The purpose of this study was to investigate the epidemiology of animal bites and rabies during 2004-2014 in Lorestan Province to prevent them in population of the province for the future prospective aspects.
Materials and Methods: In a descriptive cross-sectional study, all those cases bitten in the province, during 2004 and 2014, were studied. The required information about the age, sex, the bitten organ, type of the invasive animal time, and location of the event were collected in questionnaires and then analyzed.
Results: The total number of cases of animal rabies during the period of study was 43,892, shown at the rate of 223.23 in 100,000 people. Seventy-eight percent of animal bites in rural areas, 41.42% in the ages 10-29-year-old, 26.8% of cases were students, 56.77% leg bites, and 82.5% of dog bites. Four cases of human rabies were observed during this period.
Conclusions: Rate of animal bites and rabies is high in Lorestan Province. Controlling animals such as dogs and cats in the province through training people at risk, especially among the students, rural areas and inter-sectorial coordination to eliminate stray animals should be considered over and over. Preventive actions to avoid bites are a priority.
Background
Spatial and space–time scan statistics are widely used in disease surveillance to identify geographical areas of elevated disease risk and for the early detection of disease outbreaks. With a scan statistic, a scanning window of variable location and size moves across the map to evaluate thousands of overlapping windows as potential clusters, adjusting for the multiple testing. Almost always, the method will find many very similar overlapping clusters, and it is not useful to report all of them. This paper proposes to use the Gini coefficient to help select which of the many overlapping clusters to report.
Methods
The Gini coefficient provides a quick and intuitive way to evaluate the degree of the heterogeneity of the collection of clusters, which is useful to explain how well the cluster collection reveal the underlying true cluster patterns. Using simulation studies and real cancer mortality data, it is compared with the traditional approach for reporting non-overlapping clusters.
Results
The Gini coefficient can identify a more refined collection of non-overlapping clusters to report. For example, it is able to determine when it makes more sense to report a collection of smaller non-overlapping clusters versus a single large cluster containing all of them. It also fulfils a set of desirable theoretical properties, such as being invariant under a uniform multiplication of the population numbers by the same constant.
Conclusions
The Gini coefficient can be used to determine which set of non-overlapping clusters to report. It has been implemented in the free SaTScan™ software version 9.3 (www.satscan.org).
Background
When analytical techniques are used to understand and analyse geographical events, adjustments to the datasets (e.g. aggregation, zoning, segmentation etc.) in both the spatial and temporal dimensions are often carried out for various reasons. The ‘Modifiable Areal Unit Problem’ (MAUP), which is a consequence of adjustments in the spatial dimension, has been widely researched. However, its temporal counterpart is generally ignored, especially in space-time analysis.
Methods
In analogy to MAUP, the Modifiable Temporal Unit Problem (MTUP) is defined as consisting of three temporal effects (aggregation, segmentation and boundary). The effects of MTUP on the detection of space-time clusters of crime datasets of Central London are examined using Space-Time Scan Statistics (STSS).
Results and Conclusion
The case study reveals that MTUP has significant effects on the space-time clusters detected. The attributes of the clusters, i.e. temporal duration, spatial extent (size) and significance value (p-value), vary as the aggregation, segmentation and boundaries of the datasets change. Aggregation could be used to find the significant clusters much more quickly than at lower scales; segmentation could be used to understand the cyclic patterns of crime types. The consistencies of the clusters appearing at different temporal scales could help in identifying strong or ‘true’ clusters.
The scan statistic is commonly used to test if a one dimensional point process is purely random, or if any clusters can be detected. Here it is simultaneously extended in three directions:(i) a spatial scan statistic for the detection of clusters in a multi-dimensional point process is proposed, (ii) the area of the scanning window is allowed to vary, and (iii) the baseline process may be any inhomogeneous Poisson process or Bernoulli process with intensity pro-portional to some known function. The main interest is in detecting clusters not explained by the baseline process. These methods are illustrated on an epidemiological data set, but there are other potential areas of application as well.
We generalize the method proposed by Gelman and Rubin (1992a) for monitoring the convergence of iterative simulations by comparing between and within variances of multiple chains, in order to obtain a family of tests for convergence. We review methods of inference from simulations in order to develop convergence-monitoring summaries that are relevant for the purposes for which the simulations are used. We recommend applying a battery of tests for mixing based on the comparison of inferences from individual sequences and from the mixture of sequences. Finally, we discuss multivariate analogues, for assessing convergence of several parameters simultaneously.
Four novel phylogenetic clades of canine rabies virus (RABV) variants have been identified in the Middle East and North Africa. The three novel Middle Eastern clades comprise RABV isolates from the borders between Israel and neighbouring countries. The North African clade (Africa 4) comprises four RABV isolates from Egypt and one from Israel. We characterized various RABV lineages antigenically by using a panel of monoclonal antibodies to the nucleoprotein (N) and phylogenetically by analysis of entire N gene sequences. The estimated mean substitution rate for the N gene alignment (2.7x10(-4) substitutions per site per year) is comparable with previous estimates for RABV. The application of a molecular clock indicates the emergence of current canine RABV diversity to have occurred at about the same time (approx. 1870) in the Middle East and Europe, following divergence from established lineages in Africa and Asia.
This book explores the field of geographical variations in disease. Especially with respect to variations in environmental exposures at the small-area scale, the book gives an account of current practice and developments. The recent and rapid expansion of the field looks set to continue in line with growing public, governmental, and media concern about environmental and health issues, and the scientific need to understand and explain the effects of environmental pollutants on health. The book is concerned with fostering an understanding of the geographical distribution of disease and the effects of environmental exposures on human health.
Rabies is one of the most deadly infectious diseases, with a case-fatality rate approaching 100%. The disease is established on all continents apart from Antarctica; most cases are reported in Africa and Asia, with thousands of deaths recorded annually. However, the estimated annual figure of almost 60 000 human rabies fatalities is probably an underestimate. Almost all cases of human rabies result from bites from infected dogs. Therefore, the most cost-effective approach to elimination of the global burden of human rabies is to control canine rabies rather than expansion of the availability of human prophylaxis. Mass vaccination campaigns with parenteral vaccines, and advances in oral vaccines for wildlife, have allowed the elimination of rabies in terrestrial carnivores in several countries worldwide. The subsequent reduction in cases of human rabies in such regions advocates the multidisciplinary One Health approach to rabies control through the mass vaccination of dogs and control of canine populations.
We generalize the method proposed by Gelman and Rubin (1992a) for monitoring the convergence of iterative simulations by comparing between and within variances of multiple chains, in order to obtain a family of tests for convergence. We review methods of inference from simulations in older to develop convergence-monitoring summaries that are relevant for the purposes for which the simulations are used. We recommend applying a battery of tests for mixing based on the comparison of inferences from individual sequences and from the mixture of sequences. Finally, we discuss multivariate analogues, for assessing convergence of several parameters simultaneously.
This article presents an overview of GeoDa™, a free software program intended to serve as a user-friendly and graphical introduction to spatial analysis for non-geographic information systems (GIS) specialists. It includes functionality ranging from simple mapping to exploratory data analysis, the visualization of global and local spatial autocorrelation, and spatial regression. A key feature of GeoDa is an interactive environment that combines maps with statistical graphics, using the technology of dynamically linked windows. A brief review of the software design is given, as well as some illustrative examples that highlight distinctive features of the program in applications dealing with public health, economic development, real estate analysis, and criminology.
The capabilities for visualization, rapid data retrieval, and manipulation in geographic information systems (GIS) have created the need for new techniques of exploratory data analysis that focus on the “spatial” aspects of the data. The identification of local patterns of spatial association is an important concern in this respect. In this paper, I outline a new general class of local indicators of spatial association (LISA) and show how they allow for the decomposition of global indicators, such as Moran's I, into the contribution of each observation. The LISA statistics serve two purposes. On one hand, they may be interpreted as indicators of local pockets of nonstationarity, or hot spots, similar to the Gi and G*i statistics of Getis and Ord (1992). On the other hand, they may be used to assess the influence of individual locations on the magnitude of the global statistic and to identify “outliers,” as in Anselin's Moran scatterplot (1993a). An initial evaluation of the properties of a LISA statistic is carried out for the local Moran, which is applied in a study of the spatial pattern of conflict for African countries and in a number of Monte Carlo simulations.
The problems arising when modelling counts of rare events observed in small geographical areas when overdispersion and residual spatial autocorrelation are present or anticipated are considered. Different models are presented for handling inference in this case. The different strategies are implemented using data on offender counts at the enumeration district scale for Sheffield, England and results compared. This example is chosen because previous research suggests that social processes and social composition variables are key to understanding geographical variation in offender counts which will, as a consequence, show evidence of clustering both at the scale of the enumeration district and at larger scales. This in turn leads the analyst to anticipate the presence of overdispersion and spatial autocorrelation. Diagnostic measures are described and different modelling strategies are implemented. The evidence suggests that modelling strategies based on the use of spatial random effects models or models that include spatial filters appear to work well and provide a robust basis for model inference but gaps remain in the methodology that call for further research.
To determine the incidence and characteristics of the injuries caused by animals among the population of Khuzestan region, Iran admitted to teaching hospital emergency departments.
Retrospective study.
From 1997 to 2006 in teaching hospitals in Ahvaz, Iran.
The medical records of 894 patients admitted to hospital with animal bites or stings were studied. Data including epidemiological aspects, clinical findings and outcomes of treatment were analyzed using descriptive statistics and the chi(2) test.
Of 894 patients 62.0% were male, and the median age of males and females was 24.4 years and 26.2 years, respectively. Dogs, scorpions, mice and snakes were the most commonly involved animal species, causing injuries with a frequency of 69%, 12.5%, 8.8% and 4.4%, respectively. Feet (58.1%) and hands (30.6%) were the most commonly affected body parts, followed by the face and other parts. Infectious complications were seen in 127 patients, among them 94 soft tissue infections (74.1%), 28 cases of sepsis (22.0%) and five of endocarditis (3.9%). Thirty-five cases (3.9%) died following animal bites and stings, among them 28 (80%) due to scorpion stings, four (11.4%) related to dogs and three (8.6%) from snake bites. No cases of rabies were observed in these patients.
Animal bite is a major public health problem in Khuzestan, with a high frequency, a high percentage of hospitalization and considerable mortality.
A reported "cluster" of excess childhood leukemia cases and possible environmental causes in Woburn, Massachusetts, formed a key motivation for the events described in the popular book and motion picture A Civil Action. Although statistical methods to assess spatial clustering existed prior to the events in Woburn, increasing interest in environmental risk factors and recent developments in geographical information systems and data availability prompt increased attention to such methods and their application to public health data. In this article, we review statistical and epidemiological concepts involved in the analysis of disease clusters. We discuss data issues, outline some methodological approaches, and illustrate ideas using data regarding leukemia incidence in upstate New York for the years 1978-1982.
Subnational HDI in Iran
- H D I Subnational