A. Meteorological Data Analysis Results – The overall mean temp. (Degree Celsius) ± (SD) standard deviation recorded in Winter Season of study period during Jan-Feb (°C), were 20.91 ± .29, with 95% Conf. Interval 20.20 - 21.62, Std. Err. .16, Min 20.71, and Max 21.24; The mean temperature (degree Celsius) ± standard deviation recorded in Pre-Monsoon Season Mar-May(°C), were 27.91 ± .30,, with 95% Conf. Interval 27.17 - 28.66, Std. Err. .17, Min 27.58, and Max 28.16; The mean temperature (degree Celsius) ± standard deviation recorded in Monsoon Season Jun-Sep(°C), were 28.44 ± .16,, with 95% Conf. Interval 28.05 -28.84, Std. Err. .09, Min 28.28, and Max 28.6; The mean temperature (degree Celsius) ± standard deviation recorded in Post-Monsoon Season Oct-Dec(°C) were 23.59 ± .14,, with 95% Conf. Interval 23.26 - 23.93, Std. Err. .08, Min 23.49 and Max 23.75 see Table-1 and Figure-1.
B. Total Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases from 1st January 2018 to 31st May 2021- A total of 11171113 eligible childhood diarrhoea (0-5 years) and 1704819 Childhood diarrhoea treated in Inpatients (0-5 years) were analyzed during the 41 month study period. The analysis of monthly / seasonal / COVID-19 variations of eligible Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) different months of different years and combined all years is discussed below as per timeline for better understanding.
C. 2018 – Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases
The total number of childhood diarrhoea (0-5 years) and childhood diarrhoea treated in Inpatients (0-5 years) observed in 12 months of 2018 from were 3768149 and 608284 respectively; Mean- 314012.42 and 50690.33 respectively; Max / month – 376029 and 61572 respectively; Min / month – 266881and 39479 respectively for cases and inpatient treatments and no. of Obs-12 for each (one / month). Childhood diarrhoea cases period prevalence was highest in the month of July-18(376029) while lowest monthly prevalence was found in January-2018 (266881). Childhood diarrhoea cases treated in Inpatients period prevalence was highest in the month of June-2018(376029) while lowest monthly prevalence was found in January-2018 (266881).
The mean seasonal childhood diarrhoea cases period prevalence were highest in monsoon June to September (mean temperature 28.28°C) with mean number childhood diarrhoea cases 356387.5 followed by pre monsoon March to May (mean temperature 28.16°C) with mean cases 318880.67, post monsoon, October to December, (mean temperature 23.55°C) with mean cases 282773.67, and lowest in Winter Season Jan to Feb (mean temperature 21.24°C) having mean cases 268818 and See table-1, 2, and figure-2. It was observed that the prevalence of mean childhood diarrhoea cases increased with increase in temperature.
The mean seasonal childhood diarrhoea treated in Inpatients period prevalence were highest in monsoon June to September (mean temperature 28.28°C) with mean number childhood diarrhoea cases treated in Inpatients 57893 numbers followed by pre monsoon March to May (mean temperature 28.16°C) with mean number of cases treated in Inpatients 53919, post monsoon, October to December, (mean temperature 23.55°C) with mean cases treated in Inpatients 43947, and lowest in Winter Season Jan to Feb (mean temperature 21.24°C) having mean cases treated in Inpatients 41557 and See table-1, 2, and figure-2. It was observed that the prevalence of mean childhood diarrhoea cases treated in Inpatients increased with increase in temperature.
D. 2019 – Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases
The total number of childhood diarrhoea (0-5 years) and childhood diarrhoea treated in Inpatients (0-5 years) observed in 12 months of 2019 from were 3894116 and 645998 respectively; Mean- 324509.7 and 53833.2 respectively; Max / month – 418722 and 71140 respectively; Min / month – 261319 and 39376 respectively for cases and inpatient treatments and no. of Obs-12 for each (one / month). Childhood diarrhoea cases period prevalence was highest in the month of July-2019(418722) while lowest monthly prevalence was found in December-2019 (261319).
The mean seasonal childhood diarrhoea cases period prevalence were highest in monsoon June to September 2019 (mean temperature 28.6°C) with mean number childhood diarrhoea cases 384530 followed by pre monsoon, March to May 2019 (mean temperature 28°C) with mean cases 320582.67, post monsoon, October to December 2019, (mean temperature 23.49°C) with mean cases 279600, and lowest in Winter Season Jan to Feb 2019 (mean temperature 20.71°C) having mean cases 277724 and See table-1, 2, and figure-3. It was observed that the prevalence of mean childhood diarrhoea cases increased with increase in temperature. Added to this the prevalence pattern of 2019 was almost similar to previous year 2018.
The mean seasonal childhood diarrhoea cases treated in Inpatients (0-5 years) period prevalence were highest in monsoon June to September 2019 (mean temperature 28.6°C) with mean number childhood diarrhoea cases treated in Inpatients (0-5 years) 63219.25 followed by pre monsoon, March to May 2019 (mean temperature 28°C) with mean cases treated in Inpatients 57446.67, Winter Season Jan to Feb 2019 (mean temperature 20.71°C) having mean cases treated in Inpatients 47996.5 and lowest in post monsoon, October to December 2019, (mean temperature 23.49°C) with mean cases treated in Inpatients (0-5 years) 41596, See table-1, 2, and figure-3. The prevalence pattern of 2019 was almost similar to previous year 2018 except the inpatients treatment was lowest in post-monsoon instead of winter season.
E. 2020 – Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases during COVID-19 period
The total number of childhood diarrhoea (0-5 years) and childhood diarrhoea treated in Inpatients (0-5 years) observed in 12 months of 2020 from were 2505838 and 300385 respectively; Mean- 208819.83 and 25032.08 respectively; Max / month – 284075 and 48957 respectively; Min / month – 158007 and 17563 respectively for cases and inpatient treatments and no. of Obs-12 for each (one / month). Childhood diarrhoea cases period prevalence was highest in the month of February-2020(284075) while lowest monthly prevalence was found in April -2020 (158007). Here it is important to mention that there is an abrupt shift in monthly as well as annual and seasonal prevalence of Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases during the COVID-19 pandemic period. The question arises why? This will be discussed in discussion part.
The mean seasonal childhood diarrhoea cases period prevalence were highest in Winter Season Jan to Feb 2020 (mean temperature 20.79°C) having mean cases 275228.5 followed by monsoon, June to September 2020 (mean temperature 28.45°C) with mean number childhood diarrhoea cases 202150, pre monsoon, March to May 2020 (mean temperature 27.58°C) with mean cases 196285, and lowest in post monsoon, October to December 2020, (mean temperature 23.75°C) with mean cases 185975.33, See table-1, 2, and figure-4. It was observed that the prevalence of mean childhood diarrhoea cases increased in winter season. Added to this the prevalence pattern of seasonal childhood diarrhoea cases changed significantly compared to 2019 and 2018.
The mean seasonal childhood diarrhoea cases treated in Inpatients period prevalence were highest in Winter Season Jan to Feb 2020 (mean temperature 20.79°C) having mean treated in Inpatients cases 45544 followed by pre monsoon, March to May 2020 (mean temperature 27.58°C) with mean treated in Inpatients cases 25393, post monsoon, October to December 2020, (mean temperature 23.75°C) with mean treated in Inpatients cases 19488.33, and lowest in monsoon, June to September 2020 (mean temperature 28.45°C) with mean number childhood diarrhoea cases treated in Inpatients 18663.25, See table-1, 2, and figure-4. It was observed that the prevalence of mean childhood diarrhoea cases treated in Inpatients increased in winter season. Added to this the prevalence pattern of seasonal childhood diarrhoea treated in Inpatients cases changed significantly compared to 2019 and 2018. This change may be due to COVID-19 impact which is discussed in other section.
F. 2021 – Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases during COVID-19 period
The complete data of 2021 was not available and as a medical doctor the researcher feels that diarrhoeal outbreaks are unpredictable hence mathematical modelling or linear regression are not applied to predict the future data. This will be discussed in next version with full data availability. Only figure 5 below is presented to readers as per available accredited data.
G. 2018-2019-2020-2021 combined –analysis of Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) and Childhood diarrhoea treated in Inpatients (0-5 years) due to Diarrhoeal diseases -The 41 months of study when grouped into two groups as pre-pandemic era and pandemic era shows that the Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) were MAX in July 2019 monsoon season during pre-pandemic period with 418722 cases ([95% CONF. INTERVAL] 299758.7- 338763.3; STD. ERR.- 9427.519; MEAN-319261; STD. DEV- 46185.22; and MIN-261319 in December 2019, post monsoon season, See table- 1, 3, and 4; figure-5 and 6.
During the COVID-19 pandemic period Monthly /seasonally Prevalence of Childhood diarrhoea (0-5 years) were MAX in February 2020 winter season during pre-pandemic period with 284075 cases ([95% CONF. INTERVAL] 188170.3 - 224635.3; STD. ERR.- 8600.616; MEAN-206402.8; STD. DEV- 35461.25; and MIN-158007 in April 2020.
The impact of COVID-19 on mean seasonal Prevalence of Childhood diarrhoea and treatment in Inpatients will be discussed in next version.
Table – 4- Comparison of Pre-pandemic and pandemic period
Stat
|
Childhood Diseases - Diarrhoea(0-5 years) – Pre-pandemic period
|
Childhood Diseases - Diarrhoea(0-5 years) –pandemic period
|
Childhood Diseases - Diarrhoea treated in Inpatients(0-5 years) – Pre-pandemic period
|
Childhood Diseases - Diarrhoea treated in Inpatients(0-5 years) –pandemic period
|
Mean
|
319261
|
206402.8
|
52261.75
|
26502.18
|
Min. / month
|
261319
|
158007
|
39376
|
16756
|
Max. / month
|
418722
|
284075
|
71140
|
48957
|
Obs
|
24
|
17
|
24
|
17
|
Std. Dev.
|
46185.22
|
35461.25
|
9133.012
|
11214.68
|
sum
|
7662265
|
3508848
|
1254282
|
450537
|
range
|
157403
|
126068
|
31764
|
32201
|
se(mean)
|
9427.519
|
8600.616
|
1864.268
|
2719.961
|
p50
|
302824.5
|
199524
|
51066
|
18977
|
[95% Conf. Interval]
|
299758.7- 338763.3
|
188170.3 - 224635.3
|
48405.22- 56118.28
|
20736.12 - 32268.24
|
The 41 months of study when grouped into two groups as pre-pandemic era and pandemic era shows that the Monthly /seasonally Prevalence of Childhood diarrhoea treated in Inpatients (0-5 years) were MAX in July 2019 monsoon season during pre-pandemic period with 71140 cases ([95% CONF. INTERVAL] 48405.22- 56118.28; STD. ERR. - 1864.268; MEAN-52261.75; STD. DEV- 9133.012; and MIN-39376 in December 2019, post monsoon season.
During the COVID-19 pandemic period Monthly /seasonally Prevalence of Childhood diarrhoea treated in Inpatients (0-5 years) were MAX in February 2020 winter season during pre-pandemic period with 48957 cases ([95% CONF. INTERVAL] 20736.12 - 32268.24; STD. ERR.- 2719.961; MEAN-26502.18; STD. DEV- 11214.68; and MIN-16756 in May 2021 See table- 1, 3, and 4; figure-7.