Master Thesis in Geographical Information Science nr 70 USING GEOGRAPHICAL INFORMATION SYSTEMS IN EPIDEMIOLOGY: MAPPING & ANALYZING OCCURRENCE OF DIARRHEA IN URBAN – RESIDENTIAL AREA OF ISLAMABAD, PAKISTAN Mirza Amir Liaquat Baig 2017 Department of Physical Geography and Ecosystem Science Centre for Geographical Information Systems Lund University Sölvegatan 12 S -223 62 Lund Sweden Mirza Amir Liaquat Baig (2017). Using geographical information systems in epidemiology: Mapping and analyzing occurrence of diarrhea in urban - residential area of Islamabad, Pakistan. Master degree thesis, 30/ credits in Master in Geographical Information Science Department of Physical Geography and Ecosystem Science, Lund University ii ___________________________________________________________________ Using Geographical Information Systems in Epidemiology: Mapping & Analyzing Occurrence of Diarrhea in Urban – Residential Area of Islamabad, Pakistan Mirza Amir Liaquat Baig Master Degree Project (2017), 30 credits in Geographic Information Sciences Advisor: Harry Lankreijer Senior lecturer at Department of Physical Geography and Ecosystems Science, Lund University, Sweden iii Acknowledgements Glory is to Almighty Allah, the creator for uncountable favors and for this success. I the merciful God) but to those who matter most) ﷲ am grateful not just to Allah the greatest role model for ,ﷺ in my life, starting from Prophet Muhammad the humanity. I wish to thank my parents, siblings, friends and my wife for their support, my deepest gratitude goes to Erasmus Mundus, Lund University, GIS Center, University Administration and Faculty for providing such a wonderful opportunity, last but not the least to my supervisor Harry Lankreijer for the invaluable support and guidance during Master’s research. The Muslim holy book the Quran says in Surah5 Verse32 “if anyone saves a life, it shall be as though he had saved the lives of all mankind”. Research using Geographic Information System would reap best of its utilization in epidemic study which is a motivation behind. iv Abstract Islamabad, the capital of Pakistan is attracting families due to safety, lush green scenery and good infrastructure. Almost 2 million people are living in this city, and significant number of workforce commute from neighboring areas and other parts of the country. The city is facing restraint on natural resources due to increased urban migration coupled with rapid population growth. As a result, the infrastructure facilities and living conditions are deteriorating. Approximately 43 % shortage in water supply was reported by Capital Development Authority (CDA) in year 2015, the problems associated with drinking water availability and quality is rising along with other challenges including poor hygiene conditions and low income areas. A significant portion of population living in Islamabad is vulnerable to diarrhea epidemic, which has become a major public health problem. This research is limited to several residential sectors of Islamabad (city) to understand diarrhea epidemiology through the mapping of residents with diarrhea incidence, then global and focused test were conducted for cluster detection based on covariate factors illustrated using Geographic Information System (GIS). Diarrhea patient’s data from a main public sector hospital was available for a complete year (2013). Other relevant data on district boundary, residential sectors, Streets and Highways, Water Filtration Plants (WFP), Water Drainage Streams (WDS), Slums and Non-slum was received and prepared according to research requirements. During data preparation, all the data were digitized using point shapefiles, polyline shapefiles and polygon shapefiles. v Hypothesis testing was conducted using global test (Average Nearest Neighbor) on diarrhea patients, the results indicated the spread of diarrhea had strong evidence of pattern. The study further explored, whether the disease spread is random or has some covariate factors influencing the spread. Henceforth, focused test was conducted using the location of WFP, WDS, Slums and Non-Slum to understand the role of those factors for the spatial dispersion of the disease using Average Nearest Neighbor. Diarrhea Incidence Rate (DIR) for each factor was found for summer and winter season to understand the effect of season/ temperature. In addition to that, KD maps were used for the detection of diarrhea hotspots visually. Finally, hotspot maps were produced for summer and winter using Getis-Ord GI* statistics method using DIR to show vulnerable areas in Islamabad with diarrhea Hotspots & Coldspots. GIS methods and tools were used in this study to explore spatial patterns of diarrhea based on factors identified. The results clearly demonstrated that the increase in distance of a household from WDS decreases diarrhea risk in summer and winter; the increase in distance of a household from WFP increases diarrhea risk in summer but the same is not observed for winter; increased diarrhea risk is observed in Slum during summer and winter, and increased diarrhea risk is observed during summer but the same is not observed for winter in Non-Slum. The derived information can be used for the containment of diarrhea epidemic in Islamabad using proper planning based on observed phenomenon. Similarly, GIS methodology adopted in this research can be further used in researches for other diseases spread through water contamination. vi Table of Contents Acknowledgements ............................................................................................................................ iv Abstract .................................................................................................................................................. v Table of Contents .............................................................................................................................. vii List of Figures ....................................................................................................................................... ix List of Tables ......................................................................................................................................... x List of Appendices ............................................................................................................................... x List of Abbreviations ........................................................................................................................... xi Keywords .............................................................................................................................................. xi 1. Introduction ....................................................................................................................................... 1 1.1 Background ................................................................................................................................... 2 1.1.1 Diarrhea ................................................................................................................................. 2 1.1.2 Geographic Information System (GIS) in Epidemiology ......................................................... 8 1.2 Study Objective ........................................................................................................................... 12 1.3 Study Area ................................................................................................................................... 13 1.4 Limitations of the study .............................................................................................................. 19 2. Data & Methodology ....................................................................................................................23 2.1 Thesis Structure .......................................................................................................................... 23 2.2 Data Acquisition & Preparation .................................................................................................. 25 2.2.1 Patients ................................................................................................................................ 25 2.2.2 Water Drainage Streams (WDS) ........................................................................................... 29 2.2.3 Water Filtration Plants (WFP) .............................................................................................. 30 2.2.4 Slums .................................................................................................................................... 34 2.3 Concepts & Application ............................................................................................................... 36 3. Results ............................................................................................................................................. 45 3.1 To explore whether diarrhea incidence are clustered, randomly distributed or dispersed, and its tendency to aggregate in space or in time? ........................................................................... 45 3.2 To explore DIR in Water Drainage Stream’s (WDS) proximity? .................................................. 48 3.3 To explore DIR in Water Filtration Plant’s (WFP) proximity? ..................................................... 53 vii 3.4 To explore DIR in Slum & Non-Slum? .......................................................................................... 57 3.5 To study