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An abstract of the thesis of Rhonda Rae Robb for the Master of Science in Geography presented June 8, 2004. Title: Risk factors for pre-post monsoon cholera epidemics in Bangladesh from 1992-1994. The primary objective of this thesis is to differentiate between the risk factors for preand post-monsoon cholera epidemics in rural Bangladesh by analyzing the complex interaction between select environmental, culturallbehavioral, and socioeconomic variables over space and time. In rural Bangladesh, cholera epidemics correspond with the annual monsoon: the first, and smallest, occurs between March and June, while the larger cholera peak occurs between September and December. The differences between the spatial and temporal patterns of seasonal cholera are analyzed, and the risk factors are calculated for preand post-monsoon cholera epidemics. The theoretical approach that underlies this medical geographical study is disease ecology, which espouses that risk ofdisease is caused by an interaction between people and their environment. This thesis is structured around a holistic understanding that human-environment interactions are inseparable. In Bangladesh, the monsoon season typically starts between May and June. The 1992 and 1993 cholera peaks occurredju~t before the monsoon in April and March respectively, while the 1994 cholera peak occurred between April and June. In 1992 and 1993 cholera incidence increased in the post-monsoon period, and peaked in October. The 1994 post-monsoon cholera peak occurred in November. There is a regular temporal pattern to cholera, as the peaks followed a seasonal pattern with the smaller epidemic occurring in the pre-monsoon period and the larger epidemic occurring in the post-monsoon period. This study shows that there are different risks associated with pre-monsoon cholera epidemics and post-monsoon cholera epidemics. The two main risk factors associated with cholera incidence pre-monsoon were bari population (Le., crowding) and a house located within the flood controlled area. These two variables were even more strongly associated with post-monsoon cholera incidence to a greater degree, along with a number of other variables including water use, sanitation practices, and socioeconomic status. RISK FACTORS FOR PRE-POST MONSOON CHOLERA EPIDEMICS IN BANGLADESH FROM 1992-1994.

Risk Factors for Pre-Post Monsoon Cholera Epidemics in Bangladesh from 1992-1994