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Spatiotemporal clustering, climate periodicity, and social-ecological risk factors for dengue during an outbreak in Machala, Ecuador, in 2010.

ABSTRACT: BACKGROUND: Dengue fever, a mosquito-borne viral disease, is a rapidly emerging public health problem in Ecuador and throughout the tropics. However, we have a limited understanding of the disease transmission dynamics in these regions. Previous studies in southern coastal Ecuador have demonstrated the potential to develop a dengue early warning system (EWS) that incorporates climate and non-climate information. The objective of this study was to characterize the spatiotemporal dynamics and climatic and social-ecological risk factors associated with the largest dengue epidemic to date in Machala, Ecuador, to inform the development of a dengue EWS. METHODS: The following data from Machala were included in analyses: neighborhood-level georeferenced dengue cases, national census data, and entomological surveillance data from 2010; and time series of weekly dengue cases (aggregated to the city-level) and meteorological data from 2003 to 2012. We applied LISA and Moran's I to analyze the spatial distribution of the 2010 dengue cases, and developed multivariate logistic regression models through a multi-model selection process to identify census variables and entomological covariates associated with the presence of dengue at the neighborhood level. Using data aggregated at the city-level, we conducted a time-series (wavelet) analysis of weekly climate and dengue incidence (2003-2012) to identify significant time periods (e.g., annual, biannual) when climate co-varied with dengue, and to describe the climate conditions associated with the 2010 outbreak. RESULTS: We found significant hotspots of dengue transmission near the center of Machala. The best-fit model to predict the presence of dengue included older age and female gender of the head of the household, greater access to piped water in the home, poor housing condition, and less distance to the central hospital. Wavelet analyses revealed that dengue transmission co-varied with rainfall and minimum temperature at annual and biannual cycles, and we found that anomalously high rainfall and temperatures were associated with the 2010 outbreak. CONCLUSIONS: Our findings highlight the importance of geospatial information in dengue surveillance and the potential to develop a climate-driven spatiotemporal prediction model to inform disease prevention and control interventions. This study provides an operational methodological framework that can be applied to understand the drivers of local dengue risk.

SUBMITTER: Stewart-Ibarra AM

PROVIDER: S-EPMC4264610 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Spatiotemporal clustering, climate periodicity, and social-ecological risk factors for dengue during an outbreak in Machala, Ecuador, in 2010.

Stewart-Ibarra Anna M AM Muñoz Ángel G ÁG Ryan Sadie J SJ Ayala Efraín Beltrán EB Borbor-Cordova Mercy J MJ Finkelstein Julia L JL Mejía Raúl R Ordoñez Tania T Recalde-Coronel G Cristina GC Rivero Keytia K

BMC infectious diseases 20141125

<h4>Background</h4>Dengue fever, a mosquito-borne viral disease, is a rapidly emerging public health problem in Ecuador and throughout the tropics. However, we have a limited understanding of the disease transmission dynamics in these regions. Previous studies in southern coastal Ecuador have demonstrated the potential to develop a dengue early warning system (EWS) that incorporates climate and non-climate information. The objective of this study was to characterize the spatiotemporal dynamics a ...[more]

PMID: 25420543

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Project description:BACKGROUND: The growing burden of dengue fever and the lack of a vaccine or specific medical treatment have increased the urgency of the public health sector to identify alternative management strategies. A prevailing trend in Latin America has been a shift towards decentralized vector control programs with integrated management strategies, requiring significant intersectoral coordination, community engagement, and knowledge of the local social-ecological system (SES). Community perceptions and responses are a critical component of this system, since perceptions shape actions, and thus govern behavioral responses and acceptance of shifts in policy and management. METHODS: We investigated perceptions, misconceptions, and local SES risk factors for dengue in high risk communities located at the urban periphery and center in Machala, Ecuador. We facilitated twelve focus group discussions with community members using semi-structured question guides and causal diagrams. Focus groups were recorded, transcribed, and coded to identify emergent themes using qualitative methods for theme analysis. To estimate the relative importance of the themes in each study area, we tabulated the number of focus groups in which each theme was present. Household surveys (n = 79) were conducted to further explore these themes, and we compared survey responses from the two areas using descriptive statistics. RESULTS: We identified thirty biophysical, political-institutional, and community-household risk factors for dengue. People at the periphery identified a greater number of risk factors. Dengue control required considerable investment of time and resources, which presented a greater challenge for women and people at the periphery. Common misperceptions included confusion with other febrile diseases, lack of knowledge of transmission mechanisms, and misconceptions about mosquito behavior. People perceived that dengue control programs had been limited by the lack of inter-institutional coordination and lack of social cohesion. CONCLUSIONS: There is a need for local, policy-relevant research that can be translated to strengthen the design, implementation, and evaluation of new dengue management strategies. This study contributes to a growing body of research in this area. Based on these findings, we identify key policy and management recommendations that will inform the ongoing transition to a decentralized dengue control program in Ecuador and other dengue endemic countries.

Project description:BACKGROUND:In Ecuador, dengue virus (DENV) infections transmitted by the Aedes aegypti mosquito are among the greatest public health concerns in urban coastal communities. Community- and household-level vector control is the principal means of controlling disease outbreaks. This study aimed to assess the impact of knowledge, attitudes, and practices (KAPs) and social-ecological factors on the presence or absence of DENV infections in the household. METHODS:In 2014 and 2015, individuals with DENV infections from sentinel clinics in Machala, Ecuador, were invited to participate in the study, as well as members of their household and members of four neighboring households located within 200 meters. We conducted diagnostic testing for DENV on all study participants; we surveyed heads of households (HOHs) regarding demographics, housing conditions and KAPs. We compared KAPs and social-ecological factors between households with (n = 139) versus without (n = 80) DENV infections, using bivariate analyses and multivariate logistic regression models with and without interactions. RESULTS:Significant risk factors in multivariate models included proximity to abandoned properties, interruptions in piped water, and shaded patios (p<0.05). Significant protective factors included the use of mosquito bed nets, fumigation inside the home, and piped water inside the home (p<0.05). In bivariate analyses (but not multivariate modeling), DENV infections were positively associated with HOHs who were male, employed, and of younger age than households without infections (p<0.05). DENV infections were not associated with knowledge, attitude, or reported barriers to prevention activities. DISCUSSION:Specific actions that can be considered to decrease the risk of DENV infections in the household include targeting vector control in highly shaded properties, fumigating inside the home, and use of mosquito bed nets. Community-level interventions include cleanup of abandoned properties, daily garbage collection, and reliable piped water inside houses. These findings can inform interventions to reduce the risk of other diseases transmitted by the Ae. aegypti mosquito, such as chikungunya and Zika fever.

Project description:BackgroundDengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines.MethodsA 37-item questionnaire of dengue knowledge, attitudes, and practices was developed and administered to dengue healthcare providers in Machala, Ecuador. Survey focus areas included: "Demographics," "Infection and Prevention of Dengue," "Dengue Diagnosis and the WHO Dengue Guide," "Laboratory Testing," "Treatment of Dengue," and "Opinions Regarding Dengue."ResultsA total of 76 healthcare providers participated in this study, of which 82 % were medical doctors and 14 % were nurses. Fifty-eight percent of healthcare professionals practiced in ambulatory clinics and 34 % worked in a hospital. Eighty-nine percent of respondents were familiar with the 2009 WHO Dengue Guidelines, and, within that group, 97 % reported that the WHO Dengue Guide was helpful in dengue diagnosis and clinical management. Knowledge gaps identified included Aedes aegypti mosquito feeding habits and dengue epidemiology. Individuals with greater dengue-related knowledge were more likely to consider dengue a major health problem. Only 22 % of respondents correctly reported that patients with comorbidities and dengue without warning signs require hospital admission, and 25 % of providers reported never admitting patients with dengue to the hospital. Twenty percent of providers reported rarely (?25 % of cases) obtaining laboratory confirmation of dengue infection. Providers reported patient presumptive self-medication as an ongoing problem. Thirty-one percent of healthcare providers reported inadequate access to resources needed to diagnose and treat dengue.ConclusionParticipants demonstrated a high level of knowledge of dengue symptoms and treatment, but additional training regarding prevention, diagnosis, and admission criteria is needed. Interventions should not only focus on increasing knowledge, but also encourage review of the WHO Dengue Guidelines, avoidance of presumptive self-medication, and recognition of dengue as a major health problem. This study provided an assessment tool that effectively captured healthcare providers' knowledge and identified critical gaps in practice.

Dataset Information

Spatiotemporal clustering, climate periodicity, and social-ecological risk factors for dengue during an outbreak in Machala, Ecuador, in 2010.

Publications

Spatiotemporal clustering, climate periodicity, and social-ecological risk factors for dengue during an outbreak in Machala, Ecuador, in 2010.

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