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Rotejanaprasert C, Chinpong K, Lawson AB, Chienwichai P, Maude RJ. Evaluation and comparison of spatial cluster detection methods for improved decision making of disease surveillance: a case study of national dengue surveillance in Thailand. BMC Med Res Methodol 2024; 24:14. [PMID: 38243198 PMCID: PMC10797994 DOI: 10.1186/s12874-023-02135-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Dengue is a mosquito-borne disease that causes over 300 million infections worldwide each year with no specific treatment available. Effective surveillance systems are needed for outbreak detection and resource allocation. Spatial cluster detection methods are commonly used, but no general guidance exists on the most appropriate method for dengue surveillance. Therefore, a comprehensive study is needed to assess different methods and provide guidance for dengue surveillance programs. METHODS To evaluate the effectiveness of different cluster detection methods for dengue surveillance, we selected and assessed commonly used methods: Getis Ord [Formula: see text], Local Moran, SaTScan, and Bayesian modeling. We conducted a simulation study to compare their performance in detecting clusters, and applied all methods to a case study of dengue surveillance in Thailand in 2019 to further evaluate their practical utility. RESULTS In the simulation study, Getis Ord [Formula: see text] and Local Moran had similar performance, with most misdetections occurring at cluster boundaries and isolated hotspots. SaTScan showed better precision but was less effective at detecting inner outliers, although it performed well on large outbreaks. Bayesian convolution modeling had the highest overall precision in the simulation study. In the dengue case study in Thailand, Getis Ord [Formula: see text] and Local Moran missed most disease clusters, while SaTScan was mostly able to detect a large cluster. Bayesian disease mapping seemed to be the most effective, with adaptive detection of irregularly shaped disease anomalies. CONCLUSIONS Bayesian modeling showed to be the most effective method, demonstrating the best accuracy in adaptively identifying irregularly shaped disease anomalies. In contrast, SaTScan excelled in detecting large outbreaks and regular forms. This study provides empirical evidence for the selection of appropriate tools for dengue surveillance in Thailand, with potential applicability to other disease control programs in similar settings.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
| | - Kawin Chinpong
- Chulabhorn Learning and Research Centre, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Andrew B Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Peerut Chienwichai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Richard J Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- The Open University, Milton Keynes, UK
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Mustafa UK, Sauli E, Brinkel J, Kreppel KS. Health professionals' knowledge on dengue and health facility preparedness for case detection: A cross-sectional study in Dar es Salaam, Tanzania. PLoS Negl Trop Dis 2023; 17:e0011761. [PMID: 37988330 PMCID: PMC10662763 DOI: 10.1371/journal.pntd.0011761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
Dengue presents a growing public health concern in the Dar es Salaam region of Tanzania, marked by the recurring incidence of outbreaks. Unfortunately, there is little information available on the region's preparedness in terms of health care workers' knowledge on dengue as well as the availability of reagents and equipment essential for diagnosing and monitoring of dengue infections. To elucidate this, 78 health facilities were visited in Temeke district and structured questionnaires were distributed to 324 health care workers. The aim was to evaluate health care workers' knowledge on dengue and to assess the availability of reagents and equipment essential for diagnosing and monitoring of dengue infections. Content validity of the questionnaire was achieved through extensive literature review and it exhibited high reliability (Cronbach Alpha coefficient = 0.813). Cumulative scores for responses on knowledge questions by health care workers were computed. Characteristics such as level of education, place of work and gender were tested for association with these scores using chi-square tests and logistics regression. Almost all health care workers (99.7%) were aware of dengue disease. However, less than half (46.9%) had knowledge scores of or over 40%. Clinicians had approximately four times higher knowledge scores than other cadres (AOR, 3.637; p-value≤ 0.0001), and those who worked in private facilities had twice the knowledge score than those working in government institutions (AOR, 2.071; p-value = 0.007). Only 8.6%, 35.6% and 14.7% of respondents reported the availability of dengue rapid tests, medical guidelines and refresher training respectively, showing a lack of health facilities readiness for the detection of dengue infections. Based on findings from this study, we recommend government authorities to build capacity of health care workers, to improve their understanding of dengue. We also urge the government and stakeholders to work together to ensure availability of diagnostic tests and other tools needed for diagnosis and surveillance of dengue.
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Affiliation(s)
- Ummul-khair Mustafa
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Elingarami Sauli
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
| | - Johanna Brinkel
- Department of Infectious Disease Epidemiology, Bernhard Nocht lnstitute for Tropical Medicine, Hamburg, Germany
| | - Katharina Sophia Kreppel
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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3
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Man O, Kraay A, Thomas R, Trostle J, Lee GO, Robbins C, Morrison AC, Coloma J, Eisenberg JNS. Characterizing dengue transmission in rural areas: A systematic review. PLoS Negl Trop Dis 2023; 17:e0011333. [PMID: 37289678 PMCID: PMC10249895 DOI: 10.1371/journal.pntd.0011333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
Dengue has historically been considered an urban disease associated with dense human populations and the built environment. Recently, studies suggest increasing dengue virus (DENV) transmission in rural populations. It is unclear whether these reports reflect recent spread into rural areas or ongoing transmission that was previously unnoticed, and what mechanisms are driving this rural transmission. We conducted a systematic review to synthesize research on dengue in rural areas and apply this knowledge to summarize aspects of rurality used in current epidemiological studies of DENV transmission given changing and mixed environments. We described how authors defined rurality and how they defined mechanisms for rural dengue transmission. We systematically searched PubMed, Web of Science, and Embase for articles evaluating dengue prevalence or cumulative incidence in rural areas. A total of 106 articles published between 1958 and 2021 met our inclusion criteria. Overall, 56% (n = 22) of the 48 estimates that compared urban and rural settings reported rural dengue incidence as being as high or higher than in urban locations. In some rural areas, the force of infection appears to be increasing over time, as measured by increasing seroprevalence in children and thus likely decreasing age of first infection, suggesting that rural dengue transmission may be a relatively recent phenomenon. Authors characterized rural locations by many different factors, including population density and size, environmental and land use characteristics, and by comparing their context to urban areas. Hypothesized mechanisms for rural dengue transmission included travel, population size, urban infrastructure, vector and environmental factors, among other mechanisms. Strengthening our understanding of the relationship between rurality and dengue will require a more nuanced definition of rurality from the perspective of DENV transmission. Future studies should focus on characterizing details of study locations based on their environmental features, exposure histories, and movement dynamics to identify characteristics that may influence dengue transmission.
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Affiliation(s)
- Olivia Man
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Alicia Kraay
- Department of Kinesiology and Community Health, University of Illinois, Urbana, Illinois, United States of America
- Institution for Genomic Biology, University of Illinois, Urbana, Illinois, United States of America
| | - Ruth Thomas
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - James Trostle
- Department of Anthropology, Trinity College, Hartford, Connecticut, United States of America
| | - Gwenyth O. Lee
- Rutgers Global Health Institute, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
- Rutgers Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
| | - Charlotte Robbins
- Department of Anthropology, Trinity College, Hartford, Connecticut, United States of America
| | - Amy C. Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, California, United States of America
| | - Josefina Coloma
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, Berkeley, California, United States of America
| | - Joseph N. S. Eisenberg
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America
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Braack L, Wulandhari SA, Chanda E, Fouque F, Merle CS, Nwangwu U, Velayudhan R, Venter M, Yahouedo AG, Lines J, Aung PP, Chan K, Abeku TA, Tibenderana J, Clarke SE. Developing African arbovirus networks and capacity strengthening in arbovirus surveillance and response: findings from a virtual workshop. Parasit Vectors 2023; 16:129. [PMID: 37059998 PMCID: PMC10103543 DOI: 10.1186/s13071-023-05748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/18/2023] [Indexed: 04/16/2023] Open
Abstract
This meeting report presents the key findings and discussion points of a 3-h virtual workshop, held on 21 September 2022, and organized by the "Resilience Against Future Threats through Vector Control (RAFT)" research consortium. The workshop aimed to identify priorities for advancing arbovirus research, network and capacity strengthening in Africa. Due to increasing human population growth, urbanization and global movement (trade, tourism, travel), mosquito-borne arboviral diseases, such as dengue, Chikungunya and Zika, are increasing globally in their distribution and prevalence. This report summarizes the presentations that reviewed the current status of arboviruses in Africa, including: (i) key findings from the recent WHO/Special Programme for Research & Training in Tropical Diseases (WHO/TDR) survey in 47 African countries that revealed deep and widespread shortfalls in the capacity to cope with arbovirus outbreak preparedness, surveillance and control; (ii) the value of networking in this context, with examples of African countries regarding arbovirus surveillance; and (iii) the main priorities identified by the breakout groups on "research gaps", "networks" and "capacity strengthening".
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Affiliation(s)
- Leo Braack
- Malaria Consortium Asia, Bangkok, Thailand.
| | | | | | - Florence Fouque
- WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - Corinne S Merle
- WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - Udoka Nwangwu
- National Arbovirus & Vectors Research Centre (NAVRC), Enugu, Nigeria
| | - Raman Velayudhan
- Department for the Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Marietjie Venter
- Zoonotic Arbo- and Respiratory Virus Research Programme, Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | - A Gildas Yahouedo
- WHO Special Programme for Research & Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - Jo Lines
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kallista Chan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Sian E Clarke
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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5
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Tangsathapornpong A, Thisyakorn U. Dengue amid COVID-19 pandemic. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001558. [PMID: 36962879 PMCID: PMC10021186 DOI: 10.1371/journal.pgph.0001558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023]
Abstract
The increasing in dengue cases nowadays is a global threat concern. Fifty per cent of the world's population is vulnerable to dengue infection with Asia contributing over two-thirds of the global burden. The double trouble of Coronavirus disease 2019 (COVID-19) arising from novel severe respiratory syndrome coronavirus (SARS-CoV-2) and dengue virus is a major challenge, particularly in developing countries due to overburdened public health systems and economic constraints including the ability to diagnose. The objective of this study was to analyze the prevalence of dengue in Thailand during the outbreak of COVID-19. We studied data on dengue cases reported at epidemiological information centers, the Bureau of Epidemiology, and the Ministry of Public Health, Thailand during 2019 to 2021. Patients can be observed across all age groups, particularly adolescents and adults. Dengue was seen year-round, with highest incidence in the rainy seasons between June and September. Total number of cases was markedly declined by nearly 93 percentage from 2019 to 2011. Taken together, Thailand is still at risk of spreading of dengue in the midst of COVID-19 pandemic. Continuous status updates on dengue patients in Thailand should be incorporated into global health advisory on preventive measures before travelling.
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Affiliation(s)
- Auchara Tangsathapornpong
- Division of Pediatric Infectious Disease, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
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6
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Thisyakorn U, Saokaew S, Gallagher E, Kastner R, Sruamsiri R, Oliver L, Hanley R. Epidemiology and costs of dengue in Thailand: A systematic literature review. PLoS Negl Trop Dis 2022; 16:e0010966. [PMID: 36534668 PMCID: PMC9810168 DOI: 10.1371/journal.pntd.0010966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 01/03/2023] [Accepted: 11/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dengue is the fastest-spreading vector-borne viral disease worldwide. In Thailand, dengue is endemic and is associated with a high socioeconomic burden. A systematic literature review was conducted to assess and describe the epidemiological and economic burden of dengue in Thailand. METHODS Epidemiological and economic studies published in English and Thai between 2011-2019 and 2009-2019, respectively, were searched in MEDLINE, Embase, and Evidence-Based Medicines reviews databases. Reports published by the National Ministry of Public Health (MoPH) and other grey literature sources were also reviewed. Identified studies were screened according to predefined inclusion and exclusion criteria. Extracted data were descriptively summarised and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 155 publications were included in the review (39 journal articles and 116 grey literature). Overall, dengue incidence varied yearly, with the highest rates per 100,000 population in 2013 (dengue fever (DF) 136.6, dengue haemorrhagic fever (DHF) 100.9, dengue shock syndrome (DSS) 3.58) and 2015 (DF 133.1, DHF 87.4, DSS 2.14). Peak incidence coincided with the monsoon season, and annual mortality was highest for DSS, particularly in the age group 15-24-year-olds. The highest dengue incidence rates were reported in children (10-14-year-olds) and young adults (15-24-year-olds), irrespective of dengue case definition. Economic and societal burdens are extensive, with the average cost per case ranging from USD 41 to USD 261, total cost per year estimated at USD 440.3 million, and an average of 7.6 workdays lost for DHF and 6.6 days for DF. CONCLUSIONS The epidemiological, economic, and societal burden of dengue in Thailand is high and underreported due to gaps in national surveillance data. The use of expansion factors (EFs) is recommended to understand the true incidence of dengue and cost-benefit of control measures. Furthermore, as dengue is often self-managed and underreported, lost school and workdays result in substantial underestimation of the true economic and societal burden of dengue. The implementation of integrated strategies, including vaccination, is critical to reduce the disease burden and may help alleviate health disparities and equity challenges posed by dengue.
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Affiliation(s)
- Usa Thisyakorn
- Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand
| | - Surasak Saokaew
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Unit of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | | | - Randee Kastner
- Takeda Vaccines Inc., Cambridge, Massachusetts, United States of America
| | | | - Louisa Oliver
- Adelphi Values, Bollington, Macclesfield, United Kingdom
| | - Riona Hanley
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
- * E-mail:
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7
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Huang KY, Nakigudde J, Kisakye EN, Sentongo H, Dennis-Tiwary TA, Tozan Y, Park H, Brotman LM. Advancing scalability and impacts of a teacher training program for promoting child mental health in Ugandan primary schools: protocol for a hybrid-type II effectiveness-implementation cluster randomized trial. Int J Ment Health Syst 2022; 16:28. [PMID: 35718782 PMCID: PMC9206883 DOI: 10.1186/s13033-022-00538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Children in low-and-middle-income countries (LMICs) are facing tremendous mental health challenges. Numerous evidence-based interventions (EBIs) have been adapted to LMICs and shown effectiveness in addressing the needs, but most EBIs have not been adopted widely using scalable and sustainable implementation models that leverage and strengthen existing structures. There is a need to apply implementation science methodology to study strategies to effectively scale-up EBIs and sustain the practices in LMICs. Through a cross-sector collaboration, we are carrying out a second-generation investigation of implementation and effectiveness of a school-based mental health EBI, ParentCorps Professional Development (PD), to scale-up and sustain the EBI in Uganda to promote early childhood students' mental health. Our previous studies in Uganda supported that culturally adapted PD resulted in short-term benefits for classrooms, children, and families. However, our previous implementation of PD was relied on mental health professionals (MHPs) to provide PD to teachers. Because of the shortage of MHPs in Uganda, a new scalable implementation model is needed to provide PD at scale. OBJECTIVES This study tests a new scalable and sustainable PD implementation model and simultaneously studies the effectiveness. This paper describes use of collaboration, task-shifting, and Train-the-Trainer strategies for scaling-up PD, and protocol for studying the effectiveness-implementation of ParentCorps-PD for teachers in urban and rural Ugandan schools. We will examine whether the new scale-up implementation approach will yield anticipated impacts and investigate the underlying effectiveness-implementation mechanisms that contribute to success. In addition, considering the effects of PD on teachers and students will influence by teacher wellness. This study also examines the added value (i.e. impact and costs) of a brief wellness intervention for teachers and students. METHODS Using a hybrid-type II effectiveness-implementation cluster randomized controlled trial (cRCT), we will randomize 36 schools (18 urban and 18 rural) with 540 teachers and nearly 2000 families to one of three conditions: PD + Teacher-Wellness (PDT), PD alone (PD), and Control. Primary effectiveness outcomes are teachers' use of mental health promoting strategies, teacher stress management, and child mental health. The implementation fidelity/quality for the scale-up model will be monitored. Mixed methods will be employed to examine underlying mechanisms of implementation and impact as well as cost-effectiveness. DISCUSSION This research will generate important knowledge regarding the value of an EBI in urban and rural communities in a LMIC, and efforts toward supporting teachers to prevent and manage early signs of children's mental health issues as a potentially cost-effective strategy to promote child population mental health in low resource settings. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (registration number: NCT04383327; https://clinicaltrials.gov/ct2/show/NCT04383327 ) on May13, 2020.
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Affiliation(s)
- Keng-Yen Huang
- grid.240324.30000 0001 2109 4251Department of Population Health, New York University Grossman School of Medicine, 227 East, 30th St, 7th Floor, New York, NY 10016 USA
| | - Janet Nakigudde
- grid.11194.3c0000 0004 0620 0548College of Health Science, Makerere University, PO Box 7072, Kampala, Uganda
| | - Elizabeth Nsamba Kisakye
- grid.466898.d0000 0004 0648 0949Uganda Ministry of Education and Sports, Embassy House, PO Box 7063, Kampala, Uganda
| | - Hafsa Sentongo
- grid.415705.2Uganda Ministry of Health, Plot 6 Lourdel Road, PO Box 7272, Kampala, Uganda
| | - Tracy A. Dennis-Tiwary
- grid.257167.00000 0001 2183 6649Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, USA
| | - Yesim Tozan
- grid.137628.90000 0004 1936 8753College of Global Public Health, New York University, 708 Broadway, New York, USA
| | - Hyung Park
- grid.240324.30000 0001 2109 4251Department of Population Health, New York University Grossman School of Medicine, 227 East, 30th St, 7th Floor, New York, NY 10016 USA
| | - Laurie Miller Brotman
- grid.240324.30000 0001 2109 4251Department of Population Health, New York University Grossman School of Medicine, 227 East, 30th St, 7th Floor, New York, NY 10016 USA
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8
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Weerasinghe NP, Bodinayake CK, Wijayaratne WMDGB, Devasiri IV, Dahanayake NJ, Kurukulasooriya MRP, Premamali M, Sheng T, Nicholson BP, Ubeysekera HA, de Silva AD, Østbye T, Woods CW, Tillekeratne LG, Nagahawatte ADS. Direct and indirect costs for hospitalized patients with dengue in Southern Sri Lanka. BMC Health Serv Res 2022; 22:657. [PMID: 35578247 PMCID: PMC9112532 DOI: 10.1186/s12913-022-08048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Southern Province of Sri Lanka is endemic with dengue, with frequent outbreaks and occurrence of severe disease. However, the economic burden of dengue is poorly quantified. Therefore, we conducted a cost analysis to assess the direct and indirect costs associated with hospitalized patients with dengue to households and to the public healthcare system. Methods From June 2017–December 2018, we prospectively enrolled children and adults with acute dengue hospitalized at the largest, public tertiary-care (1800 bed) hospital in the Southern Province, Sri Lanka. We administered a structured questionnaire to obtain information regarding direct costs spent by households on medical visits, medications, laboratory testing, and travel for seeking care for the illness. Indirect costs lost by households were estimated by identifying the days of work lost by patients and caregivers and school days lost by children. Direct hospital costs were estimated using gross costing approach and adjusted by multiplying by annual inflation rates in Sri Lankan rupees and converted to US dollars. Results A total of 1064 patients with laboratory-confirmed dengue were enrolled. The mean age (SD) was 35.9 years (15.6) with male predominance (66.2%). The mean durations of hospitalization for adults and paediatric patients were 3.86 (SD = 1.51) and 4 (SD = 1.32) days, respectively. The per-capita direct cost borne by the healthcare system was 233.76 USD, and was approximately 14 times greater than the per-capita direct cost borne by households (16.29 USD, SD = 14.02). The per-capita average number of loss of working days was 21.51 (SD = 41.71), with mean per-capita loss of income due to loss of work being 303.99 USD (SD = 569.77), accounting for over 70% of average monthly income. On average, 10.88 days (SD = 10.97) of school days were missed due to the dengue episode. School misses were expected to reduce future annual income of affected children by 0.44%. Conclusions Dengue requiring hospitalization had a substantial economic burden on the public healthcare system in Sri Lanka and the affected households. These findings emphasize the importance of strengthening dengue control activities and improved use of hospital-based resources for care to reduce the economic impact of dengue in Sri Lanka.
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Affiliation(s)
- N P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka. .,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
| | - C K Bodinayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - W M D G B Wijayaratne
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - I V Devasiri
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Pediatrics, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - N J Dahanayake
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M R P Kurukulasooriya
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - M Premamali
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - T Sheng
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - B P Nicholson
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Institute for Medical Research, Durham, NC, USA
| | | | - A D de Silva
- Faculty of Medicine, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - T Østbye
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - C W Woods
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - L G Tillekeratne
- Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA.,Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Department of Medicine, Duke University, Durham, NC, USA
| | - A De S Nagahawatte
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke-Ruhuna Collaborative Research Centre, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,Duke Global Health Institute, Durham, NC, USA
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9
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Sigera C, Rodrigo C, de Silva NL, Weeratunga P, Fernando D, Rajapakse S. Direct costs of managing in-ward dengue patients in Sri Lanka: A prospective study. PLoS One 2021; 16:e0258388. [PMID: 34624062 PMCID: PMC8500425 DOI: 10.1371/journal.pone.0258388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction The cost in managing hospitalised dengue patients varies across countries depending on access to healthcare, management guidelines, and state sponsored subsidies. For health budget planning, locally relevant, accurate costing data from prospective studies, is essential. Objective To characterise the direct costs of managing hospitalised patients with suspected dengue infection in Sri Lanka. Methods Colombo Dengue Study is a prospective single centre cohort study in Sri Lanka recruiting suspected hospitalised dengue fever patients in the first three days of fever and following them up until discharge. The diagnosis of dengue is retrospectively confirmed and the cohort therefore has a group of non-dengue fever patients with a phenotypically similar illness, managed as dengue while in hospital. The direct costs of hospital admission (base and investigation costs, excluding medication) were calculated for all recruited patients and compared between dengue and non-dengue categories as well as across subgroups (demographic, clinical or temporal) within each of these categories. We also explored if excluding dengue upfront, would lead to an overall cost saving in several hypothetical scenarios. Results From October 2017 to February 2020, 431 adult dengue patients and 256 non-dengue fever patients were recruited. The hospitalisation costs were USD 18.02 (SD: 4.42) and USD 17.55 (SD: 4.09) per patient per day for dengue and non-dengue patients respectively (p>0.05). Laboratory investigations (haematological, biochemical and imaging) accounted for more than 50% of the total cost. The costs were largely homogenous in all subgroups within or across dengue and non-dengue categories. Excluding dengue upfront by subsidised viral genomic testing may yield overall cost savings for non-dengue patients. Conclusion As non-dengue patients incur a similar cost per day as the dengue patients, confirming dengue diagnosis using subsidised tests for patients presenting in the first three days of fever may be cost-efficient.
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Affiliation(s)
- Chathurani Sigera
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chaturaka Rodrigo
- Department of Pathology, School of Medical Sciences, Sydney, NSW, Australia
- * E-mail:
| | - Nipun L. de Silva
- Department of Clinical Sciences, Faculty of Medicine, Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Praveen Weeratunga
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Deepika Fernando
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Senaka Rajapakse
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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10
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Early warning systems (EWSs) for chikungunya, dengue, malaria, yellow fever, and Zika outbreaks: What is the evidence? A scoping review. PLoS Negl Trop Dis 2021; 15:e0009686. [PMID: 34529649 PMCID: PMC8445439 DOI: 10.1371/journal.pntd.0009686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Early warning systems (EWSs) are of increasing importance in the context of outbreak-prone diseases such as chikungunya, dengue, malaria, yellow fever, and Zika. A scoping review has been undertaken for all 5 diseases to summarize existing evidence of EWS tools in terms of their structural and statistical designs, feasibility of integration and implementation into national surveillance programs, and the users’ perspective of their applications. Methods Data were extracted from Cochrane Database of Systematic Reviews (CDSR), Google Scholar, Latin American and Caribbean Health Sciences Literature (LILACS), PubMed, Web of Science, and WHO Library Database (WHOLIS) databases until August 2019. Included were studies reporting on (a) experiences with existing EWS, including implemented tools; and (b) the development or implementation of EWS in a particular setting. No restrictions were applied regarding year of publication, language or geographical area. Findings Through the first screening, 11,710 documents for dengue, 2,757 for Zika, 2,706 for chikungunya, 24,611 for malaria, and 4,963 for yellow fever were identified. After applying the selection criteria, a total of 37 studies were included in this review. Key findings were the following: (1) a large number of studies showed the quality performance of their prediction models but except for dengue outbreaks, only few presented statistical prediction validity of EWS; (2) while entomological, epidemiological, and social media alarm indicators are potentially useful for outbreak warning, almost all studies focus primarily or exclusively on meteorological indicators, which tends to limit the prediction capacity; (3) no assessment of the integration of the EWS into a routine surveillance system could be found, and only few studies addressed the users’ perspective of the tool; (4) almost all EWS tools require highly skilled users with advanced statistics; and (5) spatial prediction remains a limitation with no tool currently able to map high transmission areas at small spatial level. Conclusions In view of the escalating infectious diseases as global threats, gaps and challenges are significantly present within the EWS applications. While some advanced EWS showed high prediction abilities, the scarcity of tool assessments in terms of integration into existing national surveillance systems as well as of the feasibility of transforming model outputs into local vector control or action plans tends to limit in most cases the support of countries in controlling disease outbreaks.
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11
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Affiliation(s)
- Davidson H Hamer
- From the Department of Global Health, School of Public Health, and the Section of Infectious Diseases, Department of Medicine, School of Medicine National Emerging Infectious Diseases Laboratory, Boston University, Boston
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12
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Sonali Fernando E, Headley TY, Tissera H, Wilder-Smith A, De Silva A, Tozan Y. Household and Hospitalization Costs of Pediatric Dengue Illness in Colombo, Sri Lanka. Am J Trop Med Hyg 2021; 105:110-116. [PMID: 33999848 DOI: 10.4269/ajtmh.20-1179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/02/2021] [Indexed: 01/31/2023] Open
Abstract
Dengue, a mosquito-borne viral infection that affects millions around the world, poses a substantial economic burden in endemic countries. We conducted a prospective costing study in hospitalized pediatric dengue patients at the Lady Ridgeway Hospital for Children (LRHC), a public pediatric hospital in Colombo district, Sri Lanka, to assess household out-of-pocket and hospitalization costs of dengue in pediatric patients during peak dengue transmission season. Between August and October 2013, we recruited 216 hospitalized patients (aged 0-3 years, 27%; 4-7 years, 29%; 8-12 years, 42%) who were clinically or laboratory diagnosed with dengue. Using 2013 US dollars, household out-of-pocket spending, on average, was US$59 (SD 49) per episode and increased with disease severity (DF, US$52; DHF/DSS, US$78). Pediatric dengue patients received free-of-charge medical care during hospitalization at LRHC, and this places a high financial burden on hospitals. The direct medical cost of hospitalization was US$68.0 (SD 31.4) for DF episode, and US$122.7 (SD 65.2) for DHF/DSS episode. Yet a hospitalized dengue illness episode still accounted for 20% to 35% of household monthly income due to direct and indirect costs. Additionally, a majority of caregivers (70%) sought outpatient care before hospitalization, most of whom (81%) visited private health facilities. Our findings indicate that hospitalized pediatric dengue illness poses a nontrivial cost burden to households and healthcare systems, emphasizing the importance of preventing and controlling the transmission of dengue in endemic countries.
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Affiliation(s)
| | - Tyler Y Headley
- 2Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Annelies Wilder-Smith
- 4Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,5Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,6Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Amala De Silva
- 7Department of Economics, University of Colombo, Colombo, Sri Lanka
| | - Yesim Tozan
- 2Department of Political Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates.,8School of Global Public Health, New York University, New York, New York
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13
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Fustec B, Phanitchat T, Hoq MI, Aromseree S, Pientong C, Thaewnongiew K, Ekalaksananan T, Bangs MJ, Corbel V, Alexander N, Overgaard HJ. Complex relationships between Aedes vectors, socio-economics and dengue transmission-Lessons learned from a case-control study in northeastern Thailand. PLoS Negl Trop Dis 2020; 14:e0008703. [PMID: 33001972 PMCID: PMC7553337 DOI: 10.1371/journal.pntd.0008703] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/13/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES Dengue fever is an important public health concern in most tropical and subtropical countries, and its prevention and control rest on vector surveillance and control. However, many aspects of dengue epidemiology remain unclear; in particular, the relationship between Aedes vector abundance and dengue transmission risk. This study aims to identify entomological and immunological indices capable of discriminating between dengue case and control (non-case) houses, based on the assessment of candidate indices, as well as individual and household characteristics, as potential risk factors for acquiring dengue infection. METHODS This prospective, hospital-based, case-control study was conducted in northeastern Thailand between June 2016 and August 2019. Immature and adult stage Aedes were collected at the houses of case and control patients, recruited from district hospitals, and at patients' neighboring houses. Blood samples were tested by RDT and PCR to detect dengue cases, and were processed with the Nterm-34 kDa salivary peptide to measure the human immune response to Aedes bites. Socioeconomic status, and other individual and household characteristics were analyzed as potential risk factors for dengue. RESULTS Study findings showed complex relationships between entomological indices and dengue risk. The presence of DENV-infected Aedes at the patient house was associated with 4.2-fold higher odds of dengue. On the other hand, Aedes presence (irrespective of infectious status) in the patient's house was negatively associated with dengue. In addition, the human immune response to Aedes bites, was higher in control than in case patients and Aedes adult abundance and immature indices were higher in control than in case houses at the household and the neighboring level. Multivariable analysis showed that children aged 10-14 years old and those aged 15-25 years old had respectively 4.5-fold and 2.9-fold higher odds of dengue infection than those older than 25 years. CONCLUSION DENV infection in female Aedes at the house level was positively associated with dengue infection, while adult Aedes presence in the household was negatively associated. This study highlights the potential benefit of monitoring dengue viruses in Aedes vectors. Our findings suggest that monitoring the presence of DENV-infected Aedes mosquitoes could be a better indicator of dengue risk than the traditional immature entomological indices.
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Affiliation(s)
- Benedicte Fustec
- University of Montpellier, Montpellier, France
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Institut de Recherche pour le Developpement, Montpellier, France
| | - Thipruethai Phanitchat
- Department of Medical Entomology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mohammad Injamul Hoq
- School of Public Health, Epidemiology and Social Medicine at the Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sirinart Aromseree
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Chamsai Pientong
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | | | - Tipaya Ekalaksananan
- Department of Microbiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- HPV & EBV and Carcinogenesis Research Group, Khon Kaen University, Khon Kaen, Thailand
| | - Michael J. Bangs
- Public Health & Malaria Control, PT Freeport Indonesia/International SOS, Mimika, Papua, Indonesia
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Vincent Corbel
- University of Montpellier, Montpellier, France
- Institut de Recherche pour le Developpement, Montpellier, France
| | - Neal Alexander
- MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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14
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Bajwala VR, John D, Rajasekar TD, Murhekar MV. Severity and costs associated with hospitalization for dengue in public and private hospitals of Surat city, Gujarat, India, 2017-2018. Trans R Soc Trop Med Hyg 2020; 113:661-669. [PMID: 31294808 DOI: 10.1093/trstmh/trz057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/16/2019] [Accepted: 05/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dengue is major public health problem in India, especially in urban areas. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, Gujarat, India. METHODS We reviewed the medical records of dengue patients hospitalized in five tertiary care facilities (private [n=2], semi-government [n=2] and government [n=1]) between April 2017 and March 2018. We used the World Health Organization 2009 classification to classify the severity of dengue. A resource utilization approach was used to estimate the cost of illness in US dollars (US$) (inflation adjusted to 2018) from a quasi-societal perspective (excluding non-medical cost) for dengue hospitalization. RESULTS Of the 732 hospitalized dengue patients, 44.7% had no warning symptoms, 39.5% had warning signs and 15.8% had severe dengue. The mean cost of hospitalization was US$86.9±170.7. The cost of hospitalization was 28.8 times higher in private hospitals compared with government hospitals. Consultant charges in private hospitals, laboratory investigations in semi-government hospitals and registration with admission charges in government hospitals accounted for 27.3%, 39.4% and 53% of the direct cost in these facilities, respectively. CONCLUSIONS A better triage system for hospitalization, subsidizing costs in the public sector and cost capping in the private sector can help to reduce the cost of hospitalization due to dengue so as to ensure affordability for larger portion of the society for universal health coverage.
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Affiliation(s)
- Viral R Bajwala
- Department of Health and Hospital, Surat Municipal Corporation, Gujarat, India
| | - Denny John
- Campbell Collaboration, New Delhi, India.,ICMR-National Institute of Medical Statistics, New Delhi, India
| | - T Daniel Rajasekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
| | - Manoj V Murhekar
- National Institute of Epidemiology, Indian Council of Medical Research, Chennai, India
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15
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Hung TM, Shepard DS, Bettis AA, Nguyen HA, McBride A, Clapham HE, Turner HC. Productivity costs from a dengue episode in Asia: a systematic literature review. BMC Infect Dis 2020; 20:393. [PMID: 32493234 PMCID: PMC7268537 DOI: 10.1186/s12879-020-05109-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background Dengue is a mosquito-borne viral infection which has been estimated to cause a global economic burden of US$8.9 billion per year. 40% of this estimate was due to what are known as productivity costs (the costs associated with productivity loss from both paid and unpaid work that results from illness, treatment or premature death). Although productivity costs account for a significant proportion of the estimated economic burden of dengue, the methods used to calculate them are often very variable within health economic studies. The aim of this review was to systematically examine the current estimates of the productivity costs associated with dengue episodes in Asia and to increase awareness surrounding how productivity costs are estimated. Method We searched PubMed and Web of Knowledge without date and language restrictions using terms related to dengue and cost and economics burden. The titles and abstracts of publications related to Asia were screened to identify relevant studies. The reported productivity losses and costs of non-fatal and fatal dengue episodes were then described and compared. Costs were adjusted for inflation to 2017 prices. Results We reviewed 33 relevant articles, of which 20 studies reported the productivity losses, and 31 studies reported productivity costs. The productivity costs varied between US$6.7–1445.9 and US$3.8–1332 for hospitalized and outpatient non-fatal episodes, respectively. The productivity cost associated with fatal dengue episodes varied between US$12,035-1,453,237. A large degree of this variation was due to the range of different countries being investigated and their corresponding economic status. However, estimates for a given country still showed notable variation. Conclusion We found that the estimated productivity costs associated with dengue episodes in Asia are notable. However, owing to the significant variation in methodology and approaches applied, the reported productivity costs of dengue episodes were often not directly comparable across studies. More consistent and transparent methodology regarding the estimation of productivity costs would help the estimates of the economic burden of dengue be more accurate and comparable across studies.
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Affiliation(s)
- Trinh Manh Hung
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.
| | - Donald S Shepard
- Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, USA
| | - Alison A Bettis
- London Centre for Neglected Tropical Disease Research, London, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Marys Campus, Imperial College London, Norfolk Place, London, UK
| | - Huyen Anh Nguyen
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam
| | - Angela McBride
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer, Brighton, England
| | - Hannah E Clapham
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Hugo C Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, St Mary's Campus, Imperial College London, Norfolk Place, London, UK
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16
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Thompson R, Martin Del Campo J, Constenla D. A review of the economic evidence of Aedes-borne arboviruses and Aedes-borne arboviral disease prevention and control strategies. Expert Rev Vaccines 2020; 19:143-162. [PMID: 32077343 DOI: 10.1080/14760584.2020.1733419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Aedes-borne arboviruses contributes substantially to the disease and cost burden.Areas covered: We performed a systematic review of the economic evidence surrounding aedes-borne arboviruses and strategies to prevent and control these diseases to inform disease control policy decisions and research directions. We searched four databases covering an 18-year period (2000-2018) to identify arboviral disease-related cost of illness studies, cost studies of vector control and prevention strategies, cost-effectiveness analyses and cost-benefit analyses. We identified 74 published studies that revealed substantial global total costs in yellow fever virus and dengue virus ranging from 2.1 to 57.3 billion USD. Cost studies of vector control and surveillance programs are limited, but a few studies found that costs of vector control programs ranged from 5.62 to 73.5 million USD. Cost-effectiveness evidence was limited across Aedes-borne diseases, but generally found targeted dengue vaccination programs cost-effective. This review revealed insufficient economic evidence for vaccine introduction and implementation of surveillance and vector control programs.Expert opinion: Evidence of the economic burden of aedes-borne arboviruses and the economic impact of strategies for arboviral disease prevention and control is critical to inform policy decisions and to secure continued financial support for these preventive and control measures.
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Affiliation(s)
- Ryan Thompson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), International Vaccine Access Center (IVAC), Baltimore, MD, USA
| | | | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (JHBSPH), International Vaccine Access Center (IVAC), Baltimore, MD, USA
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17
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Tozan Y, Headley TY, Sewe MO, Schwartz E, Shemesh T, Cramer JP, Eberhardt KA, Ramharter M, Harrison N, Leder K, Angheben A, Hatz C, Neumayr A, Chen LH, De Pijper CA, Grobusch MP, Wilder-Smith A. A Prospective Study on the Impact and Out-of-Pocket Costs of Dengue Illness in International Travelers. Am J Trop Med Hyg 2020; 100:1525-1533. [PMID: 30994088 DOI: 10.4269/ajtmh.18-0780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Although the costs of dengue illness to patients and households have been extensively studied in endemic populations, international travelers have not been the focus of costing studies. As globalization and human travel activities intensify, travelers are increasingly at risk for emerging and reemerging infectious diseases, such as dengue. This exploratory study aims to investigate the impact and out-of-pocket costs of dengue illness among travelers. We conducted a prospective study in adult travelers with laboratory-confirmed dengue and recruited patients at travel medicine clinics in eight different countries from December 2013 to December 2015. Using a structured questionnaire, we collected information on patients and their health-care utilization and out-of-pocket expenditures, as well as income and other financial losses they incurred because of dengue illness. A total of 90 patients participated in the study, most of whom traveled for tourism (74%) and visited countries in Asia (82%). Although 22% reported hospitalization and 32% receiving ambulatory care while traveling, these percentages were higher at 39% and 71%, respectively, after returning home. The out-of-pocket direct and indirect costs of dengue illness were US$421 (SD 744) and US$571 (SD 1,913) per episode, respectively, averaging to a total out-of-pocket cost of US$992 (SD 2,052) per episode. The study findings suggest that international travelers incur important direct and indirect costs because of dengue-related illness. This study is the first to date to investigate the impact and out-of-pocket costs of travel-related dengue illness from the patient's perspective and paves the way for future economic burden studies in this population.
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Affiliation(s)
- Yesim Tozan
- New York University College of Global Public Health, New York, New York.,New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Tyler Y Headley
- New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maquines Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tamar Shemesh
- Sheba Medical Center, Institute of Tropical and Travel Medicine, Ramat-Gan, Israel
| | - Jakob P Cramer
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kirsten A Eberhardt
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine and I Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Harrison
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Leder
- School of Public Health and Preventive Medicine, Monash University and Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrea Angheben
- Centre for Tropical Diseases, IRCCS Hospital Sacro Cuore-Don Calabria, Verona, Italy
| | - Christoph Hatz
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Andreas Neumayr
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Lin Hwei Chen
- Mount Auburn Hospital, Cambridge, and Harvard Medical School, Boston, Massachusetts
| | - Cornelis A De Pijper
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Martin P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Heidelberg Global Health Institute, University of Heidelberg, Heidelberg, Germany.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
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18
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Xu Z, Bambrick H, Pongsumpun P, Ming Tang I, Yakob L, Devine G, Frentiu FD, Williams G, Hu W. Does Bangkok have a central role in the dengue dynamics of Thailand? Parasit Vectors 2020; 13:22. [PMID: 31931886 PMCID: PMC6958813 DOI: 10.1186/s13071-020-3892-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/07/2020] [Indexed: 01/28/2023] Open
Abstract
Background Bangkok plays a central role in the commerce of Thailand. This study aimed to characterize the district-level spatial-temporal patterns of dengue in Thailand and explore if a dengue peak in Bangkok led the peaks of dengue in other Thai provinces. Methods Monthly dengue data at district level in Thailand from January 2004 to December 2017 were obtained and used to assess the spatial and seasonal patterns of dengue in Thailand. As our seasonal decomposition and cross-correlation analyses showed that dengue in Bangkok peaked in November, which was a few months after the dengue peak in most other provinces, we used a time-series generalized linear model to explore if there was another province in which the dengue case number was most predictive of dengue case numbers in other Thai provinces. Results The highest district-level annual dengue incidence rates (per 10,000) in the three time periods (i.e. 2004–2008, 2009–2013 and 2014–2017) were 58.08 (Samphanthawong), 85.93 (Mueang Krabi), and 66.60 (Mae Sariang), respectively. Dengue incidence rates in the western part of Northern Thailand, southern part of Central Thailand, southern part of Eastern Thailand, and Southern Thailand were higher than in other regions. Dengue in most districts of Thailand peaked in June, July or August, but dengue peaks in all districts of Bangkok occurred in November. The number of dengue cases in Nakhon Ratchasima was most predictive of the number of dengue cases in other provinces in Thailand by a one-month lag. Conclusions Our results suggest that the dengue peak in Bangkok did not lead the peaks of dengue in other Thai provinces. Future research exploring how changes in socio-ecological factors (e.g. road network and climate factors) in Nakhon Ratchasima have affected the transmission of dengue in Thailand might shed some new light on the prevention and control of dengue.
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Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, 4006, Australia
| | - Hilary Bambrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia
| | - Puntani Pongsumpun
- Department of Mathematics, Faculty of Science, King Mongkut's Institute of Technology Ladkrabang, Bangkok, 10520, Thailand
| | - I Ming Tang
- Computational & Applied Science for Smart Innovation Cluster (CLASSIC), Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | - Gregor Devine
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Francesca D Frentiu
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia.,School of Biomedical Sciences, Queensland University of Technology, Brisbane, 4059, Australia
| | - Gail Williams
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, 4006, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, 4059, Australia. .,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia.
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19
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Xu Z, Bambrick H, Yakob L, Devine G, Lu J, Frentiu FD, Yang W, Williams G, Hu W. Spatiotemporal patterns and climatic drivers of severe dengue in Thailand. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 656:889-901. [PMID: 30625675 DOI: 10.1016/j.scitotenv.2018.11.395] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The burden of dengue fever in Thailand is considerable, yet there are few large-scale studies exploring the drivers of transmission. This study aimed to investigate the spatiotemporal patterns and climatic drivers of severe dengue in Thailand. METHODS Geographic Information System (GIS) techniques and spatial cluster analysis were used to visualize the spatial distribution and detect high-risk clusters of severe dengue in 76 provinces of Thailand from January 1999 to December 2014. The seasonal patterns of severe dengue cases in different provinces were identified. A two-stage modelling approach combining a generalized linear model with a distributed lag non-linear model was used to quantify the effects of monthly mean temperature and relative humidity on the occurrence of severe dengue cases in 51 provinces of Thailand. RESULTS Significant severe dengue clustering was detected, especially during epidemic years, and the location of these clusters showed substantial inter-annual variation. Severe dengue cases in Northern and Northeastern Thailand peaked in June to August and this pattern was stable across the study period, whereas the seasonality of severe dengue cases in other regions (especially Central Thailand) was less predictable. The risk of the occurrence of severe dengue cases increased with an increase in mean temperature in Northeastern Thailand, Central Thailand, and Southern Thailand, with peaks occurring between 24 °C to 30 °C in Northeastern Thailand and 27 °C to 29 °C in Southern Thailand West Coast, respectively. Relative humidity significantly affected the occurrence of severe dengue cases in Northeastern and Central Thailand, with optimal ranges observed for each region. CONCLUSIONS Our findings substantiate the potential for developing climate-based dengue early warning systems for Thailand, and have implications for informing pre-emptive vector control.
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Affiliation(s)
- Zhiwei Xu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Hilary Bambrick
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Gregor Devine
- Mosquito Control Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jiahai Lu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Francesca D Frentiu
- Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Weizhong Yang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Gail Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Wenbiao Hu
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
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