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Early warning and response system (EWARS) for dengue outbreaks: Recent advancements towards widespread applications in critical settings

Artikel i vetenskaplig tidskrift
Författare Laith Hussain-Alkhateeb
Axel Kroeger
Piero Olliaro
Joacim Rocklöv
Maquins Odhiambo Sewe
Gustavo Tejeda
David Benitez
Balvinder Gill
S. Lokman Hakim
Roberta Gomes Carvalho
Leigh Bowman
Max Petzold
Publicerad i PLoS ONE
Volym 13
Nummer/häfte 5
Publiceringsår 2018
Publicerad vid Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa
Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för arbets-och miljömedicin
Språk en
Länkar doi.org/10.1371/journal.pone.019681...
Ämneskategorier Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Samhällsmedicin, Epidemiologi

Sammanfattning

© 2018 Hussain-Alkhateeb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Dengue outbreaks are increasing in frequency over space and time, affecting people’s health and burdening resource-constrained health systems. The ability to detect early emerging outbreaks is key to mounting an effective response. The early warning and response system (EWARS) is a toolkit that provides countries with early-warning systems for efficient and cost-effective local responses. EWARS uses outbreak and alarm indicators to derive prediction models that can be used prospectively to predict a forthcoming dengue outbreak at district level. Methods We report on the development of the EWARS tool, based on users’ recommendations into a convenient, user-friendly and reliable software aided by a user’s workbook and its field testing in 30 health districts in Brazil, Malaysia and Mexico. Findings 34 Health officers from the 30 study districts who had used the original EWARS for 7 to 10 months responded to a questionnaire with mainly open-ended questions. Qualitative content analysis showed that participants were generally satisfied with the tool but preferred open-access vs. commercial software. EWARS users also stated that the geographical unit should be the district, while access to meteorological information should be improved. These recommendations were incorporated into the second-generation EWARS-R, using the free R software, combined with recent surveillance data and resulted in higher sensitivities and positive predictive values of alarm signals compared to the first-generation EWARS. Currently the use of satellite data for meteorological information is being tested and a dashboard is being developed to increase user-friendliness of the tool. The inclusion of other Aedes borne viral diseases is under discussion. Conclusion EWARS is a pragmatic and useful tool for detecting imminent dengue outbreaks to trigger early response activities.

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