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Background: Dengue is the most important arboviral disease worldwide and a major public health problem in tropical areas. The increasing case burden is associated with an expanding geographic range and increasing intensity of transmission in affected areas.Knowledge of spatial and temporal patterns in dengue transmission at a sub-national level is relevant for two main reasons: it can provide insights into the biological and ecological mechanisms that drive transmission, and it may facilitate predictions of the magnitude, timing and location of future dengue epidemics.Methods & Materials: For both of these purposes we have analyzed, with wavelet analysis, phase analysis and Granger causality, the spatial and temporal pattern of propagation of dengue epidemics in different countries in Southeast Asia.Results: The results reveal spatial heterogeneity in the propagation of the annual epidemic. Each year, epidemics are highly synchronous over a large geographic area at regional scale. In most of the cases, travelling waves emanate from a few rural areas and move towards the regional capital where epidemics occurred 1-3 months later than elsewhere. These results clearly refute the main paradigm of urban origin of dengue propagation, urban centres are thought to act as a reservoir of the virus from where it can spread to the rest of the country. Conclusion:These findings constitute a new starting point in the understanding of the processes driving dengue spread and can aid the targeting of vector-control interventions and the planning for dengue vaccine implementation.
Background: Since 1962, the Queen Sirikit National Institute of Child Health (former Bangkok Children Hospital) and AFRIMS have engaged in a long termed collaborative study of clinical epidemiology, virology and serology of dengue. hospitalized dengue cases This is an update of a previous report spanning the period between 1973period between to 1999period between . (Nisalak A, et al, 2003.This update contains data from 1973 to 2010.Methods: Study sites. Queen Sirikit National Institute of Child Health, Ministry of Public Health is located in Bangkok, Thailand with 429beds. There is a hemorrhagic fever unit with 25 beds and ICU unit with 8 beds. This is also a WHO collaborating centre for case management of Dengue, DHF and DSS.Clinical Diagnosis.The attending physicians assigned dengue clinical diagnosis and severity grading at the time of discharge according to the 1997 WHO case definitions.Laboratory methodology.Serology diagnoses were determined using on dengue/JE IgM/IgG capture enzyme immunoassay developed at AFRIMS (Innis BL, Nisalak A., et al, 1989).Determination of infecting viral serotypes was based on viral isolation (prior to 1994) and molecular technique (1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010).Statistical analysis.Stastistical analysis was performed using SPSS for Windows version 12.0(SPSS Inc.)Results: The updated findings are consistent with our previous findings: 1) primary cases are increasing relative to secondary cases, 2) symptomatic primary cases are still most likely to be DENV-1 and DENV-3) primary non-infant hospitalized cases are still less severe than secondary non-infant hospitalized cases. 4) DENV-2 is still most associated with DHF. Higher case fatality rates were found in non-infant cases and cases with a secondary infection. Among non-infant cases, the fatality rates were higher in cases with a secondary infection compared to cases with a primary infection. This is different from our previous analysis which showed similar case fatality rates between primary and secondary non-infant infections. During 2000-2010, DENV-4 were found more frequently compared to previous years and the mean age of DHF cases increased to 8.14 years.Conclusion: These findings highlight unique information of a longitudinal epidemiological study of dengue. Further spatial analysis is planned to elucidate transmission dynamics.
Exact measurement and evaluation of indicators of period fertility in a multiracial society could help explaining disparities. This paper represents a methodological and analytical attempt to systematically analyze period fertility and discuss differentials in its level and pattern between domestic and expatriate women in Saudi Arabia as far as available data allow. The data used are obtained from official Sources published by General Authority for Statistics in the Household Health Survey 2018. Estimated period fertility indicators, started from the simplest rates to the more elegant ones with adequate illustration of the advantages and disadvantages of each of them. The purpose was to establish fertility differentials and historical pattern. The paper has consistently shown that the fertility of expatriates in Saudi Arabia is lower than the fertility of the Saudi domestic women, but the reason for the disparity was not established as contraceptive practice has not confirmed sufficient influence. It was also revealed that the fertility transition that had been taking place since early eighties will continue but it will have precautions in the future.
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