Abstract
Dengue is a continuous health burden in Laos and Thailand. We assessed and mapped dengue vulnerability in selected provinces of Laos and Thailand using multi-criteria decision approaches. An ecohealth framework was used to develop dengue vulnerability indices (DVIs) that explain links between population, social and physical environments, and health to identify exposure, susceptibility, and adaptive capacity indicators. Three DVIs were constructed using two objective approaches, Shannon’s Entropy (SE) and the Water-Associated Disease Index (WADI), and one subjective approach, the Best-Worst Method (BWM). Each DVI was validated by correlating the index score with dengue incidence for each spatial unit (district and subdistrict) over time. A Pearson’s correlation coefficient (r) larger than 0.5 and a p-value less than 0.05 implied a good spatial and temporal performance. Spatially, DVIWADI was significantly correlated on average in 19% (4–40%) of districts in Laos (mean r = 0.5) and 27% (15–53%) of subdistricts in Thailand (mean r = 0.85). The DVISE was validated in 22% (12–40%) of districts in Laos and in 13% (3–38%) of subdistricts in Thailand. The DVIBWM was only developed for Laos because of lack of data in Thailand and was significantly associated with dengue incidence on average in 14% (0–28%) of Lao districts. The DVIWADI indicated high vulnerability in urban centers and in areas with plantations and forests. In 2019, high DVIWADI values were observed in sparsely populated areas due to elevated exposure, possibly from changes in climate and land cover, including urbanization, plantations, and dam construction. Of the three indices, DVIWADI was the most suitable vulnerability index for the study area. The DVIWADI can also be applied to other water-associated diseases, such as Zika and chikungunya, to highlight priority areas for further investigation and as a tool for prevention and interventions.
Highlights
Dengue fever is a rapidly spreading arboviral disease globally and is of public health concern in many tropical and subtropical countries, and in some temperate countries
There were 25 administrative units in the Lao provinces (10 districts in Champasak and 15 in Savannakhet) and 272 in Thailand (53 subdistricts in Mukdahan and 219 in Ubon Ratchathani). These four provinces are quite similar in terms of culture, language, and history; they differ in socioeconomic and political conditions and are expected to vary in climate vulnerability, adaptive capacity, geographical and ecological diversity, and socioeconomic status
There were 48,852 cases of dengue recorded during the study period with an annual average of 2874 cases and an annual incidence of 12.7 cases per 100,000 persons in selected provinces of Laos
Summary
Dengue fever is a rapidly spreading arboviral disease globally and is of public health concern in many tropical and subtropical countries, and in some temperate countries. The disease is caused by the dengue virus (DENV), which belongs to the genus Flavivirus transmitted to humans principally by Aedes aegypti and Aedes albopictus mosquitoes through blood feeding. The risk of exposure to vector-borne disease is spatiotemporally heterogeneous due to the variability of climate, mosquito densities, and the physical environment [3,4]. Dengue outbreaks in South East Asian countries are exacerbated by climate change and modification in landcover because of urbanization, deforestation, and agricultural intensification [5,6]. The dengue burden has been disproportionately affecting socioeconomically disadvantaged populations, who often have less capacity to invest in resilience-building and adaptation activities [7,8,9]
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