Abstract
BackgroundWhile floods can potentially increase the transmission of dengue, only few studies have reported the association of dengue epidemics with flooding. We estimated the effects of river levels and rainfall on the hospital admissions for dengue fever at 11 major hospitals in Dhaka, Bangladesh.MethodsWe examined time-series of the number of hospital admissions of dengue fever in relation to river levels from 2005 to 2009 using generalized linear Poisson regression models adjusting for seasonal, between-year variation, public holidays and temperature.ResultsThere was strong evidence for an increase in dengue fever at high river levels. Hospitalisations increased by 6.9% (95% CI: 3.2, 10.7) for each 0.1 metre increase above a threshold (3.9 metres) for the average river level over lags of 0–5 weeks. Conversely, the number of hospitalisations increased by 29.6% (95% CI: 19.8, 40.2) for a 0.1 metre decrease below the same threshold of the average river level over lags of 0–19 weeks.ConclusionsOur findings provide evidence that factors associated with both high and low river levels increase the hospitalisations of dengue fever cases in Dhaka.
Highlights
While floods can potentially increase the transmission of dengue, only few studies have reported the association of dengue epidemics with flooding
An increase in dengue fever was seen with high river levels at lag 0–5 weeks, and an increase in the number of cases with low river levels
In the distributed lag model, a “high river level” effect was observed at shorter lags with the highest estimate at a lag of six weeks followed by lower estimates in later lags (Figure 4A)
Summary
While floods can potentially increase the transmission of dengue, only few studies have reported the association of dengue epidemics with flooding. We estimated the effects of river levels and rainfall on the hospital admissions for dengue fever at 11 major hospitals in Dhaka, Bangladesh. Dengue fever is a mosquito-borne infection that causes potentially fatal complications like dengue haemorrhagic fever (DHF) and dengue shock syndrome. About 2.5 billion people living in tropical and subtropical urban and semi-urban areas are at risk, and over 50 million cases of dengue are estimated to occur annually [1]. In Bangladesh, sporadic cases of dengue fever were documented between 1964 and 1999. The first outbreak of DHF occurred in Dhaka in 2000 [3] and since cases have been reported every year with clear
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