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Liyanage, Prasad
Publications (3 of 3) Show all publications
Liyanage, P., Rocklöv, J., Tissera, H., Palihawadana, P., Wilder-Smith, A. & Tozan, Y. (2019). Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis. The Lancet Planetary Health, 3(5), e211-e218
Open this publication in new window or tab >>Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis
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2019 (English)In: The Lancet Planetary Health, ISSN 2542-5196, Vol. 3, no 5, p. e211-e218Article in journal (Refereed) Published
Abstract [en]

Background: Dengue has become a major public health problem in Sri Lanka with a considerable economic burden. As a response, in June, 2014, the Ministry of Health initiated a proactive vector control programme in partnership with military and police forces, known as the Civil-Military Cooperation (CIMIC) programme, that was targeted at high-risk Medical Officer of Health (MOH) divisions in the country. Evaluating the effectiveness and cost-effectiveness of population-level interventions is essential to guide public health planning and resource allocation decisions, particularly in resource-limited health-care settings.

Methods: Using an interrupted time series design with a non-linear extension, we evaluated the impact of vector control interventions from June 22, 2014, to Dec 29, 2016, in Panadura, a high-risk MOH division in Western Province, Sri Lanka. We used dengue notification and larval survey data to estimate the reduction in Breteau index and dengue incidence before and after the intervention using two separate models, adjusting for time-varying confounding variables (ie, rainfall, temperature, and the Oceanic Niño Index). We also assessed the cost and cost-effectiveness of the CIMIC programme from the perspective of the National Dengue Control Unit under the scenarios of different levels of hospitalisation of dengue cases (low [25%], medium [50%], and high [75%]) in terms of cost per disability-adjusted life-year averted (DALY).

Findings: Vector control interventions had a significant impact on combined Breteau index (relative risk reduction 0·43, 95% CI 0·26 to 0·70) and on dengue incidence (0·43, 0·28 to 0·67), the latter becoming prominent 2 months after the intervention onset. The mean number of averted dengue cases was estimated at 2192 (95% CI 1741 to 2643), and the total cost of the CIMIC programme at 2016 US$271 615. Personnel costs accounted for about 89% of the total cost. In the base-case scenario of moderate level of hospitalisation, the CIMIC programme was cost-saving with a probability of 70% under both the lowest ($453) and highest ($1686) cost-effectiveness thresholds, resulting in a net saving of $20 247 (95% CI −57 266 to 97 790) and averting 176 DALYs (133 to 226), leading to a cost of −$98 (−497 to 395) per DALY averted. This was also the case for the scenario with high hospitalisation levels (cost per DALY averted −$512, 95% CI −872 to −115) but with a higher probability of 99%. In the scenario with low hospitalisation levels (cost per DALY averted $690, 143 to 1379), although the CIMIC programme was cost-ineffective at the lowest threshold with a probability of 77%, it was cost-effective at the highest threshold with a probability of 99%.

Interpretation: This study suggests that communities affected by dengue can benefit from investments in vector control if interventions are implemented rigorously and coordinated well across sectors. By doing so, it is possible to reduce the disease and economic burden of dengue in endemic settings.

Funding: None.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-163272 (URN)10.1016/S2542-5196(19)30057-9 (DOI)31128766 (PubMedID)2-s2.0-85065896383 (Scopus ID)
Available from: 2019-09-12 Created: 2019-09-12 Last updated: 2019-09-16Bibliographically approved
Quam, M. B., Liyanage, P., Appannan, M., Ramadona, A. L., Long, T. K., Yahya, A., . . . Hii, Y. L. (2017). Climate services for health: supplementing local and regional dengue early warning systems in the South East Asia with Ocean Nino Index improves outbreak predictions. Paper presented at 66th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), 5-9 November, 2017, Baltimore, MD, USA. American Journal of Tropical Medicine and Hygiene, 97(5), 465-466
Open this publication in new window or tab >>Climate services for health: supplementing local and regional dengue early warning systems in the South East Asia with Ocean Nino Index improves outbreak predictions
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2017 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 97, no 5, p. 465-466Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
American Society of Tropical Medicine and Hygiene, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-144866 (URN)000423215204216 ()
Conference
66th Annual Meeting of the American-Society-of-Tropical-Medicine-and-Hygiene (ASTMH), 5-9 November, 2017, Baltimore, MD, USA
Note

Supplement: S

Meeting Abstract: 1501

Available from: 2018-03-06 Created: 2018-03-06 Last updated: 2018-06-09Bibliographically approved
Liyanage, P., Tissera, H., Sewe, M., Quam, M., Amarasinghe, A., Palihawadana, P., . . . Rocklöv, J. (2016). A Spatial Hierarchical Analysis of the Temporal Influences of the El Niño-Southern Oscillation and Weather on Dengue in Kalutara District, Sri Lanka. International Journal of Environmental Research and Public Health, 13(11), Article ID 1087.
Open this publication in new window or tab >>A Spatial Hierarchical Analysis of the Temporal Influences of the El Niño-Southern Oscillation and Weather on Dengue in Kalutara District, Sri Lanka
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2016 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 13, no 11, article id 1087Article in journal (Refereed) Published
Abstract [en]

Dengue is the major public health burden in Sri Lanka. Kalutara is one of the highly affected districts. Understanding the drivers of dengue is vital in controlling and preventing the disease spread. This study focuses on quantifying the influence of weather variability on dengue incidence over 10 Medical Officer of Health (MOH) divisions of Kalutara district. Weekly weather variables and data on dengue notifications, measured at 10 MOH divisions in Kalutara from 2009 to 2013, were retrieved and analysed. Distributed lag non-linear model and hierarchical-analysis was used to estimate division specific and overall relationships between weather and dengue. We incorporated lag times up to 12 weeks and evaluated models based on the Akaike Information Criterion. Consistent exposure-response patterns between different geographical locations were observed for rainfall, showing increasing relative risk of dengue with increasing rainfall from 50 mm per week. The strongest association with dengue risk centred around 6 to 10 weeks following rainfalls of more than 300 mm per week. With increasing temperature, the overall relative risk of dengue increased steadily starting from a lag of 4 weeks. We found similarly a strong link between the Oceanic Niño Index to weather patterns in the district in Sri Lanka and to dengue at a longer latency time confirming these relationships. Part of the influences of rainfall and temperature can be seen as mediator in the causal pathway of the Ocean Niño Index, which may allow a longer lead time for early warning signals. Our findings describe a strong association between weather, El Niño-Southern Oscillation and dengue in Sri Lanka.

Place, publisher, year, edition, pages
MDPI AG, 2016
Keywords
dengue, vector control, Oceanic Niño Index, rainfall, temperature, weather, climate
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-127286 (URN)10.3390/ijerph13111087 (DOI)000389571300046 ()
Projects
DengueTools ResearchLinks
Funder
EU, FP7, Seventh Framework Programme
Available from: 2016-11-04 Created: 2016-11-04 Last updated: 2018-06-09Bibliographically approved
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