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Sewe, Maquins Odhiambo
Publications (10 of 20) Show all publications
Schlesinger, M., Prieto Alvarado, F. E., Borbón Ramos, M. E., Sewe, M. O., Merle, C. S., Kroeger, A. & Hussain-Alkhateeb, L. (2024). Enabling countries to manage outbreaks: statistical, operational, and contextual analysis of the early warning and response system (EWARS-csd) for dengue outbreaks. Frontiers In Public Health, 12, Article ID 1323618.
Open this publication in new window or tab >>Enabling countries to manage outbreaks: statistical, operational, and contextual analysis of the early warning and response system (EWARS-csd) for dengue outbreaks
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2024 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 12, article id 1323618Article in journal (Refereed) Published
Abstract [en]

Introduction: Dengue is currently the fastest-spreading mosquito-borne viral illness in the world, with over half of the world's population living in areas at risk of dengue. As dengue continues to spread and become more of a health burden, it is essential to have tools that can predict when and where outbreaks might occur to better prepare vector control operations and communities' responses. One such predictive tool, the Early Warning and Response System for climate-sensitive diseases (EWARS-csd), primarily uses climatic data to alert health systems of outbreaks weeks before they occur. EWARS-csd uses the robust Distribution Lag Non-linear Model in combination with the INLA Bayesian regression framework to predict outbreaks, utilizing historical data. This study seeks to validate the tool's performance in two states of Colombia, evaluating how well the tool performed in 11 municipalities of varying dengue endemicity levels.

Methods: The validation study used retrospective data with alarm indicators (mean temperature and rain sum) and an outbreak indicator (weekly hospitalizations) from 11 municipalities spanning two states in Colombia from 2015 to 2020. Calibrations of different variables were performed to find the optimal sensitivity and positive predictive value for each municipality.

Results: The study demonstrated that the tool produced overall reliable early outbreak alarms. The median of the most optimal calibration for each municipality was very high: sensitivity (97%), specificity (94%), positive predictive value (75%), and negative predictive value (99%; 95% CI).

Discussion: The tool worked well across all population sizes and all endemicity levels but had slightly poorer results in the highly endemic municipality at predicting non-outbreak weeks. Migration and/or socioeconomic status are factors that might impact predictive performance and should be further evaluated. Overall EWARS-csd performed very well, providing evidence that it should continue to be implemented in Colombia and other countries for outbreak prediction.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
climate-sensitive diseases, Colombia, dengue, outbreak prediction, outbreak response, vector-borne disease
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-220854 (URN)10.3389/fpubh.2024.1323618 (DOI)001153585100001 ()38314090 (PubMedID)2-s2.0-85183759862 (Scopus ID)
Available from: 2024-02-20 Created: 2024-02-20 Last updated: 2024-02-20Bibliographically approved
Tozan, Y., Sewe, M. O., Kim, S. & Rocklöv, J. (2023). A methodological framework for economic evaluation of operational response to vector-borne diseases based on early warning systems. American Journal of Tropical Medicine and Hygiene, 108(3), 627-633
Open this publication in new window or tab >>A methodological framework for economic evaluation of operational response to vector-borne diseases based on early warning systems
2023 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 108, no 3, p. 627-633Article in journal (Refereed) Published
Abstract [en]

Despite significant advances in improving the predictive models for vector-borne diseases, only a few countries have integrated an early warning system (EWS) with predictive and response capabilities into their disease surveillance systems. The limited understanding of forecast performance and uncertainties by decision-makers is one of the primary factors that precludes its operationalization in preparedness and response planning. Further, predictive models exhibit a decrease in forecast skill with longer lead times, a trade-off between forecast accuracy and timeliness and effectiveness of action. This study presents a methodological framework to evaluate the economic value of EWS-triggered responses from the health system perspective. Assuming an operational EWS in place, the framework makes explicit the trade-offs between forecast accuracy, timeliness of action, effectiveness of response, and costs, and uses the net benefit analysis, which measures the benefits of taking action minus the associated costs. Uncertainty in disease forecasts and other parameters is accounted for through probabilistic sensitivity analysis. The output is the probability distribution of the net benefit estimates at given forecast lead times. A non-negative net benefit and the probability of yielding such are considered a general signal that the EWS-triggered response at a given lead time is economically viable. In summary, the proposed framework translates uncertainties associated with disease forecasts and other parameters into decision uncertainty by quantifying the economic risk associated with operational response to vector-borne disease events of potential importance predicted by an EWS. The goal is to facilitate a more informed and transparent public health decision-making under uncertainty.

Place, publisher, year, edition, pages
American Society of Tropical Medicine and Hygiene, 2023
Keywords
Cost-Benefit Analysis, Humans, Probability, Uncertainty
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-205642 (URN)10.4269/ajtmh.22-0471 (DOI)000976649800031 ()36646075 (PubMedID)2-s2.0-85149173803 (Scopus ID)
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2023-09-05Bibliographically approved
Armando, C. J., Rocklöv, J., Sidat, M., Tozan, Y., Mavume, A. F., Bunker, A. & Sewe, M. O. (2023). Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016–2018: a spatial temporal analysis. Frontiers In Public Health, 11, Article ID 1162535.
Open this publication in new window or tab >>Climate variability, socio-economic conditions and vulnerability to malaria infections in Mozambique 2016–2018: a spatial temporal analysis
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2023 (English)In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1162535Article in journal (Refereed) Published
Abstract [en]

Background: Temperature, precipitation, relative humidity (RH), and Normalized Different Vegetation Index (NDVI), influence malaria transmission dynamics. However, an understanding of interactions between socioeconomic indicators, environmental factors and malaria incidence can help design interventions to alleviate the high burden of malaria infections on vulnerable populations. Our study thus aimed to investigate the socioeconomic and climatological factors influencing spatial and temporal variability of malaria infections in Mozambique.

Methods: We used monthly malaria cases from 2016 to 2018 at the district level. We developed an hierarchical spatial–temporal model in a Bayesian framework. Monthly malaria cases were assumed to follow a negative binomial distribution. We used integrated nested Laplace approximation (INLA) in R for Bayesian inference and distributed lag nonlinear modeling (DLNM) framework to explore exposure-response relationships between climate variables and risk of malaria infection in Mozambique, while adjusting for socioeconomic factors.

Results: A total of 19,948,295 malaria cases were reported between 2016 and 2018 in Mozambique. Malaria risk increased with higher monthly mean temperatures between 20 and 29°C, at mean temperature of 25°C, the risk of malaria was 3.45 times higher (RR 3.45 [95%CI: 2.37–5.03]). Malaria risk was greatest for NDVI above 0.22. The risk of malaria was 1.34 times higher (1.34 [1.01–1.79]) at monthly RH of 55%. Malaria risk reduced by 26.1%, for total monthly precipitation of 480 mm (0.739 [95%CI: 0.61–0.90]) at lag 2 months, while for lower total monthly precipitation of 10 mm, the risk of malaria was 1.87 times higher (1.87 [1.30–2.69]). After adjusting for climate variables, having lower level of education significantly increased malaria risk (1.034 [1.014–1.054]) and having electricity (0.979 [0.967–0.992]) and sharing toilet facilities (0.957 [0.924–0.991]) significantly reduced malaria risk.

Conclusion: Our current study identified lag patterns and association between climate variables and malaria incidence in Mozambique. Extremes in climate variables were associated with an increased risk of malaria transmission, peaks in transmission were varied. Our findings provide insights for designing early warning, prevention, and control strategies to minimize seasonal malaria surges and associated infections in Mozambique a region where Malaria causes substantial burden from illness and deaths.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
Bayesian, climate variability, DHS, DLNM, INLA, malaria vulnerability, Mozambique, spatio-temporal
National Category
Public Health, Global Health, Social Medicine and Epidemiology Occupational Health and Environmental Health
Research subject
climate change; Infectious Diseases
Identifiers
urn:nbn:se:umu:diva-211167 (URN)10.3389/fpubh.2023.1162535 (DOI)001005894100001 ()37325319 (PubMedID)2-s2.0-85162000346 (Scopus ID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2023-07-04 Created: 2023-07-04 Last updated: 2023-07-04Bibliographically approved
Farooq, Z., Sjödin, H., Semenza, J. C., Tozan, Y., Sewe, M. O., Wallin, J. & Rocklöv, J. (2023). European projections of West Nile virus transmission under climate change scenarios. One Health, 16, Article ID 100509.
Open this publication in new window or tab >>European projections of West Nile virus transmission under climate change scenarios
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2023 (English)In: One Health, ISSN 2352-7714, Vol. 16, article id 100509Article in journal (Refereed) Published
Abstract [en]

West Nile virus (WNV), a mosquito-borne zoonosis, has emerged as a disease of public health concern in Europe. Recent outbreaks have been attributed to suitable climatic conditions for its vectors favoring transmission. However, to date, projections of the risk for WNV expansion under climate change scenarios is lacking. Here, we estimate the WNV-outbreaks risk for a set of climate change and socioeconomic scenarios. We delineate the potential risk-areas and estimate the growth in the population at risk (PAR). We used supervised machine learning classifier, XGBoost, to estimate the WNV-outbreak risk using an ensemble climate model and multi-scenario approach. The model was trained by collating climatic, socioeconomic, and reported WNV-infections data (2010−22) and the out-of-sample results (1950–2009, 2023–99) were validated using a novel Confidence-Based Performance Estimation (CBPE) method. Projections of area specific outbreak risk trends, and corresponding population at risk were estimated and compared across scenarios. Our results show up to 5-fold increase in West Nile virus (WNV) risk for 2040-60 in Europe, depending on geographical region and climate scenario, compared to 2000-20. The proportion of disease-reported European land areas could increase from 15% to 23-30%, putting 161 to 244 million people at risk. Across scenarios, Western Europe appears to be facing the largest increase in the outbreak risk of WNV. The increase in the risk is not linear but undergoes periods of sharp changes governed by climatic thresholds associated with ideal conditions for WNV vectors. The increased risk will require a targeted public health response to manage the expansion of WNV with climate change in Europe.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Artificial intelligence, Climate change, Climate impacts, Confidence-based performance estimation (CBPE) method, Europe, West Nile virus, WNV risk projections, XGBoost, Zoonoses
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-205369 (URN)10.1016/j.onehlt.2023.100509 (DOI)001004031000001 ()2-s2.0-85148667157 (Scopus ID)
Funder
Vinnova, 2020-03367Swedish Research Council Formas, 2018-01754European Commission, 101057554
Available from: 2023-03-29 Created: 2023-03-29 Last updated: 2023-09-05Bibliographically approved
Corvetto, J. F., Federspiel, A., Sewe, M. O., Müller, T., Bunker, A. & Sauerborn, R. (2023). Impact of heat on mental health emergency visits: a time series study from all public emergency centres, in Curitiba, Brazil. BMJ Open, 13(12), Article ID e079049.
Open this publication in new window or tab >>Impact of heat on mental health emergency visits: a time series study from all public emergency centres, in Curitiba, Brazil
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 12, article id e079049Article in journal (Refereed) Published
Abstract [en]

Objectives: Quantify the risk of mental health (MH)-related emergency department visits (EDVs) due to heat, in the city of Curitiba, Brazil.

Design: Daily time series analysis, using quasi-Poisson combined with distributed lag non-linear model on EDV for MH disorders, from 2017 to 2021.

Setting: All nine emergency centres from the public health system, in Curitiba.

Participants: 101 452 EDVs for MH disorders and suicide attempts over 5 years, from patients residing inside the territory of Curitiba.

Main outcome measure: Relative risk of EDV (RR EDV) due to extreme mean temperature (24.5°C, 99th percentile) relative to the median (18.02°C), controlling for long-term trends, air pollution and humidity, and measuring effects delayed up to 10 days.

Results: Extreme heat was associated with higher single-lag EDV risk of RR EDV 1.03(95% CI 1.01 to 1.05 - single-lag 2), and cumulatively of RR EDV 1.15 (95% CI 1.05 to 1.26 - lag-cumulative 0-6). Strong risk was observed for patients with suicide attempts (RR EDV 1.85, 95% CI 1.08 to 3.16) and neurotic disorders (RR EDV 1.18, 95% CI 1.06 to 1.31). As to demographic subgroups, females (RR EDV 1.20, 95% CI 1.08 to 1.34) and patients aged 18-64 (RR EDV 1.18, 95% CI 1.07 to 1.30) were significantly endangered. Extreme heat resulted in lower risks of EDV for patients with organic disorders (RR EDV 0.60, 95% CI 0.40 to 0.89), personality disorders (RR EDV 0.48, 95% CI 0.26 to 0.91) and MH in general in the elderly ≥65 (RR EDV 0.77, 95% CI 0.60 to 0.98). We found no significant RR EDV among males and patients aged 0-17.

Conclusion: The risk of MH-related EDV due to heat is elevated for the entire study population, but very differentiated by subgroups. This opens avenue for adaptation policies in healthcare: such as monitoring populations at risk and establishing an early warning systems to prevent exacerbation of MH episodes and to reduce suicide attempts. Further studies are welcome, why the reported risk differences occur and what, if any, role healthcare seeking barriers might play.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Accident & Emergency Medicine, Health Services, Mental Health, Public Health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-219512 (URN)10.1136/bmjopen-2023-079049 (DOI)38135317 (PubMedID)2-s2.0-85181178406 (Scopus ID)
Available from: 2024-01-22 Created: 2024-01-22 Last updated: 2024-01-22Bibliographically approved
Hollowell, T., Sewe, M. O., Rocklöv, J., Obor, D., Odhiambo, F. & Ahlm, C. (2023). Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya. Malaria Journal, 22(1), Article ID 65.
Open this publication in new window or tab >>Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya
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2023 (English)In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 22, no 1, article id 65Article in journal (Refereed) Published
Abstract [en]

Background: Malaria deaths among children have been declining worldwide during the last two decades. Despite preventive, epidemiologic and therapy-development work, mortality rate decline has stagnated in western Kenya resulting in persistently high child malaria morbidity and mortality. The aim of this study was to identify public health determinants influencing the high burden of malaria deaths among children in this region.

Methods: A total of 221,929 children, 111,488 females and 110,441 males, under the age of 5 years were enrolled in the Kenya Medical Research Institute/Center for Disease Control Health and Demographic Surveillance System (KEMRI/CDC HDSS) study area in Siaya County during the period 2003–2013. Cause of death was determined by use of verbal autopsy. Age-specific mortality rates were computed, and cox proportional hazard regression was used to model time to malaria death controlling for the socio-demographic factors. A variety of demographic, social and epidemiologic factors were examined.

Results: In total 8,696 (3.9%) children died during the study period. Malaria was the most prevalent cause of death and constituted 33.2% of all causes of death, followed by acute respiratory infections (26.7%) and HIV/AIDS related deaths (18.6%). There was a marked decrease in overall mortality rate from 2003 to 2013, except for a spike in the rates in 2008. The hazard of death differed between age groups with the youngest having the highest hazard of death HR 6.07 (95% CI 5.10–7.22). Overall, the risk attenuated with age and mortality risks were limited beyond 4 years of age. Longer distance to healthcare HR of 1.44 (95% CI 1.29–1.60), l ow maternal education HR 3.91 (95% CI 1.86–8.22), and low socioeconomic status HR 1.44 (95% CI 1.26–1.64) were all significantly associated with increased hazard of malaria death among children.

Conclusions: While child mortality due to malaria in the study area in Western Kenya, has been decreasing, a final step toward significant risk reduction is yet to be accomplished. This study highlights residual proximal determinants of risk which can further inform preventive actions.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Child mortality, Children, Demographic surveillance, Epidemiological monitoring, Malaria, Public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-205495 (URN)10.1186/s12936-023-04502-9 (DOI)000937711600001 ()36823600 (PubMedID)2-s2.0-85148812992 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 206-1512
Available from: 2023-03-14 Created: 2023-03-14 Last updated: 2023-09-05Bibliographically approved
Romanello, M., Napoli, C. d., Green, C., Kennard, H., Lampard, P., Scamman, D., . . . Costello, A. (2023). The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. The Lancet, 402(10419), 2346-2394
Open this publication in new window or tab >>The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms
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2023 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 402, no 10419, p. 2346-2394Article, review/survey (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-217013 (URN)10.1016/S0140-6736(23)01859-7 (DOI)37977174 (PubMedID)2-s2.0-85176578543 (Scopus ID)
Funder
Wellcome trust, 209734/Z/17/Z
Available from: 2023-11-24 Created: 2023-11-24 Last updated: 2024-01-08Bibliographically approved
Arisco, N. J., Sewe, M. O., Bärnighausen, T., Sié, A., Zabre, P. & Bunker, A. (2023). The effect of extreme temperature and precipitation on cause-specific deaths in rural Burkina Faso: a longitudinal study. The Lancet Planetary Health, 7(6), e478-e489
Open this publication in new window or tab >>The effect of extreme temperature and precipitation on cause-specific deaths in rural Burkina Faso: a longitudinal study
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2023 (English)In: The Lancet Planetary Health, E-ISSN 2542-5196, Vol. 7, no 6, p. e478-e489Article in journal (Refereed) Published
Abstract [en]

Background: Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso.

Methods: In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure–response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area.

Findings: Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08–1·77], 42·8°C 1·57 [1·13–2·18]; malaria all ages: 41·1°C 1·47 [1·05–2·05], 41·9°C 1·78 [1·21–2·61], 42·8°C 2·35 [1·37–4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02–2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02–1·07], 0·1 cm 1·01 [1·006–1·02]; malaria all ages: 0·0 cm 1·04 [1·01–1·08], 0·1 cm 1·02 [1·00–1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01–1·10], 0·1 cm 1·02 [1·00–1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06–4·81], 42·8°C 3·68 [1·46–9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05–1·43], 41·9°C 1·30 [1·08–1·56], 42·8°C 1·35 [1·09–1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31–2·14], 61·6 cm 1·72 [1·27–2·31], 87·7 cm 1·72 [1·16–2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36–2·41], 61·6 cm 1·82 [1·29–2·56], 87·7 cm 1·93 [1·24–3·00]).

Interpretation: Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes—such as extreme weather alerts, passive cooling architecture, and rainwater drainage—should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. 

Place, publisher, year, edition, pages
Elsevier, 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-210216 (URN)10.1016/S2542-5196(23)00027-X (DOI)37286245 (PubMedID)2-s2.0-85161104966 (Scopus ID)
Funder
German Research Foundation (DFG)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27Bibliographically approved
Farooq, Z., Rocklöv, J., Wallin, J., Abiri, N., Sewe, M. O., Sjödin, H. & Semenza, J. C. (2022). Artificial intelligence to predict West Nile virus outbreaks with eco-climatic drivers. The Lancet Regional Health: Europe, 17, Article ID 100370.
Open this publication in new window or tab >>Artificial intelligence to predict West Nile virus outbreaks with eco-climatic drivers
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2022 (English)In: The Lancet Regional Health: Europe, E-ISSN 2666-7762, Vol. 17, article id 100370Article in journal (Refereed) Published
Abstract [en]

Background: In Europe, the frequency, intensity, and geographic range of West Nile virus (WNV)-outbreaks have increased over the past decade, with a 7.2-fold increase in 2018 compared to 2017, and a markedly expanded geographic area compared to 2010. The reasons for this increase and range expansion remain largely unknown due to the complexity of the transmission pathways and underlying disease drivers. In a first, we use advanced artificial intelligence to disentangle the contribution of eco-climatic drivers to WNV-outbreaks across Europe using decade-long (2010-2019) data at high spatial resolution. Methods: We use a high-performance machine learning classifier, XGBoost (eXtreme gradient boosting) combined with state-of-the-art XAI (eXplainable artificial intelligence) methodology to describe the predictive ability and contribution of different drivers of the emergence and transmission of WNV-outbreaks in Europe, respectively. Findings: Our model, trained on 2010-2017 data achieved an AUC (area under the receiver operating characteristic curve) score of 0.97 and 0.93 when tested with 2018 and 2019 data, respectively, showing a high discriminatory power to classify a WNV-endemic area. Overall, positive summer/spring temperatures anomalies, lower water availability index (NDWI), and drier winter conditions were found to be the main determinants of WNV-outbreaks across Europe. The climate trends of the preceding year in combination with eco-climatic predictors of the first half of the year provided a robust predictive ability of the entire transmission season ahead of time. For the extraordinary 2018 outbreak year, relatively higher spring temperatures and the abundance of Culex mosquitoes were the strongest predictors, in addition to past climatic trends. Interpretation: Our AI-based framework can be deployed to trigger rapid and timely alerts for active surveillance and vector control measures in order to intercept an imminent WNV-outbreak in Europe. Funding: The work was partially funded by the Swedish Research Council FORMAS for the project ARBOPREVENT (grant agreement 2018-05973).

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Climate adaptation, Culex vectors, Early warning systems, Emerging infectious disease, Europe, forecasting, Outbreaks management, Preparedness, SHAP, West Nile virus, XGBoost
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-193708 (URN)10.1016/j.lanepe.2022.100370 (DOI)000796373200002 ()35373173 (PubMedID)2-s2.0-85127132481 (Scopus ID)
Funder
Swedish Research Council Formas, 2018-05973
Available from: 2022-04-25 Created: 2022-04-25 Last updated: 2023-09-05Bibliographically approved
Fortuin-de Smidt, M. C., Sewe, M. O., Lassale, C., Weiderpass, E., Andersson, J., Huerta, J. M., . . . Wennberg, P. (2022). Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study. European Journal of Preventive Cardiology, 29(12), 1618-1629
Open this publication in new window or tab >>Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study
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2022 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 29, no 12, p. 1618-1629Article in journal (Refereed) Published
Abstract [en]

AIMS: This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors.

METHODS AND RESULTS: EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal).Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32-64%] and 21% (95%CI 2-44%), with hypercholesterolaemia were 80% (95%CI 55-108%) and 48% (95%CI 22-81%), with hypertension were 80% (95%CI 65-96%) and 49% (95%CI 28-74%), with diabetes were 142% (95%CI 63-260%), and 100% (95%CI 32-204%), and amongst smokers were 152% (95%CI 122-186%) and 109% (95%CI 74-150%).

CONCLUSIONS: In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.

Keywords
Case-cohort study, Coronary heart disease, Physical activity, Population preventable fraction, Risk factors
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-199406 (URN)10.1093/eurjpc/zwac055 (DOI)000784701700001 ()35403197 (PubMedID)2-s2.0-85136552203 (Scopus ID)
Funder
Swedish Cancer SocietySwedish Research CouncilRegion SkåneRegion Västerbotten
Available from: 2022-09-15 Created: 2022-09-15 Last updated: 2024-04-08Bibliographically approved
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