Space-time clustering characteristics of dengue based on ecological, socio-economic and demographic factors in northern Sri Lanka.

The aim of the present study was to identify geographical areas and time periods of potential clusters of dengue cases based on ecological, socio-economic and demographic factors in northern Sri Lanka from January 2010 to December 2013. Remote sensing (RS) was used to develop an index comprising rainfall, humidity and temperature data. Remote sensing data gathered by the AVNIR-2 instrument onboard the ALOS satellite were used to detect urbanisation, and a digital land cover map was used to extract land cover information. Other data on relevant factors and dengue outbreaks were collected through institutions and extant databases. The analysed RS data and databases were integrated into a geographical information system (GIS) enabling space-time clustering analysis. Our results indicate that increases in the number of combinations of ecological, socio-economic and demographic factors that are present or above the average contribute to significantly high rates of space-time dengue clusters. The spatio-temporal association that consolidates the two kinds of associations into one can ensure a more stable model for forecasting. An integrated spatiotemporal prediction model at a smaller level using ecological, socioeconomic and demographic factors could lead to substantial improvements in dengue control and prevention by allocating the right resources to the appropriate places at the right time.

Antenatal care utilization in a conflict-affected district of Northern Sri Lanka.

OBJECTIVES: To assess utilization of antenatal care (ANC) and its determinants in a conflict-affected area in Northern Sri Lanka. DESIGN AND SAMPLE: A cross-sectional study was conducted among pregnant mothers who had completed 36 weeks of gestation, and were admitted or referred to 2 leading hospitals in Vavuniya district. MEASURES: Data were collected from 392 mothers using an interviewer-administered questionnaire. RESULTS: 55% of the respondents reported that their families were affected directly by conflict. Approximately 68% of mothers were registered by public health midwife (PHM) for ANC; 31.4% were registered before 12 weeks of gestation; 38.5% were visited at home by PHM; 37.8% had the first clinic visit before 12 weeks; and 90.1% made at least 4 clinic visits. The average number of antenatal visits to specialist clinics (5.34, 95%CI: 5.03-5.65) was significantly higher than field clinics (2.97, 95%CI: 2.69-3.25). On average, a pregnant woman was seen by PHM at home 1.47 times. ANC utilization was significantly poor in women whose families were affected by conflict, living in active conflict areas and urban regions, had a lower education level, and were not involved in decision making on ANC. CONCLUSION: Provision of field antenatal clinics, early entry to ANC, and domiciliary care by PHM need improvement.