Richards, Heather and Limmer, Mark (2018) Is the application of a vulnerability framework effective in determining patterns of the incidence of dengue disease on the island of Dominica? : the Water Associated Disease Index (WADI) model. PhD thesis, Lancaster University.
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Abstract
The goal of the proposed thesis is to identify vulnerable areas of increased risk of transmission to dengue virus as a re-emerging public health threat. Vulnerability will be based on social, ecological, and environmental factors in the Commonwealth of Dominica, a small island nation in the Caribbean. Using a combination of susceptibility (social) and exposure (ecological / environmental) components, this thesis will aim to provide an evidence base for reducing disease burden from infectious disease outbreaks, by improving the understanding of the susceptibility and exposure drivers of vulnerability and making recommendations for mitigation measures that will minimize the impact of these disease outbreaks. Methodology The construction of an index model was conducted based on an eco-health model, the Water Associated Disease Index (WADI), using publicly available data sets. Secondary data analysis was carried out to examine the relationship between vulnerability to an increased risk of disease transmission and the incidence of dengue disease cases in Dominica using negative binomial regression. Using the same statistical analysis, an alternative non-index model was used for comparison. Using Geographic Information System (GIS), a visual representation of an increased risk of vulnerability to dengue virus transmission in the form of a map was constructed. Findings The index model and the non-index model exhibited a moderate fit highlighting that the components of the eco-health model can indicate vulnerable areas to an increased risk of dengue disease transmission in a small island setting. Discussion An integrative approach to assessing vulnerability, like the WADI model, is an effective tool in determining areas that are more exposed to infectious diseases through an examination of the combined social, environmental, and ecological determinants of health. Conclusion Dengue virus is a re-emerging threat to public health. As it affects the most impoverished regions of endemic areas disproportionately, low-cost effective tools are needed to neutralize this growing threat. Further research into integrative models that incorporate the vulnerability drivers within the social, ecological and environmental determinants of health is still required to review their linkages and develop effective assessment tools.