Statistical Analysis on Infectious Diseases in Dubai, UAE

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1 Internatonal Journal of Preventve Medcne Research Vol. 1, No. 4, 015, pp Statstcal Analyss on Infectous Dseases n Duba, UAE Khams F. G. 1, Hussan H. Y., * 1 College of Busness Admnstraton, Al-An Unversty of Scence and Technology, Al An, UAE Prmary Health Care, Duba Health authorty, Duba, UAE Abstract The nfectous dseases tself and ts varaton over tme are a major concern for polcy makers and publc health researchers, especally when t comes to allocatng crtcal resources relevant to the feld of health and economc sectors. Therefore, n ths study, we are among the frst to examne the crude ncdence rate (CIR) of many nfectous dseases n Duba, UAE. The study desgn s a tme seres analyss usng polynomal regresson model. The study seeks to assess the levels of nfectous dseases durng the perod The data were obtaned from preventve servces and communcable dsease Secton n Duba. The exstence and the varance of 1 nfectous dseases were examned over 19 years usng descrptve statstcs and regresson analyss. The CIR was used as a response varable and the tme as explanatory varable. It was found that CIR of all dseases decreased remarkably from n 1995 to n 013. The hghest and lowest means of CIR for all dsease were found and n 1996 and 013 respectvely. The hghest and lowest coeffcents of varaton were found and n 004 and 013 respectvely. Correlaton coeffcent between the CIR for all dseases and the tme was found The coeffcent of determnaton was found moderate to hgh n most estmated regresson equatons. The F-statstc was found moderate to hgh sgnfcant n most estmated regresson equatons. The forecasted values for CIR of all dseases n selected years, 014, 015, and 016 were found 680.4, , and respectvely. It was concluded that the CIR of most nfectous dseases were decreased remarkably n some past perods of tme, but some of them are stll exst and hghly varant over the tme perod covered by ths study. The Change n CIR of all dseases was decreased over the perod whle ncreased over the perod However, the CIR of most dseases was decreased over the perod whle ncreased over the perod The forecasted values for CIR of all dseases showed that they wll ncrease over tme. These fndngs provde nsghts for local control and preventon strateges. Keywords Statstcal Analyss, Duba, Infectous Dseases Receved: May 0, 015 / Accepted: June 3, 015 / Publshed onlne: August, 015 The Authors. Publshed by Amercan Insttute of Scence. Ths Open Access artcle s under the CC BY-NC lcense Introducton Due to hgh mgraton of expatrate workers and transent nflux of toursts from all over the world, nfectous dseases reman an mportant ssue for publc health n UAE. Infectous dseases survellance, montorng, and treatng have become an nternatonal top prorty due to the perceved rsk of boterrorsm. Although the nfectous dseases have been dscussed n the pror lterature; lttle research has been done n UAE durng relatvely a long perod of tme , that combnes descrptve and nferental statstcs. So, descrptve statstcs and polynomal regresson models were appled. The current study s an effort to promote health status and attempts to advance the lterature by usng a case study n Duba. Many studes have dscussed nfectous dseases n terms of ther spatal, temporal, or both, effects. For nstance, Johnson (008) * Correspondng author E-mal address: hussanh569@gmal.com (H. Y. Hussan)

2 Internatonal Journal of Preventve Medcne Research Vol. 1, No. 4, 015, pp stated n hs study n New York State that nfectous dsease survellance n general, can be mproved by complementng spatal cluster detecton of an outcome varable wth predctve rsk mappng that ncorporates spatotemporal data on the envronment, clmate and human populaton through the flexble class of generalzed lnear mxed models. In UAE, Loney et al. (013) studed many noncommuncable and few communcable dseases. They stated that major publc health challenges posed by certan personal (e.g. ethncty, famly hstory), lfestyle, occupatonal, and envronmental factors assocated wth the development of chronc dsease are not solated to the UAE; rather, they form part of a global health problem, whch requres nternatonal collaboraton and acton. As stated by Statstcal Analyss Secton (005), Soco-economc development n UAE accompaned by the characterstcs cultural changes observed n developed socetes elsewhere, mproved santaton and consequent reducton n the occurrence of communcable dseases has led to ncreasng lfe expectancy, changng nutrtonal habts, decreasng habtual physcal actvty and the emergency of non-communcable dseases as the domnant feature of ll health n the communty. Out of the 573 reported cases of nfectous dseases n Duba n 004, 183 (41.4%) were Emrates and 58.6% Expatrates (Statstcal Analyss Secton, 005). To the authors best knowledge no study has nvestgated the problem of nfectous dseases over tme n Duba, UAE. Brefly, the present study found sgnfcant varaton n nfectous dseases over tme. The fndngs of ths study, combned wth those of earler works, can provde useful nformaton for effcent rsk management and health decson-makng and to determne where the lmted resources should be allocated. Ths manuscrpt attempts to advance the lterature by usng a case study n Duba, UAE. In Europe Trends n communcable dseases, and preventable rsk factors, present a mxed pcture of progress and challenges across Europe. Throughout the lfe-course, ndvduals are exposed to varous. Rsks, and face dfferent threats to ther health and well-beng, Almost 3% of all new TB cases that occurred n Europe n the year 000 were also co-nfected wth HIV. Approxmately 8% of people lvng wth AIDS n the WHO European Regon n 004 were also co-nfected wth TB. However, cases of dual nfecton are unevenly dstrbuted through Europe. As an AIDS ndcator dsease among adolescent and adult cases, the TB rate among people lvng wth HIV/AIDS was 4% n Western Europe, 19% n central Europe and 56% n the former Sovet Unon (Veen and Godnho 006). In USA 013, A total of 9,58 TB cases (a rate of 3.0 cases per 100,000 persons) were reported n the. Both the number of TB cases reported and the case rate decreased; ths represents a 3.6% and 4.3% declne, respectvely, compared to 01.* Health-care provders n the Unted States are requred to report certan nfectous dseases to a specfed state or local authorty. A dsease s desgnated as modfable f tmely nformaton about ndvdual cases s consdered necessary for preventon and control of the dsease. Each year, CDC publshes a summary of the cases of notfable dsease reported for the most recent year for whch data s avalable. Ths report presents a summary of notfable dseases for 01.. Materals & Methods.1. Data Duba was selected because of ts mportance as the famous emrate n both nternatonal tradng and toursm regon not only n UAE but also n the Gulf regon; and because of the good qualty and avalable data. Duba has been facng several socoeconomc challenges, one of whch s the large numbers of expatrates from many countres and the economc crss n 010. The data on 1 nfectous dseases were obtaned from preventve servces and communcable dsease Secton n Duba durng the perod These dseases are: Amoebc Dysentery, Bacclary Dysentery, Bact Menngts/TB Menngts, Brucelloss, Chckenpox, Food Posonng, Vral Hepatts (A,B,C), Herpes Zoster, AIDS, HIV, Leprosy, Malara, Measles, Mumps, Pertosss, Pulmonary TB, Rubella, Salmonelloss, Scarlet Fever, Typhod, Vral Encephalts, and Vral Menngts. The crude ncdence rate (CIR) of nfectous dsease was used n the analyss. Hstorcally, n Duba the total of CIR of all nfectous dseases decreased remarkably from n 1995 to n 013. Crude rates are wdely used, n part because they are summary measures and so are easly nterpreted, and n part because ther calculaton requres relatvely lttle nformaton. The CIR can be calculated as follows: CIR = No. of new cases arsng n a defned populaton (100000), Md-year populaton = 1,,...,19 Where, year + year + Md-year populaton = 1, = 1,,...,19.. Analyss Descrptve and nferental statstcs were appled. Such analyss may help generate hypothess and dea on when the populaton s at rsk of nfected by many nfectous dseases.

3 6 Fasal G. Khams and Hamd Y. Hussan: Statstcal Analyss on Infectous Dseases n Duba, UAE So, we dentfed how the progress of these dseases s gong on over tme n Duba, UAE. The research desgn s a tme seres analyss usng polynomal regresson modelng. Fve steps of analyss were conducted. In step one CIR was calculated for all and each dsease. Step two nvolved descrptve statstcs for all and each dsease over the perod and n each year. In step three, polynomal regresson model was nvestgated for all and each dsease. The change n the mean of CIR assocated wth one year ncrease n tme was examned, every 4 years startng by 1997 and endng by 013, n the fourth step. In step fve, forecasted values for CIR of all and each dsease were estmated for next three years. Polynomal regresson was appled due to the relatonshp between nfectous dseases and tme s curvlnear. The PRM s a general lnear regresson model for fttng any relatonshp n the unknown parameters. PRMs are useful when the analyst knows that curvlnear effects are present n the response functon and as approxmatng functons to unknown and possbly very complex nonlnear relatonshps. The bellow quadratc functon s called a polynomal regresson model (PRM) of degree : y x x = ε, = 1,,...,19 Where, y, represents the CIR of a dsease and x represents the tme over 19 years, and ε represents the error term. The correlaton between x and x equals.97, the tme varable, x was centered. After centerng, the correlaton between ( x x) and ( x x) became. 00. The assumptons for PRM are: the behavor of a dependent varable y can be explaned by a lnear, or curvlnear, addtve relatonshp between the dependent varable and a set of k ndependent varables; the relatonshp between the dependent varable y and any ndependent varable s lnear or curvlnear (specfcally polynomal); the ndependent varables are ndependent of each other; and the errors are ndependent, normally dstrbuted wth mean zero and a constant varance. All of us know that these assumptons may, or may not be true. In practce all model assumptons need to be tested, and, n practce, there wll be no perfect model. 3. Results Descrptve statstcs are shown n Tables 1 and. The largest and smallest means of CIR of and.77 were found n Chckenpox and leprosy respectvely durng the perod The largest and smallest standard devatons n CIR of and.58 were found n Chckenpox and vral encephalts respectvely. The largest and smallest varatons n CIR of 04.1 and 6.9 were found n Measles and Pulmonary TB respectvely based on Coeffcent of Varaton (CV). The correlaton coeffcent between the CIR of all dseases and the tme was found.87. The estmated PRM for CIR of all dseases can be shown as follows: yˆ = ( x x) + 8.4( x x), = 1,,...,19 The ntercept, 0 ˆ of represents the CIR at tme, x = 10 whch s the year 004, n the range of the data. The ˆ 1 of represents a dfference n CIR for a one-year dfference n tme only at one pont of tme. As shown n Table, the largest and smallest means of CIR for all dseases of and and the largest and smallest SDs of CIR for all dseases of 4.73 and 5.00 were found n 1996 and 013 respectvely. The largest and smallest varatons of CIR for all dseases of and were found n 004 and 013 respectvely based on CV. year Amoebc Dysentery Bacllary Dysentery Table 1. Shows the CIR and descrptve statstcs for each dsease durng the perod Bact Menngts/TB Menngts Brucelloss Chckenpox Food Posonng vral hepatts (A.B.C) herpes zoster ads hv+ve leprosy

4 Internatonal Journal of Preventve Medcne Research Vol. 1, No. 4, 015, pp year Amoebc Dysentery Bacllary Dysentery Bact Menngts/TB Menngts Brucelloss Chckenpox Food Posonng vral hepatts (A.B.C) herpes zoster ads hv+ve leprosy Mean SD CV( %) Table 1. Contnued. year malara Measles mumps pulmonary rubella salmonelloss Scarlet vral vral typhod TB Fever encephalts menngts Mean SD CV(%) Table. Shows the CIR of all dseases and descrptve statstcs for the CIR of all 1 dseases n each year. year CIR of all dseases Mean SD CV(%)

5 64 Fasal G. Khams and Hamd Y. Hussan: Statstcal Analyss on Infectous Dseases n Duba, UAE Table 3. Shows the estmated parameters for the CIR of all dseases and each dsease and ther t rato wth ts p-value between two parentheses, R, adjusted R, and the F statstc wth ts p-value between two parentheses. Estmated equatons of CIR ˆ0 ˆ1 ˆ11 t rato (p-value) ˆ0 ˆ1 ˆ11 R Adjusted R F (p-value) All dseases (<.001) (<.001) 4.35 (<.001) (<.001) Amoebc Dysentery (.004) 9.77 (<.001) 5.65 (<.001) (<.001) Bacllary Dysentery (.043) (<.001) 6.67 (<.001) (<.001) Bacteral Menngts/TB (<.001) (<.001) 4.65 (<.001) (<.001) Menngts Brucelloss (.01) (<.001) 3.5 (.003) (<.001) Chckenpox (<.001) (<.001) 3.53 (.003) (<.001) Food Posonng (.009).71 (.015).30 (.035) (.009) vral hepatts (A.B.C) (<.001) -.40 (.697) 3.7 (.005) (.016) herpes zoster (<.001) 7.59 (<.001) 3.47 (.003) (<.001) Ads (.00) 1.57 (.135).8 (.037) (.043) HIV +Ve (<.001) -.09 (.933) (.007) (.05) Leprosy (.034) (.007) 3.73 (.00) (.001) Malara (.080) (<.001) 7.9 (<.001) (<.001) Measles (.7) (<.001) 5.18 (<.001) (<.001) Mumps (.588) -.81 (.013) 1.56 (.138) (.019) pulmonary TB (<.001) 3.40 (.004).10 (.05) (.004) Rubella (.413) -.81 (.013).63 (.018) (.005) Salmonelloss (.050) (<.001) 4.17 (.001) (<.001) Scarlet Fever (<.001).5 (.809) 1.33 (.03) (.4) Typhod (.045) (<.001) 4.4 (<.001) (<.001) Vral Encephalts.5 < (.008) -.13 (.900).75 (.014) (.045) Vral Menngts (.001) (<.001) 3.16 (.006) (<.001) Table 4. Shows the change n the mean of CIR assocated wth one year ncrease n tme every 4 years startng by 1997 and endng by 013. Change n CIR of Change n tme All dseases Amoebc Dysentery Bacllary Dysentery Bact Menngts/TB Menngts Brucelloss Chckenpox Food Posonng vral hepatts (A.B.C) herpes zoster Ads HIV +Ve Leprosy Malara Measles Mumps pulmonary TB Rubella Salmonelloss Scarlet Fever Typhod vral encephalts vral menngts

6 Internatonal Journal of Preventve Medcne Research Vol. 1, No. 4, 015, pp Table 5. Shows forecasted values for CIR of all and each dsease n selected years: 014, 015, and 016. Forecasted values for CIR of All dseases Amoebc Dysentery Bacllary Dysentery Bact Menngts/TB Menngts Brucelloss Chckenpox Food Posonng vral hepatts (A.B.C) Fgure 1. Shows area chart for the CIR for all 1 communcable dseases and for each dsease durng the perod The estmated regresson parameters for all dsease and each dsease are shown n Table 3. Most of these parameters were found sgnfcant at p.05. The adjusted R of most estmated regresson models was found moderate to hgh whch means most models are accepted for forecastng purposes. The F-statstc for all estmated models of dseases except Scarlet Fever was found sgnfcant wth p.05. The change n the mean of CIR assocated wth one year ncrease n tme can be summarzed every 4 years startng by 1997 and endng by 013 n Table 4. As shown n Table 4 the change n the mean of CIR of most dseases was n general decreased between 1995 and 003 wth dfferent rates but was n general ncreased between 007 and 013 wth also dfferent rates. Of course we can fnd forecasted values for CIR n multple next years but we found them for just three selected years, 014, 015, and 016 as shown n Table 5. Forecasted values show that there wll be an ncrease n all and each dsease wth dfferent rates over tme. Fgure 1 shows area chart for the CIR for all dseases and for each dsease durng the perod Dscusson Ths study was lmted n terms of the use of PRM. Dozens of regresson models exst and t s possble that other models may be more successful to change n dseases over tme. However, a man objectve of ths study was to apply well known model that s avalable n an open source envronment. The authors were much careful n nterpretaton the results found n the current study. There are several confoundng varables that are not accounted for n the analyss, because the necessary data were not avalable; therefore t s potentally dangerous to draw strong conclusons from the results found n the present study. Yet the fgures concluded by ths study can provde consderable evdences about the trends of communcable dsease n Duba and assocated rsk factors based on whch polcy and decson makers can

7 66 Fasal G. Khams and Hamd Y. Hussan: Statstcal Analyss on Infectous Dseases n Duba, UAE moblze the resources and provde better targetng strateges. The queston to ask here s why the analyss was perodcally appled 4 tmes? Mathematcally, the avalable data set for the perod , ncludng 19 years, s approxmately dvded by 5; the result equals approxmately 4 tmes, where these tmes are dstanced equally n 4 years. Hence, the analyss and comparson mght be correct. Also, t s logcally and n common sense to assume the CIR cannot be seen or happened every few years, where t can be seen over a couple of years. Nevertheless the data obtaned s worthy clncal wse and polcy developng wse, t gves baselne where to focus and how to more concernng communcable dseases profle changng overtme and the clncal mplcatons of these changes. Communcable dseases sgnfcantly contrbute to morbdty, mortalty, and economc losses n Duba. In vew of the populaton demographcs of Duba, future populaton-based publc health ntatves should consder the sococultural, relgous, ethnc, and educatonal dversty n the desgn, development, and mplementaton of campagns, nterventons, and strateges. As current study talked all soco-demographc factors assocated wth communcable dseases events n Duba throughout last 0 years, t prepare the floor for developng proper nterventon n terms of preventon and control of the dseases and modfyng the trend. Regardng prevous studes and reports, we are agree wth the fndng n the report conducted n Duba stated that the lnear trend for mnmum attack rate of nfectous dseases n was a steadly sgnfcantly decreased n the mnmum attack rate to reach 5.1 per thousand n 004 (Statstcal Analyss Secton, 005). Ths fndng reflectng the mprovement n Duba health care system capacty to encounter communcable dseases among Duba populaton along the last decades and better understandng and addressng the gaps n preventve health programs. (Bader, 011. MOH, 011. GCC,013) 5. Conclusons & Recommendatons The conclusons can be summarzed n at least fve aspects: Frst, the CIR of most nfectous dseases were decreased remarkably n some past perods of tme, but some of them are stll exst and hghly varant over the tme perod covered by ths study. Second, the Change n CIR of all dseases was decreased over the perod whle ncreased over the perod However, the CIR of most dseases was decreased over the perod whle ncreased over the perod Thrd, the forecasted values for CIR of all dseases showed that they wll ncrease over tme and for each dsease wll ncrease over tme wth dfferent rates. Fourth, the hghest change of decrease and ncrease n CIR were found n Chckenpox and Mumps over tme; whle the lowest change of decrease and ncrease n CIR were found n Vral Encephalts and Herpes Zoster over tme. Ffth, the largest and smallest varatons n CIR were found n Measles and Pulmonary TB respectvely. These fndngs provde nsghts for local control and preventon strateges. Although the present paper could not study all nfectous dseases and ts relatonshp to the socoeconomc and demographc ndcators, t was possble to hghlght mportant ssues rased n socal and publc health analyses. One of the man recommendatons s to focus on creatng socal and awareness programs and servces for the nfected people for the purpose of mprovng ther lvng condtons and ther famles and consequently ther communtes. Adoptng government and prvate tranng strateges correspondng to the needs of health care centers can create health awareness and mprovement. Fnally, encouragng full uptake of mmunzaton s another specfc health protecton that wll further enhance the health status of the Duba populaton. Further studes ncludng the necessary need n studyng the explanatory varables such as gender, age, race, socoeconomc, etc. that probably cause these dseases are requred. Polces to mprove health status need to montor every tme. It s very mportant to study these dseases n other emrates of UAE and make comparson between them. References [1] Bandar, Shar. (011). Ads among workers n Gulf Regon. Al Haya Dgtal News Paper. Retreved from ttp://webcache.googleusercontent.com/search?q=cache: moble.alhayat.com/content/ /saud [] Johnson, G. D. (008) Prospectve spatal predcton of nfectous dsease: experence of New York State (USA) wth West Nle Vrus and proposed drectons for mproved survellance. Envronmental Ecologcal Statstcs, 15: Do /s [3] Loney, T., Aw, T.C., Handysdes, D. G., et al. (013) An analyss of the health status of the Unted Arab Emrates: the Bg 4 publc health ssues. Glob Health Acton, 6: [4] Mnstry of Health U.A.E. (011) news release retreved from - See more at: [5] Statstcal Analyss Secton (005) Statstcal News. Department of Medcal and Health servces, ssue 4. Polcy/Documents/Lstng- Feb%06%0007%0%0551AM-13.pdf.

8 Internatonal Journal of Preventve Medcne Research Vol. 1, No. 4, 015, pp [6] Veen J, Godnho J (006). HIV and TB: A crtcal co-nfecton. In: Matc S, Lazarus JV, Donoghoe MC (eds). HIV/AIDS n Europe. Movng from death sentence to chronc dsease management. Copenhagen, WHO Regonal Offce for Europe: [7] ds.htm [8] September 19, 014 / Vol. 61 / No. 53,Summary of Notfable Dseases Unted States, 01 [9] [10] The Executve Board of Health Mnsters Councl for GCC states. 013(n.d.). Expatrate workers Check-Up-Project. Retreved from [11] Mnstry of Health U.A.E. (011) news release retreved from - See more at:

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