BackgroundDespite intensive vector control efforts, dengue epidemics continue to occur throughout Southeast Asia in multi-annual cycles. Weather is considered an important factor in these cycles, but the extent to which the El Niño-Southern Oscillation (ENSO) is a driving force behind dengue epidemics remains unclear.MethodsWe examined the temporal relationship between El Niño and the occurrence of dengue epidemics, and constructed Poisson autoregressive models for incidences of dengue cases. Global ENSO records, dengue surveillance data, and local meteorological data in two geographically diverse regions in Thailand (the tropical southern coastal region and the northern inland mountainous region) were analyzed.ResultsThe strength of El Niño was consistently a predictor for the occurrence of dengue epidemics throughout time lags from 1 to 11 months in the two selected regions of Thailand. Up to 22% (in 8 northern inland mountainous provinces) and 15% (in 5 southern tropical coastal provinces) of the variation in the monthly incidence of dengue cases were attributable to global ENSO cycles. Province-level predictive models were fitted using 1996-2004 data and validated with out-of-fit data from 2005. The multivariate ENSO index was an independent predictor in 10 of the 13 studied provinces.ConclusionEl Niño is one of the important driving forces for dengue epidemics across the geographically diverse regions of Thailand; however, spatial heterogeneity in the effect exists. The effects of El Niño should be taken into account in future epidemic forecasting for public health preparedness.

Background: HIV/AIDS contributes to a disproportionate burden of maternal deaths in Sub-Saharan Africa. In generalized HIV epidemic settings especially where strong programmes are in place to reduce infant transmission of HIV, antenatal clinics (ANC) provide a good opportunity to link mothers who are HIV infected to HIV care and treatment services. This study assessed the care provided to HIV infected pregnant women attending public sector primary health care (PHC) clinics.Methods: As part of an annual anonymous survey undertaken from October to December 2009 at the 7 PHC clinics in the Vulindlela sub-district, all clinic records were reviewed for coverage of HIV counselling and testing (HCT), compliance with the South African government's requirement for CD4 cell counts and ART provision on all newly diagnosed HIV positive mothers.Results: A total of 410 records were reviewed. Of these 384 (93.6%) received information on HCT services in place at the clinic and 374 (97.4%) agreed to have an HIV test. Of the 10 women declining, 6 (1.6%) had known their HIV test result and 4 were on ART. The prevalence of HIV infection was 37.7% (141/374). Only 88/141 (62.4%) of HIV infected mothers had a CD4 cell count result available, 67% of whom had CD4 cell counts <350 cells/mm3 and by current South African guidelines eligible for ART initiation. However, only 4/88 had been initiated on ART.Conclusion: Missing CD4 cell count results and delays in ART initiation in eligible HIV infected pregnant women represent a huge missed opportunity to impact on maternal morbidity and mortality patterns in these settings.

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