Dr Niyaf's Online Clinic

The fact that we eradicated Malaria from the Maldives a few decades ago gives us an indication of what we are capable of achieving should we really put our best foot forward and give a 100% to achieve something. One would expect, and the vector control program workers claim, that with the necessary commitment and community support, we should be able to achieve similar results in the fight against Dengue fever. However, it’s been ages since the struggle with Dengue fever began making headlines in the Maldives and we seem to have achieved little in terms of preventing an almost annual epidemic of the sometimes deadly disease that Dengue is.

Dengue is making headlines yet again. The incidence of Dengue fever seems to be on the rise. The recent media reports quote Department of Public Health sources reporting a clear increase in the number of cases notified from around the country. The epidemiological data is perhaps not alarming at this stage, but allowed to take its natural course the alarm bells could ring very loud indeed.

I was in Haa Alif atoll in December 2007. I visited Muraidhoo, Molhadhoo, Utheemu, Ihavandhoo, Kelaa, Dhihdhoo and also stopped over at Haa Dhaal Hanimaadhoo. The islands are some of the most beautiful I have seen anywhere in Maldives. They would have been perfect too, had it not been for the horrifying number of mosquitoes that hounded us on each and every one of the islands. I have never, ever seen so many mosquitoes in one place as I did in Molhadhoo. Luckily for my family, we had a good stock of mosquito repellents with us.

I believe we have failed most years in the recent past in mounting an effective mosquito control/eradication program to coincide with the seasonal increase in the mosquito population. These sharp rises in mosquito population are often predictable, based on the rainy season. Nonetheless, mosquito control programs, both at the public health level and the community level, have almost always been a response to increased morbidity or at times mortality from the potentially fatal illness. We have never really anticipated and acted to prevent an “epidemic”.

Clinical management of Dengue fever in the Maldives has improved over the years. It would be fair to say that improved clinical management of cases has led to improved treatment outcome over the past few years. As a result, a steady decline in mortality from Dengue fever has been been recorded. However, the disease is such that, concentrating on management of affected cases alone leaves the door open for a small but significant number of cases reaching clinical stages that are often fatal. An effective prevention program needs to be in place. There needs to be special emphasis on mosquito vector control programs in all the inhabited islands.

The cost of Dengue fever on our country must be huge. If studied I am sure we’d find that enormous amount of public funds have been spent on managing cases at health centers and hospitals around the country. Add to that the loss of productivity, school hours, travel costs, cost of living away from home………emotional and psychological cost to the entire family and the numbers could be staggering. And that doesn’t even account for the cost of the lives lost!

We did see, last year, the huge positive impact community action had in preventing a predicted epidemic of Dengue fever projected for September/October 2007. Many of the island communities organised their own, local programs in removing and clearing up mosquito breeding areas within their communities. The fact that all these programs happened simultaneously AND that they were carried out for a sustained period of time had a very notable impact on the mosquito population and consequently on the Dengue disease burden. A projected increase in number of cases was averted because of the commitment and dedication shown by the public in taking the responsibility of looking after their welfare on themselves. The vector control program of DPH was significantly augmented to yield the very kind of results that we need to see year after year.

We need a similar commitment this year too. I hope that the mosquito control program for this year starts soon, is better coordinated and sustained for longer period to break the life cycle of the mosquito to achieve even better results. As with the Malaria eradication program; we need to believe in ourselves again. The task is bigger than it was for Malaria, the goals much more challenging and the cost of inaction too great.

I wrote these in the past:

 
Tuesday, June 26, 2007

Dengue Making a Come back!

Dengue is still here. Sadly, there are indications that things could get as bad as the past few years. Yet again, there is a visible increase in the number of Dengue Fever cases requiring treatment. 

This come as no surprise as the rainy season begins and the mosquito burden increases. Public and public health authorities vigilance in mosquito control has waned since the near crisis situation last year. 

This is very worrying indeed. It feels like we never learn from any past experience….year after year we have had rising incidence of Dengue around this time of the year, yet we fail to stage a mosquito control program to target this period. We have always waited till the incidence and the “damage” from Dengue become a public health emergency. 

If we continue to see the current trend of rising incidence of Dengue Fever, I predict that we will have on our hands another public health crisis. 

I call upon all those involved in management of public health to get off their butts and start working on preventing this imminent crisis. I also urge the general public to exert pressure on the authorities to ensure that this work done. 

The medical community also need to do more in overcoming this potential crisis. All clinician, whether government or privately employed need to improve their case surveillance and reporting. Case management also needs improvement. It is vital for all clinicians to update their knowledge and skills in recent advances in management of DF, DHF, and DSS. This information is available via the WHO web-site. The new management guideline is available online from the SEARO office.

Monday, June 05, 2006

Dengue Fever

Dengue fever remains a major health issue for the country. If we continue to concentrate only on improving management (without a question an important and essential component of any management strategy) with little or no work on prevention, WE are more likely to FAIL!!!! 

All concerned authorities and the general public MUST take steps to control the transmission of the disease by effectively decreasing or getting rid of the mosquito vector responsible for transmission. The only way to do this effectively is to clear up ALL mosquito breeding areas.