Dengue is linked to Poverty More than a Mosquito

Written by Dr Harold Gunatillake FRCS, MBBS (Cey), AM (Sing), FACS, FIACS.
Health writer to Newspapers, Ex-patriate Tabloids, Websites and Health Magazines

Year after year our Health experts talk about eradication of Dengue, and many conferences and seminars are held withor without politicians, audiences including health personnel, listening most enthusiastically to the deliberations, to grasp and understand the methods of controlling this deadly mosquito causing problem and channel video cameras invariably capturing the highlights of the occasions. They talk of the statistics, mortalities and morbidities from this deadly viralhemorrhagicdisease, plan actions to implement and go home well satisfied with solutions.

Dengue is not simply about clearing stagnant water around our homes and work places, old dilapidated buildings, coconut shells and plastic bottles, nor is it simply about getting rid of mosquitoes”

Dengue fever has been endemic in Sri Lanka from the beginning of the century and it was confirmed on blood specimens in 1965. There had been an island-wide epidemic from 1965 to 1968. During that period only two cases were detected, and subsequently scattered cases have been detected until there was the largest outbreak occurring in 1990.

Today, it is widespread and most hospital beds are occupied with victims of the disease sporadically, with low platelet counts requiring blood transfusions and lifesaving support. The health authorities were desperate and got down even expert team of specialist doctors from Thailand led by Bangkok WHO Collaboration Centre Director Prof Siripan Kalyanrooj now in Sri Lanka to provide specialized training on dengue patient management to our specialist doctors attached to all main state hospitals, spending much of our money.

Dengue fever is not specific to Sri Lanka alone. Our neighboring countries like Pakistan, the crisis is worse and over 2000 dengue cases have been officially accepted with deaths via Viral Hemorrhagic Fever approaching well over 50, in 2006 tsunami hit Pakistan. The situation in neighboring India was equally apathetic, with over 5000 dengue cases admitted. The disease is prevalent also in Maldives, Vietnam, Brazil, and a few other Western countries.

The control programs declared by the Epidemiological Unit of the Department of health Services, in Sri Lanka have been
(1) Surveillance: (a) Disease surveillance; (b) Vector surveillance; and (c) Laboratory active surveillance;
(2) Vector control;
(3) Social mobilization;
(4) Clinical management;
(5) Emergency responses, and so on.

On paper the control strategies sound well, but are we taking genuine steps to control the spread and eradication of the disease? Are we looking into the root causes, or just taking action more superficially, spraying chemical into stagnant water pools and fining people for having collections of water in their compounds for mosquito breeding.

There does not seem to appear that planned actions taken so far have easedcontrolof the incidence of epidemics, according to the statistical figures available. The highest number of cases continues to be reported by the Deputy Provincial Director of Health Services, Colombo division, with a progressive spread from the city of Colombo to its suburbs and thence to major towns outside Colombo.

The disease seems to be widespread in developing countries mostly, due to poor maintenance of environments, poor sanitation, as in India, Pakistan and Sri Lanka among other countries. In the more developed countries the holiday makers who travel abroad to developing countries seem to bring in the disease from those respective countries. Recently, a few cases of Dengue were identified in Australia from holiday makers abroad. Dengue and other communicable diseases are less prevalent in developed countries due to good infrastructure, planned cities with proper drainage and sewer systems, and most people wanting to live healthy, and attempting hopefully to be free of diseases.

In 1996, a large outbreak (289 cases) of dengue fever was reported from the Kurunegala health division which is about 100 km from Colombo, and focal outbreaks were reported from the provincial towns of Galle, Kandy and Batticaloa.

The age-wise distribution of the cases reported between 1991 and 1996 shows that about 60% of the cases occurred among the under-15-year age-group and that the highest percentage was among children in the 5-9 year age-group. There was not much difference between the two sexes. The percentage of males affected by the disease ranged from about 50% to 59%. (Vide reports by T.A.Kulatilaka and W.S. Jayakuru, Epidemiological Unit, Dept. of health Services).

Poverty, ignorance and unhygienic living standards among the poorer class of people are also, as responsible for the spread of the disease mostly in the congested towns and slum areas.
Visit to slum areas in Colombo and its suburbs, one could see howfamilies with many kids live in shanty dwellings,in unhealthy environments without much fresh air. As mentioned above the large percentage of dengue among children comes from such environments. In such unhealthy areas it is quite well seen the blocked dilapidated drains occupying the front or the rare of these dwellings and are congenial situations for breeding mosquitoes. These broken down drains need repair and frequent cleaning for smooth running of water.

These drains have become part and parcel of their lifestyle to survive. Their clothes washings, kitchen wastes and other water from ablutions are sent down these inefficiently running drains due to the substandard living conditions.

Cracked damaged drains all over the city side streets need extensive repairs for their proper function, so preventing breeding spots for the mosquitoes.

You only have to walk along Station Road, Wellawatte and you will notice the collections of dirty water and blocked drains with house effluents. I am surprised to notice that there is a well-established restaurant down this street, and front drain is smelly and full of mosquito breeding spots.

Recently, there was an incident where the health inspectors summoned to magistrate courts the manager of a well administered, cleanly maintained apartment block, adjacent to the restaurant, for car washing water flowing to the dilapidated road drain. The charge was that, that discharge was creating an impending mosquito breeding situation for spread of dengue. At the court hearing the health inspector from the municipality was pulled up by the magistrate for bringing in cases assuming dengue spread when there were no collections of fresh water within the premises.

Most side streets on Galle road extending from Colpetty to Ratmalana are heavily populated and are exposed to the highest health risk, meaning residents living in tiny homes have no running water, no wastewater treatment, no paved roads or solid waste disposal situations. Water and mosquito-borne illnesses are rampant, the result of poor drainage, pooling sewage and water contaminations and unhygienic living. Garbage is dumped on the side lane roads, and the dogs searching for their food, steaming with flies and mosquitoes are not rare sites.
Have the health authorities visited the mushroom eating places along Galle Road? Have they ever inspected the kitchens and toilet facilities in these areas?

Any sensible man with smelling sense will run a mile without eating from these outlets if they only visited the rare of these eating houses. The poorest people, unable to cook meals at homes due to the high prices of cooking oils, gases, vegetables are compelled to eat from these outlets, especially in the evenings on the way home after a hard day’s work.

The government has launched an enormous community based campaign to check the spread of dengue fever in the country.The third week of August was declared the national dengue prevention week and efforts to clean up breeding grounds and spread awareness through TV channels, billboards and school children, were launched.

Cleaning up gardens, pruning water collecting plants, removing water collecting items like coconut shells and other material are being done by the occupants of most houses.

"Our final aim is to stop the spread right at the source with public participation," Sudath Peiris, an official with the Dengue Prevention Unit of the Health Ministry's Epidemiology Unit, told IRIN. "We feel that with public help the spread can be brought under control."

The Dengue control campaign talks mainly the collections of rainwater that breeds the mosquito and not concerned about dirty smelly water collections down the dilapidated drains. The campaigners say that success in control and prevention of this problem has been limited by the lack of effective methods to control Aedes aegypti that breeds in discarded containers that collect rainwater and in other water storage containers.

Dengue is not simply about clearing stagnant water around our homes and work places, old dilapidated buildings, coconut shells and plastic bottles, nor is it simplyabout getting rid of mosquitoes. Dengue prevention is about strengthening the immune system, especially among the inhabitants of the poverty stricken slum areas to allow fight the virus that penetrates during a dengue invasion of the body. The unhealthy bodies of the malnourished poor people are more susceptible to the dengue virus than a healthy one. Our body has the immune system mostly in balanced in healthy people to fight diseases like the common cold, flu, or even cancer, or any communicable disease.

So Dengue is not only a disease caused by a mosquito, but also it is linked to poverty.

You need to eat green vegetables like carrots, parsley, cabbage leaves, lettuce, leaks and so on, containing free radical neutralizing antioxidants,, vitamins, folic acid, protein, calcium zinc and other micronutrients to fight these diseases, and the poor man can well ill afford these days. Poverty eradication projects would and should be the aim of governments in power, working for the less fortunate people to give them opportunities for better lifestyles.

Fresh fruits are not within the reach of most people. Few years back one minister of parliament introduced an import tax on imported fruits when fruits had to be imported due to shortages within the country. A moderate size papaw is over rupees hundred today, when one could purchase a rice packet for less.

Exercising daily is another event to ward of diseases in any healthy nation. Today, in the developed world even working places have gyms for the staff to work out before they commence work in the morning. Exercising before work helps efficiency and more productivity in businesses. Most of our people are standing in bus stands in the hot sun, waiting for the bus to go to work, inhaling all the poisonous fumes from the smoke belching vehicles, tired even before they reach the working places. That is the plight of the working class man inherited to suffer in unhealthy environments and contract communicable diseases.

So now the readers will understand why eradication of this deadly disease is a wild goose chase.

When DDT had been widely in use about 38 years ago, this vector had almost disappeared from many countries. With diminished use of DDT, the menace of Dengue fever has now returned. The problem has become more pronounced with urban expansion, increased movement of people by air transport system, population growth, overcrowding, inadequate solid waste management, decreased support for mosquito control programs (decreased funding for vector control), increased use of non-biodegradable products (that can hold rain water and allow mosquitoes to lay eggs), deterioration of mosquito control efforts and public health infrastructure. In addition, lack of water supply via pipes makes water storage in containers and tanks a necessity – vide report by Biji T.Kurien Senior Research Scientist, Oklahoma Medical Research Foundation, and USA)

Mosquito control and making the nation healthy are the only effective strategy that can be used to control dengue. Community participation seems to be necessary for the eradication by removing the breeding containers at homes, weekly emptying of storage containers which will disrupt mosquito life cycles. Introducing larvivorous fish into permanent water collections as in ponds and lakes will control the vectors (mosquito) breeding. A novel insecticide delivery instrument named Mossle-Buter has been developed to control mosquito larvae from urban breeding places in Townsville, Australia.

Another simple way of being not attacked by dengue mosquito would be to use organic, nontoxic repellants on your skin and in your home. Some of these repellants use tea tree oil, eucalyptus and citronella. A little tip, “Siddhalapaya” the popular aurvedic ointment for aches and pains is an excellent repellant.

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