Comment: Dengue fever, a problem for everyone

Although the MNDF has been drafted in to help combat the problem of dengue fever that is affecting Male and several other atolls, it is important that people don’t stand back and think that this action alone will solve the problem.

Experience in many other countries has shown that a ‘top-down’ or vertical campaign against dengue fever is only part of the solution to preventing outbreaks of the virus from getting worse.

Most people know that dengue fever is spread by a mosquito that takes the blood of an infected person. The blood contains a virus that causes dengue fever and this is passed on to a new person when they are bitten in turn by the mosquito. The mosquito seems fine – but people infected by the virus may become very seriously ill and a small proportion may die.

Most action to prevent the spread of dengue fever is aimed at the mosquito itself. If the mosquitoes are stopped from breeding then the transmission of the dengue virus from person to person will be interrupted and no new cases will occur. Often the strategy against the mosquito relies on spraying chemicals and treating water storage containers. But without having fully integrated community involvement, this strategy has failed almost everywhere in the world that it has been tried. The mosquitoes will always find ways to outwit their human adversaries unless locally tailored eradication programmes are implemented.

Community involvement is key to the success of the eradication programme and every member of the community should be involved in understanding the problem of controlling the mosquitoes (vector control). Within each community the local community leaders should be involved in forming a dedicated steering committee that can create formal task forces or community working groups that will undertake environmental management. The working groups will need to know in detail exactly what they are supposed to be doing and precise training sessions need to be organised. Every locality is different so each community task force needs to identify the exact local conditions in which their mosquitoes will be breeding. Precise local knowledge is the most important resource for beating the disease. In particular waste water needs to be evacuated efficiently; water pipelines and water storage containers must be protected and communal waste collection improved.

A research programme in Cuba compared the usual ‘top down’ ways of combating dengue fever with a community activist approach as described above. They found that the community based environmental strategy was much more effective that the usual eradication programme. You can read more about this research on:

Garbage: a special problem throughout the Maldives

The mosquitoes love little collections of water. When I was in the Maldives as a volunteer for the Friends of Maldives health programme I noticed that outside almost every house there is a little collection of garbage. This includes plastic drink containers, tins, discarded tyres, containers and invariably a pile of half coconuts. These are ideals breeding sites for the mosquitoes that carry dengue fever. Unless each and every one of these piles is cleaned up, dengue fever will continue to be a problem throughout the Maldives in urban and rural areas.

Mosquitoes love the little collections of water that form in garbage piles.

Dr Tom Heller is a Senior Lecturer in the Open University’s Faculty of Health and Social Welfare.  He has previously visited the country as a medical volunteer for the UK-based NGO, Friends of Maldives.

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10 thoughts on “Comment: Dengue fever, a problem for everyone”

  1. Well Dr Tom Heller, your advice and methods of controlling dengue mosquitoes is simple and cost nothing.
    The problems with our Island communities are, they are of opinion that it is the duty of the government to clean up the Islands and also their backyards!
    Dengue epidemic is not a new thing in Maldives and the people know about it. For various barbaric thinking and reasons the people of Maldives don’t to change their absurd ways and they always want their government to do the work for them.
    Idea of community work is a remote in Maldives!

  2. Give freedom only to their mouth and self abuse, but no freedom to behave as they wish that harms everyone. Punish those who cannot keep their homes clean and those who maintain the places conducive for mosquito breeding

  3. The strategy you propose to deal with the dengue problem in the Maldives seems copied from the standard WHO manuals.

    In principle, community engagement is fine, but I would very much appreciate if you can give me one example of where community participation has led to elimination of dengue (or malaria or any other vector-borne disease). I am not talking about control (many successes there), but specifically about elimination. I'm afraid these don't exist...

    Textbooks have been written on community participation in vector control, and in as much as the community can play a big role in it, they will not be able to eliminate. The reason why this is so is that whenever a vector-borne disease has almost (I repeat 'almost') disappeared, that people will loose interest and shift priorities to other pressing issues. Almost gone means: It will come back. And it always has, everywhere where the community was in charge.

    These are different days. It is time that we consider the war on such diseases seriously once more, like we used to in the middle of the last Century. Communities should be involved, make not mistake, and at minimum should provide consent, but the final blow should come from well-organised teams that are paid and are well trained and motivated.

    There is and will be no other way to eliminate dengue from Male or any of the other atolls, I'm afraid.

    Unfortunately, the reality we'll see is that when this epidemic is over, business will return to usual. And everyone will just wait until the next outbreak occurs, when again children will die.

    The Maldives are perfectly isolated and could embark on a vector elimination campaign. And deal with the matter once and for all. But that requires a war on the mosquito. And wars are not fought with the community, but with an army.

  4. who is Dr heller? minivan should get comments from ministry of health. we really are not interested to hear what some arbitrary foreigner has to seems like all these british people are now in charge of this country.

  5. With one of the largest military per capita in the world - with no known enemies - it seems ideal to get the military to sort this out. But cant help Dr Heller seems to make more sense than Prof Knols when he says the community has to be mobilised. Prof Knols thinks it can be 'eradicated' - I dont think it will be that easy when you have 1200 islands! Also Prof Knols who gonna pay for it? Money dont grow on trees. Education costs v little...

  6. It seems that Maldives is the only country that needs defense personals to be in all sectors of government.
    Now we have defense force looking after immigration department, human resource and labor ministry and maybe after few days the health ministry and Maldives monetary authority too.

  7. @Hussein. I fully understand and appreciate your comment, thank you.

    In my comment above, I did not say that the community shouldn't be engaged. On the contrary, the more the better.

    What I did say is that communities on their own will not be able to end this problem once and for all.

    Elimination is indeed more expensive than control (which is largely ineffective and leads to upsurges of dengue every few years).

    Dengue is closely linked to human habitation and transmitted by Aedes aegypti which prefers human blood. Not all 1200 islands will have a dengue and dengue mosquito problem...

    Costly, yes. Feasible? Well, if it succeeded over 8.5 million square km in Central and South America between 1947 and 1962...

    With 1.2 million tourists per year visiting the Maldives, charging a dengue tax of 1 USD per visitor will enable the country to end its dengue problem. It's all a matter of choices, not whether it is technically feasible.

  8. With the politicising of every one in the country, no wonder it has fallen on the army to look after the country! This is precisely what democracy was meant to avoid. How ironic.

    The situation we have is that everyone is working in the interests of the "party" and not of the nation. So, if a mosquito wants to escape punishment, all they've got to do is go with the flow, i.e. the ruling party.

  9. What else is the army to do? Serving and helping the people is the best role for this army (and any army). After all why does tiny country with no enemy need an army?

  10. no no no your great and powerful army are there to protect you against the ever immanent invasion of the Kafirun, the great masses lie awake in terror every night wondering how they are going to muster enough courage to fight against the mighty Maldivian army...

    HEy NOT! The massive Maldivian army has only existed in the last hundred or so years to protect the rulers against your own ppl!!!

    IT is about frickin' time they served the ppl rather than the God's who have ruled Maldives.

    I salute them, go guys, first cause your forces would have represented for years, without the aid of foreigners, which is noble and truly for the Maldives.

    ANd please help them by doing YOUR BIT!

    I have had dengue and it is pain (was laid out in IGMH for a week and trust me, you need to fight this thing TOGETHER!


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