Construction sites blamed as dengue cases surge

The Centre for Community Health and Disease Control (CCHDC) on Tuesday issued the first warning this year on a possible outbreak of dengue fever, and urged the public to to take preventive measures to fight the mosquito-borne disease that has become one of the worst public health threats in the Maldives.

Though the Maldives holds South-East Asia’s record for being malaria-free, since 2004 the country has been battling a growing epidemic of dengue fever annually with nearly a 1000 reported cases and three deaths annually, except in 2006 and 2011 where the reported cases doubled, and fatalities reached 10 and 12 respectively – a record high in the country’s history.

According to the CCHDC statement, 163 cases have been reported so far this year, 100 cases from Male’ and Hulhumale’ and the other cases from across the islands.

Although Maldives usually experience two peaks of dengue following the rainy seasons; one between January to March and the other during June to August, the center observed that dengue cases continues to be reported from Male’ and Hulhumale’ outside the peak periods.

“This is due to the non-stop construction work going on Male’ and Hulhumale”, noted the center.

Health experts have also echoed similar concerns and pinpointed Male’s mosquito-breeding to pools of stagnant water in building sites across the city – which is often poorly monitored.

The center meanwhile called for public support to in the fight against dengue by taking preventive measures including the clearance of mosquito breeding grounds inside homes, schools and other public areas and increased use of mosquito repellant sprays and lotions.

Ignorance

However, health experts worry that public will ignore the warnings until the death toll increases.

In 2011, dengue did not come to the center of attention until June when four children died of dengue in 48 hours, making headlines on almost all local media outlets. The government the next day set up a task force to combat the outbreak.

At the time, speaking to this author, Public Health Programme Coordinator for the Center for Community Health and Disease Control (CCHDC) Dr Fathmath Nazla Rafeeq shared her concerns over the lack of public attention to the center’s alerts.

“Since December [2010] we had warned about the increase in dengue cases. But most of the people don’t even remember. They assume that mosquitoes should be controlled if there is a dengue outbreak and everything will be okay when authorities spray fog,” Nazla observed. “Therefore, on most islands, its [mosquito control] is highly neglected. Once dengue starts to spread, people panic,” she added.

According to her, a dengue outbreak is inevitable, unless public collaborate with the authorities to eliminate mosquito breeding sites regularly.

Health Minister and former Director of CCHDC Dr Ahmed Jamsheed meanwhile wrote on his blog on June 2011: “Multiple reminders in the form of health warnings and press releases issued by CCHDC following heavy rain and prior to an expected outbreak are either ignored or not acted upon sufficiently”.

Furthermore, he noted “there are several fundamental problems in how mosquito control work is being carried out; with improper approaches and wrong techniques resulting not only in a failure to control mosquito, but also mosquitoes getting resistant to chemicals due to irrational and improper use of chemicals, which is an extremely worrying problem.”

While advice and reminders fail, Jamsheed suggests that punitive measures need to be taken to continue the fight against dengue – including the introduction of Health Protection Bill.

When passed, the bill will provide “sufficient resources to ongoing efforts on community education, awareness and health promotion, access to premises with mosquito breeding and legal action against those who do not comply with the law or regulations,” according to Dr Jamsheed.

“With neither a cure nor a specific treatment, prevention becomes the only strategy we have,” Jamsheed concluded.

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