A 22 year-old man has died in Indira Gandhi Memorial Hospital (IGMH) of dengue fever, reports Haveeru, taking the death toll to 11 and making 2011 the worst recorded year for fatalities due to the virus.
Ten people died in 2006 from the mosquito-borne virus.
The latest victim, Ahmed Shinah from the island of Vaadhoo in Gaaf Dhaal Atoll, was treated for dengue fever at regional hospitals in Villingili and Thinadhoo, Haveeru reported.
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(0)An expatriate worker has died of dengue haemorrhagic fever, after being infected on Konottaa in Gaaf Dhaal Atoll.
The 37 year-old Indian national died during treatment at Thinadhoo Regional Hospital.
“He died of dengue shock syndrome less than three hours into treatment,” hospital overseer Aminath Abdul Hakeem told Haveeru.
Five more workers from the island tested positive to the disease, and were treated at the hospital.
Meanwhile, a team from Thinadhoo was dispatched to destroy breeding grounds and fog the island, which is being developed as a resort.
Nine people have died of the mosquito-borne disease this year.
(0)Dislikes(0)The Ministry of Health is expected to once again take the reins of the national response to a dengue fever outbreak linked to the deaths of eight Maldivians this year, after last week handing control of the focus to a task force appointed to bring island management of the disease under a single body.
A spokesperson for the task force, which has attempted to combine the efforts of the Maldives National Defense Force (MNDF), government ministries and NGOs, said the body expected its work to be “wound down” today, with the Ministry of Health once again taking control of efforts after infection rates were said to have fallen.
The task force had initially been budgeted to operate from within the social centre at Maafanu School in Male’ for seven days. However, despite initial optimism that the outbreak – which has been labelled by the government as an “epidemic” – would be under control in this time, doubts arose later during last week about the likelihood of meeting such a deadline.
Speaking to Minivan News today, a media spokesperson for the task force said it once again expected management of the virus outbreak to revert back to the Health Ministry, after having itself overcome a number of difficulties allegedly including collaborating with recently established local councils.
“We are seeing the number of confirmed cases dropping once again and I expect we will be winding up our work today,” the spokesperson added. The spokesperson claimed that Male’s Indira Gandhi Memorial Hospital (IGMH) was itself now returning to normal operations after adapting several wards and surgeries specifically to coping with dengue during the outbreak.
On Thursday (July 7), several Male’-based hospitals including IGMH said that although they were busy continuing to deal with a significant numbers of patients suspected of contracting the virus, the situation was said to be under “control” by some senior management staff.
Government view
In addressing the work undertaken as part of a collaborative approach to disease control , Press Secretary for the President Mohamed Zuhair claimed that the initiative’s work in identifying and focusing on regional and island prevention measures would ensure the government was better prepared in the future for similar outbreaks.
“The government’s main focus has remained targeting mosquito breeding grounds, particularly areas such lakes and stagnant water collections,” he said. “However, we have also been working on community focal points where we have focused many types of control measures.”
Zuhair claimed these control measures had been focused specifically on trying to put more emphasis on focusing on island communities to identify possible difficulties with dengue, despite reports from the dengue task force of initial coordination problems in working with the local councillors.
A spokesperson for the opposition Dhivehi Rayyithunge Party (DRP) was unavailable for comment at the time of going to press over its views of the government’s response in dealing with the dengue epidemic” of recent weeks.
Yet over the course of last week DRP Spokerson Ibrahim ‘Mavota’ Shareef, reiterated his belief to the press that the government had “bungled” their response to trying to control dengue fever. Shareef added that although the DRP welcomed and would cooperate with the government in efforts to try and limit the spread of the virus, he said that authorities had acted too slowly in trying to deal with the outbreak.
“From what we have seen the government is just not doing enough. We don’t believe they have been willfully negligent, but there has been negligence in their approach [to dengue outbreak],” he claimed. “They have not responded fast enough, which could be inexperience on their part. But I think this will be a wake-up call for them to change policy in dealing with these type of situations.”
(0)Dislikes(0)The government’s dengue task force will be disbanded if incidents of dengue fever remain stable over the next few days, Haveeru has reported.
Speaking on behalf of the task force, Deputy Education Minister Dr Abdulla Nazeer said in the last 24 hours new cases had only been identified in four of the eight islands most affected by the mosquito-borne disease.
The work of the task force would be handed to the Health Ministry, Dr Nazeer said.
The official dengue death toll is eight this year, including seven children. A 41 year-old man died on Thursday while a 62 year-old man admitted to hospital with dengue died yesterday.
(0)Dislikes(0)The news that dengue is hitting the Maldives hard has reached the Netherlands, along with other parts of the world from which your beautiful country attracts large numbers of tourists.
That Maldivian children are dying of dengue is distressing and of course a horrific experience for the families affected, but there will surely be broader ramifications for the country. The blame culture that followed these deaths, fuelled by emotional debates in the press is affecting your country badly. Negative press will influence the tourism sector and may have a major economic impact.
When the Indian Ocean island La Reunion was struck by an outbreak of Chikungunya virus – also transmitted by dengue mosquitoes – in 2005/6, it suffered losses of tourism income amounting to €225 million (US$325 million). The French government had to inject €76 million to keep the tourism industry alive. With 1.2 million tourists per year, surely the Maldives cannot afford to wait for such a thing to happen.
So how can the war against dengue be won and can it be done quickly? In my opinion this is possible by doing just one thing well: learning from the past.
In the absence of a vaccine and specific medicines, the sole option to contain or eliminate dengue is through controlling the mosquito that transmits it. It is this option where many countries are failing miserably. Whereas in the middle of the last century, the responsibility for mosquito control remained in strong government hands and was rigorously organised and meticulously executed, a gradual shift of responsibility to the general population in recent decades has yielded disastrous outcomes.
Community awareness and engagement in controlling potential mosquito breeding sites has at best been partially effective, but remains hopeless in most countries with endemic dengue. The result at present: 2,5 billion people at risk, and an estimated 100 million cases of infection per year. These numbers keep growing steadily.
By 1947, the same mosquito that is causing havoc in the Maldives today had invaded 11 million square kilometres of Central and South America. The Pan-American Sanitary Bureau then took the decision to eliminate it. By 1962, these efforts had succeeded in 21 countries, an area encompassing 8.5 million square kilometres. I repeat, 8.5 million square kilometres. Compare that to the size of Male’, or even the Maldives at large, and one wonders why we have forgotten past successes and not simply repeated these.
Back then, these huge successes were based on intensive campaigns to search for breeding sites and either remove or treat them with insecticides to kill mosquito larvae. Large teams of inspectors moved from house to house, and all they did was that. Clean up trash and kill mosquito larvae. These teams were well organised, well funded, well trained, motivated, and well paid. Much of that has changed, and with the shift of responsibility away from governments, so has the capacity and know-how to deal with outbreaks waned.
Pro-activism to control dengue mosquitoes is gone. Instead, waiting for things to go wrong and then act has become the norm for policy. Why is that?
First, it’s a money issue, and the lack of willingness of governments to put money on the table when prevention is the issue. Politicians like to solve problems that are visible but shy away from spending money on something that may strike one day. Further complicating chronic underfunding are five other factors that contribute to the failure of dengue vector control programmes.
These factors are:
I emphasize that the most important factor in achieving successful control of dengue mosquitoes is a programme led by a high calibre administration and staffed by well-trained, supervised and motivated personnel. Most countries suffering from dengue lack precisely these things and call upon experts from the World Health Organization (WHO) when disaster strikes. Beyond the WHO’s advisory role, which mostly emphasizes strategies based on community participation of which we know that they don’t really work, there isn’t much it can do.
When the experts fly home, you remain with the problem and responsibility to execute their well-meant advice. They will not do it for you. Setting up a high-level response team is certainly a good thing, but meetings do not control epidemics.
What is needed are highly competent control staffs that know how to systematically cover areas and reduce vector breeding; staff that go out into the country and are capable of containing transmission of the virus and to prevent further misery. Although this should be done in a military style, this is not the same as mobilising the military as is now being done in the Maldives.
We have taken a different approach to the persistent problem of dengue by building on the hugely successful campaigns of the past, and augmenting the old strategies with the latest scientific knowledge and modern tools. The successes of the past were accomplished without computers, mobile telephony, satellite imagery, modern monitoring and surveillance tools, and so on.
We have these now, and should use them to the full. Not just to control outbreaks, but solve the problem permanently, in a sustainable and green manner.
We are discussing this approach with various islands in the Caribbean at present, and consider the Maldives as another great example of where dengue mosquitoes can be eliminated for good.
Now you are facing bad press, political turmoil, and deaths. A public-private partnership holds the key towards avoiding this from happening every few years, and if given an opportunity we are ready to lend a helping hand with our team that holds some of the world’s leading mosquito and dengue experts.
Maldivians should not worry about keeping their kids from going to school. Instead, the country should be planning a dengue mosquito elimination campaign. Good for the public, good for tourism.
Prof. Dr. Bart G.J Knols of the University of Amsterdam is a medical entomologist and CEO of the private firm Soper Strategies, which aims to provide comprehensive mosquito-borne disease elimination programmes.
(http://www.soperstrategies.com)
All comment pieces are the sole view of the author and do not reflect the editorial policy of Minivan News. If you would like to write an opinion piece, please send proposals to [email protected]
(0)Dislikes(0)A fourth dengue fever fatality in just two days has prompted meetings between Male’ City Council and the Ministry of Health to discuss “immediate steps” to reduce the number of mosquito breeding grounds in the capital.
The President’s Press Secretary Mohamed Zuhair said cabinet had also launched a program to counter the dengue outbreak and appointed a committee to oversee mosquito reduction efforts.
Haveeru reported that a four year old child from Muraidhoo in Haa Alif Atoll became the fourth death in two days, dying this morning while in transit to Kulhudhuffushi Regional Hospital.
The cause of the death was dengue hemorrhagic fever, the newspaper reported.
A two year old infant died at 3:00am this morning while being treated in Indira Gandhi Memorial Hospital in Male’. Haveeru reported a relative as claiming that the infant had to be transferred from ADK due to lack of availability of a blood transfusion machine.
A six year-old girl and a nine month-old baby died yesterday after being transferred to Male’ from Meemu Atoll.
Health Minister Dr Aminath Jameel, replying to a question from MDP MP Ali Waheed during yesterday’s parliament session, said the ministry was providing information to islands through teleconferencing and stressed that controlling mosquito breeding grounds was key to combating the rise in dengue fever across the country.
“Mosquitoes don’t travel very far,” she explained. “Therefore, it’s mosquitoes from nearby areas that are spreading it. Controlling mosquito [breeding] is needed from the public and individuals as well. We are working together with island councils and the Male’ city council.”
She added that the Addu City council had taken initiative and organised activities to combat the spread of the disease.
“An additional problem that we encounter is the quick turnover of doctors in the country’s hospitals and health centres,” she said. “So they are not very familiar with the protocol here. We are facing that problem as well. But as I’ve said, this can’t solved without controlling mosquito [breeding].”
When People’s Alliance (PA) MP Abdul Raheem Abdulla asked if she was considering resignation “since based on what is being said here your sector has very much failed,” Dr Jameel replied that she did not believe that was the case.
The Maldives has been battling a growing epidemic of dengue fever this year, with 300 cases and five deaths reported in just the first two months of the year.
There has been a spike in the number of cases reported in Male’, however most of the fatalities have been islanders who died in transit to regional hospitals. Many of the most serious cases have affected children.
Early symptoms of virus include fever, joint paint and a distinctive rash and headache, although it can be difficult to distinguish from the milder Chikungunya disease which can last for up to five days. Even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.
The government and health authorities have expressed concern about mosquito breeding grounds developing in stagnant water in the city’s many construction sites.
“The boom in the construction industry has created a huge number of mosquito breeding grounds,” former head of the Community Health and Disease Control (CCHDC), Dr Ahmed Jamsheed, told Minivan News in April.
“In Male’ when the Council gives planning permission it requires management of mosquito breeding grounds, but have so far failed to enforce it or conduct inspections. My experience in Male’ was that when our teams visited construction sites there was often nobody at the site to communicate with in Dhivehi or English.”
While the teams might be contact with the construction company responsible for the building, often those working at the site were employed under layers of subcontracting which made it difficult to place responsibility, he added.
Zuhair told Minivan News today that the problem was exacerbated by the large number of unfinished buildings where construction had ceased.
“For example, one proposed seven storey-building has [ceased construction] at four storeys, and has pools of stagnant water on top,” he said, adding that it was sometimes difficult to pinpoint who was responsible for the building site due to the layers of subcontractors involved.
Many islands had sought to combat the problem by borrowing fogging equipment and expertise from nearby resorts to kill their mosquito populations, but this also killed beneficial insects, he said.
“It is common for resorts to loan fogging equipment and technical assistance to local islands, but this has negative side effects: it kills all the other insects, which prevents pollination and impacts agricultural activity,” Zuhair explained, adding that human intervention and the elimination of breeding sites was the main priority.
(0)Dislikes(0)Malaria still maintains its respect as the leading killer disease in sub-Saharan Africa, surpassing the 20th century wave of HIV infections that rocked the continent. Malaria is spread by a mosquito known as CULEX.
The Maldives and many other South East Asian countries are infested with a mosquito species known as AEDES AEGYPTI, the carrier of Dengue Fever and Chikungunya that have claimed lives of many young and old. In population comparison with neighboring countries, the deaths and spread of dengue in Maldives is and should be considered as alarming.
A visit to health centers or hospitals in islands and Male reveals panic among parents with infants or small kids. Four deaths in two days, the youngest being a nine month-old baby has sent shockwaves in many households and I hope the World Health Organisation (WHO) has intervened. It ultimately raises the suspicion and doubt on the management of public health in a country where health and health education is inadequate, and not an immediate priority in the eyes of the lawmakers.
I support the government health insurance policy which we have enrolled and I have seen benefits in the past year. But think of a person with similar insurance facility but lives in an island village 600 miles from Male’, which cannot provide urgent medical assistance. It’s not acceptable; it’s just immoral, and unfair.
Each Maldivian citizen deserves the right to standard medical facilities, and I ask the Ministry of Health to explain why many atolls/islands still have inadequate facilities. Why a heart patient has to wait for two weeks to use a treadmill in IGMH, or cannot do ECG because the equipment is broken down, why desperate parents of sick children have to wait for days for an appointment, and why Maldivians have to depend on doctors who visit once every six weeks.
Ironically, Male’ is mushrooming with high tech clinics, specialty doctors, and a sequence of tests that leave you broke for a whole month. Most victims are from islands where basic medical facilities sometimes cease to exist.
In December of 2005, WHO Epidemiologist Dr Shalini Pooransingh and the Maldivian government had a fact finding, training and knowledge awareness program on Communicable Diseases, and dengue was well addressed.
Since then, many other workshops and programs followed partly sponsored by international organisations and the local health authorities. Looking at statistics (weekly dengue cases 2009-2011) published on line, it is appalling to see the magnitude of the spread especially in other islands all over the country. What happened to all the training and expertise?
It is nearly a year ago when an article by Aishath Shazra and A. R. Abdulla was published online: “Maldives hit by dengue fever in global epidemic”.
It is a simple straightforward report that is alarming to any parent who reads it, and at the same time it exposes loopholes which law makers and health ministry should look at.
Unbelievably, just 14 persons made comments, and as you can read them, most were abusive, political and out of context. Exactly at the same time of this dengue infestation last year, the streets of Male were crowded every night with demonstrations, ironically not concerned over the outbreak, but keen to unseat the then Education Minister [Dr Mustafa Luthfy] out of office… at which they succeeded.
These street scenarios were well documented and covered by most media outlets. The Maldives has not seen a meaningful demonstration against inadequate health services, deteriorating or lack of
equipment or lack of simple medicines. The Maldives has not demonstrated effectively against pedophiles, abuse of women and children, crime or the bleak and uncertain future of the youth.
But it’s a common thing to have live meetings, street demonstrations, and special TV and radio programs on topics that will not move the country one step forward but lead it to an uncivilised world. Why not use these funds to help the needy?
I do not need to bore you repeating facts and statistics on dengue that you can easily find from the Department of Public Health and WHO websites. My objective was to openly voice my personal concern based on day to day events and to answer the most disturbing simple question: “Who is to blame?”
In sequence, responsibility lies heavily with the Ministry of Health (in charge of public health), lawmakers (who decide laws), municipalities/councils (who manage day to day issues), politicians (who represent the people’s voices) and the public (for not focusing on life-threatening grievances).
I really hope that somewhere, a Good Samaritan in the authorities will seriously look at the four deaths in these two days, the daily grievances of desperate people far away in need of health facilities, and use it as a platform to start a campaign to try manage this outbreak.
The government alone cannot, we need a combined effort from everyone, or each day we would have a new headline of yet another death.
It is time the President, the Minister of Health, politicians and the media take time-off from the daily politics that have slowed our development and taken us nowhere. Better to concentrate on what is affecting the country right now. Public Health is at stake!
Not long ago Male’ had illicit drug problems which were visible on the streets. Boys and girls turned into zombies, but today I also salute the NGO Journey, the government (police, army, NGOs) for helping these kids off the street. It has been successful and many have been rehabilitated, and openly talked about it on TV. Why not temporarily close Majlis sessions, use all available resources and let MPs, health coordinators and doctors go out to the islands and help those in need? Thinaadhoo continues to suffer from a strange unexplainable fever, and sooner or later it will spread to other islands. By the time it reaches the concern of authorities, many will have buried their loved ones.
We had a great laugh last evening watching the match between MDP and the government. So much money was collected, some of it for charity. The night closed with a very tearful yet important program on MNBC (My Way). Hishko and her husband, my very good friends, have done so much in so short a time, for the health of many kids. 192 kids today who have had their Tiny Hearts examined, operated or diagnosed with heart cardio problems, will forever remember this couple for their entire lives. This is just an example of how simple people can make a change in the lives of many.
To MNBC: Congrats, My Way is the greatest program watched by over 80 percent of households and Maldivians abroad. Through such great ideas, I believe you could have similar programs on health, education, computer and drug addiction, career guidance, etc. Not to forget, you guys Minivan, continue publishing the truth. With information, we can partly control this outbreak that is claiming a child per day.
All comment pieces are the sole view of the author and do not reflect the editorial policy of Minivan News. If you would like to write an opinion piece, please send proposals to [email protected]
(0)Dislikes(0)The Maldives is battling a growing epidemic of dengue fever which is believed to have contributed to the deaths of at least five people this year.
More than 300 cases were reported in the first two months of 2011, compared with 737 cases and two fatalities reported last year. Many cases have been reported in Male’, although most of the fatalities have been islanders. One patient died during transit to Indira Gandhi Memorial Hospital (IGMH), and the more serious cases have disproportionately affected children.
Dr Ahmed Jamsheed, who until recently headed the Centre for Community Health and Disease Control (CCHDC), observed that 2011 had seen higher instances of dengue shock syndrome, where the mosquito-borne parasite causes blood pressure to drop so low that organs cannot function.
“Our initial theory was that this was a new strain of dengue,” he said. “There are four different strains, and strains one and three have been most prevalent. We took samples and sent them abroad but I had left the office by the time the results came back. I’m told out of the samples we sent a few tested positive for dengue one, which means no new strain.”
Instead of a new strain, Dr Jamsheed suggested that the growing number of dengue fatalities could be related to lapses in managing the disease, due to the high turnover of foreign doctors “particularly on the islands.”
“Usually dengue management in the Maldives is quite good, but new doctors are not very well orientated for dealing with dengue, and cases are being referred to Male’ quite late. It would be hard to say for sure at this point unless we did a case-by-case audit, to see where we’re going wrong,” he added.
IGMH Registrar Dr Fathimath Nadia noted that at least two of the fatalities this year involved children, “although these were quite complicated cases.”
Nadia said that health services had previously printed and issue a handbook on managing dengue to every incoming doctor and conducted briefings of incoming doctors, but was not sure if this was still carried out.
The CCHDC and the Maldives National Defence Force (MNDF) in February this year conducted spraying of mosquito breeding sites in Male’ and the surrounding islands, but reported difficulty obtaining access to residential and construction sites.
Minivan News also understands that a international mosquito expert brought in to exterminate breeding habitats at a resort had last month pinpointed the source of Male’s mosquito-breeding to pools of stagnant water in building sites across the city. However she was also reportedly unable to obtain the required permission to inspect the properties.
“The boom in the construction industry has created a huge number of mosquito breeding grounds,” Dr Jamsheed explained. “In Male’ when the Council gives planning permission it requires management of mosquito breeding grounds, but have so far failed to enforce it or conduct inspections. My experience in Male’ was that when our teams visited construction sites there was often nobody at the site to communicate with in Dhivehi or English.”
While the teams might be contact with the construction company responsible for the building, often those working at the site were employed under layers of subcontracting which made it difficult to place responsibility, he added.
Private and community rainwater tanks were also prime breeding grounds, he said, a particular problem on many islands.
“IGMH has a large underground water tank and we even found that full of mosquitoes,” he said. “They had not taken measures to make it airtight, although I think it’s been corrected now.”
Malaysia, which has had nearly 50,000 cases of dengue reported already this year, is currently working with France pharmaceutical company Sanofi-Aventis to develop a vaccine. The country has also launched a nationwide campaign to encourage people to destroy breeding grounds on their private property.
Early symptoms of dengue include fever, joint paint and a distinctive rash and headache, although it can be difficult to distinguish from the milder Chikungunya disease which can last for up to five days. However even healthy adults can be left immobile by dengue for several weeks while the disease runs its course.
(0)Dislikes(0)An Environmental Protection Unit has been established by the Sri Lankan police to assist in the country’s current dengue eradication campaign which is being conducted by the army and police.
Traders have been warned not to dump their garbage in front of their premises, says the Inspector General of Police Mahinda Balasuriya, and the police have already arrested over 300 persons who have flouted this order and taken them before courts.
Police have been deployed to provide security for public health inspectors to carry out house-to-house searches for mosquito breeding areas and take action against persons who contribute to the spread of dengue carrying mosquitoes.
Sri Lanka has officially reported around 25,000 dengue fever victims and over 150 dengue related deaths so far this year.
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