Pregnant woman dies of dengue fever

An 18-year-old pregnant woman died of dengue fever at the Indira Gandhi Memorial Hospital last night in the second death from the mosquito-borne disease this year.

The woman died after going into shock around 2:20am, IGMH media official Zeenath Ali Habeeb told Minivan News. The patient was three months pregnant and was admitted on Thursday with a high fever, she said.

The hospital declined to provide personal information, but local media has identified the deceased as Hamdha Hassan, from Noonu Maalhendhoo.

A migrant worker had also died of dengue in Gaaf Alif Kooddoo last week as the Health Protection Agency (HPA) warned of the rapid spread of dengue across the Maldives.

Speaking at a press conference on Thursday, health minister Iruthisham Adam revealed that 374 cases of dengue has been reported so far this year, of which 125 were reported from Malé. Some 112 cases have been reported in June.

The incidence of dengue was “alarming,” she said, and appealed for public cooperation with mosquito control programmes.

Dr Ahmed Faisal from the IGMH said most patients admitted at hospitals with dengue were at a dangerous stage and expressed concern with the spread of dengue among migrant workers.

Last year, the health ministry said dengue fever has become endemic in the Maldives since 2004 with annual outbreaks.

A relatively severe outbreak of dengue in 2011 saw a record high 12 fatalities.

A total of 1,083 dengue cases were reported in the Maldives in 2012. The HPA has previously said that construction workers face an increased risk.

Earlier this month, the HPA issued an alert warning of the spread of dengue and viral fever in Malé and the atolls and advised precautionary measures to control mosquito breeding during the rainy season.

The agency advised the public to empty stagnant water from containers, throw trash into dustbins, and keep containers sealed to prevent water from accumulating.

The HPA also advised wearing clothes that hide the skin, using mosquito repellants, and keeping doors and windows closed during dawn and dusk.

The agency has stressed the importance of cleanliness and hygiene to prevent the spread of the disease and advised seeking medical assistance if a fever persists for more than three days.

Symptoms of dengue fever include fever, headache, muscle and joint pains, and a characteristic skin rash.

Dr Faisal said the worst incidence of dengue has been reported from Alif Alif and Alif Dhaal atolls as well as Baa Thulhaadhoo and Malé.

The most dangerous stage of dengue is when the fever subsides after three days, he warned, and advised seeking medical attention if symptoms such as bleeding and fatigue persist.

He also advised drinking lots of liquid and resting to recover from the fever and warned against the use of unprescribed strong medicines.

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Viral fever, dengue, diarrhoea speading, warns health protection agency

Viral fever, dengue, common cold, and diarrhoea is spreading across the Maldives at an alarming rate, the health protection agency (HPA) has warned.

In a health alert issued yesterday (September 12), the agency revealed that 2,000 cases of common cold, 500 cases of diarrhoea, 800 cases of viral fever, and 500 cases of dengue fever were reported across the country during the past week.

The HPA cautioned that common cold and viral fever were highly contagious diseases and advised those affected to drink lots of liquids.

The agency also advised taking precautionary measures to prevent breeding of mosquitos during rainy weather.

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Unsafe dredging in Meedhoo can cause lung and respiratory diseases, says HPA

In a letter addressed to the minister of environment and energy, the Health Protection Agency (HPA) has said that said unsafe dredging in Meedhoo, Dhaalu atoll, will have great health risks for the local population.

The Meedhoo land reclamation project was halted by the Environment Protection Agency (EPA) for failing to take measures to minimise the environmental impact of the work as per regulations.

The HPA launched an investigation to identify the health impact of the project after having received complaints.

HPA’s letter – a copy of which was obtained by Minivan News today – noted that there is a high chance that the continuation of the project as it is would have a negative health impact in the long run.

According to the letter, the agency’s investigations indicated that it is highly likely to cause lung and respiratory diseases.

“Therefore we request to find another way of carrying out the work, and to encourage working in a way that would not have any negative impact on human beings,” read the letter.

Using the rainbowing technique – the propulsion of materials through the air in a high arc – rather than using pipelines to take the the sand closer to the land, has left a large part of the island’s shoreline vegetation and many houses near the beach covered in fine sand and sea water.

Environmental NGO Ecocare earlier said that the project’s environmental implications are “frightening” and both public and private property are at risk.

“While layers of sedimentation found on some rooftops were 2-3 inches thick, large trees on the shoreline and inland had also effected loosing its leaves, and are now drying and dying,” the organisation said in a statement issued yesterday.

Meedhoo Council President Ahmed Aslam confirmed that rainbowing has affected destroyed the vegetation on the island and caused some damage to property as well.

“It is true, rainbowing has caused some damages to the island. Soil and seawater was sprayed all over the place. And as this is a small island, it was all over the houses near the beach and had damaged the vegetation all over the island,” Aslam explained.

He said that when the council took the issue to the Housing Ministry, they requested they communicate with Boskalis International – the company contracted to carry out the work – to ensure mitigation measures are taken properly.

Aslam however denied media reports that the dredging vessel had left the island due to the environmental issues.

“We communicated directly with Boskalis people. They confirmed that the vessel was leaving the island to repair a pump. They are bringing in mechanic from abroad. We expect the work to resume within four days,” he said.

Meanwhile, Minister of Housing Dr Mohamed Muiz told Haveeru that the EPA had acted without discussing the issue with the ministry and that there were political reasons in the EPA’s suspension of the operation.

“The issue of EIA [Environmental Impact Assessment] came up while some political people were trying to stop the work, because we are speeding up a work which they were unable to do during MDP’s three years in government,“ Muiz was quoted as saying in Haveeru.

While the EPA is a legal regulatory authority, the agency it not independent and functions under the Ministry of Environment and Energy.

Muiz confirmed to Haveeru that the work was halted due to violation of EIA conditions and said Boskalis International had now been asked to suspend operations and to continue work after resolving the issues.

The US$10.8 million government project to have 17.5 hectors of land reclaimed and a 485 metre revetment constructed in Meedhoo is being implemented by Netherlands’ Boskalis International.
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Alert issued after migrant construction worker dies of dengue in Male’

The Maldives Health Protection Agency (HPA) has issued a dengue fever alert, following the death of a foreign migrant worker and the hospitalisation of two children for hemorrhagic dengue fever in Male’, with the HPA and World Health Organisation (WHO) emphasising that construction workers are particularly at risk.

Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world, including the Maldives, which only has two strains of the virus. 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.

The year 2011 saw quite a severe outbreak of dengue in Maldives – though far below the 2788 cases recorded in 2006, the worst year ever for dengue in Maldives, according to the WHO. Fatalities reached 10 in 2006 and 12 in 2011 – a record high in the country’s history. While in 2012 there were a total of 1083 dengue cases in the Maldives.

Between January 1 and July 13 of this year, a total of 256 cases of dengue have been reported, with 90 in Male’ and 166 in the atolls, while dengue hemorrhagic fever accounts for 16 of those cases, the Health Ministry’s HPA has noted.

“The HPA issued a general alert – the first one for 2013 – regarding dengue fever to raise the level of public awareness a bit,” HPA Epidemiologist Dr Aishath Aroona Abdulla told Minivan News today (July 15). “Since it’s Ramazan it’s very difficult to conduct normal activities, so we wanted to alert people early.”

“We are beginning to see a rise in reported cases, but starting in May [the beginning of the south west monsoon season] this is to be expected,” said Dr Aroona. “Generally dengue peak season is June to early July, so this year its coming a little later, which could be because of changing rainfall patterns.”

She explained that while one of the dengue virus strains found in the Maldives is not fatal, the hemorrhagic strain is life threatening.

“The hemorrhagic variety is usually found in the Atolls, however people are getting sick from that strain of the virus in Male’,” explained Dr Aroona.

“Unfortunately one person, a foreign construction site worker, already died from the hemorrhagic strain [of dengue],” she continued. “He was in the country for about 15 days, according to the report we received.”

“Construction workers and people living near construction sites are at very high risk [for contracting dengue],” she noted.

Dr Aroona explained that when the sites are abandoned or the owner is not there, no one takes responsibility to ensure standing water or items that could collect water are removed.

“It’s important for the owners – the government or private businesses – to get rid of the [standing] water at the sites,” she said. “If removing all the water is not possible, large areas can be filled with sand as an alternative.”

“[However,] the Male’ City Council (MCC) or Local Government Authority (LGA) can be contacted to help control mosquitoes in these areas,” she added.

Foreign workers at risk

“While any reports of dengue are not good, comparatively, dengue cases in 2013 are not something to think of as an outbreak,” WHO Representative Dr Akjemal Magtymova told Minivan News today.

“However, there has been an unfortunate case of death and a few individuals in critical condition,” she noted.

While the children have subsequently been released from the hospital, the death of one foreign migrant worker has highlighted the risk foreign construction workers face due to their lack of social safety net support.

With an abundance of active construction sites in Male’ and the lack of inspection and control of these sites to prevent and control mosquito breeding places, it is expected that vector borne diseases will continue to persist in the capital, the WHO has noted.

“This [HPA alert] relates to foreign migrant workers. The individual who died was only here for about two weeks and must not have had a social safety net support,” said Dr Magtymova.

“While Maldivians are generally aware of dengue fever, migrant workers need more information and support because they may not know about dengue or have a support network if they fall ill,” she added.

“There should be more forceful promotion of awareness materials,” emphasised Dr Magtymova. “Everyone needs to be vigilant and aware, we don’t want people in critical condition.”

The WHO is working with the Health Ministry to leverage resources and extend dengue awareness. Additionally, the WHO in the Maldives has been an active partner in all aspects of dengue prevention, control and management – including training of doctors and nurses in clinical management of dengue, technical support in surveillance and situational analysis, provision of supplies and support in health promotion activities both at national and local levels.

Prevention

The Aedes mosquito breeds in small clean water collections in and around the home, places where people live (e.g. rainwater collections, pots, wells, tanks, tires, gutters, etc.). This is why controlling mosquitoes is everyone’s responsibility, noted the HPA.

“The dengue carrying mosquito bites in the early morning and in the evening close to sunset,” said HPA’s Dr Aroona.

There are two primary ways to prevent the spread of dengue, the most effective being to remove breeding areas and also to protect against bites.

“In addition to standing water at construction sites, garbage areas are also prime breeding grounds, especially since only a small amount of water is needed for mosquitoes to lay their eggs,” Dr Aroona said.

“It is very important for people to keep their gardens and homes clean, by collecting cups, cans, and other items that collect water,” she explained. “It takes seven days for mosquitoes to hatch after the eggs have been laid, so cleaning at least once a week is essential.”

The HPA has highlighted additional preventative measures individuals can take to protect themselves and their families from contracting the disease:

  • Keeping windows and doors shut in the early morning, as well as covering air vents.
  • Not littering, including throwing trash into air vents – which is particularly problematic in Male’.
  • Covering any open tanks or wells and putting fish that eat larvae into them.
  • Adding a little soap or salt to water to prevent eggs from being laid in planters, or they can be covered with cotton wool.
  • Wearing clothes that cover the arms and legs.
  • Using mosquito nets and screens.
  • Using sand to fill areas that collect standing water.

Seek medical attention

“Although individuals can develop a lifelong immunity after recovering from dengue, they are only immune to that particular strain and are still at risk of infection,” explained Dr Aroona.

Dengue symptoms appear three to 14 days after the infective bite.

The fever is typically high grade, above 38oC (101oF) and continuous. The fever may not disappear even after taking paracetamol, although paracetamol may reduce the fever to some extent, noted the HPA.

Other accompanying symptoms are headache, body aches, backache and joint pains, and sometimes a transient rash or reddening of skin.

Symptoms of simple viral fever generally last less than 3 days. Dengue fever, a more severe form of viral fever caused by the dengue virus may last slightly longer, between three to five days, and may be accompanied by more severe symptoms like vomiting and fatigue, particularly when the fever begins to subside, the HPA has highlighted.

If an individual has a fever, the HPA recommends rest, drinking coconut water, oral rehydration solution, fruit juices, milk or any home-based drinks, and only taking paracetamol – not other medication which can lead to bleeding.

“Fever is an important part of your immune reaction to the virus in your body, and helps to kill the virus. So you need not be alarmed, so long as you do not have any of the warning signs or danger signs,” stated the HPA.

The HPA has urged people to seek immediate medical attention if the fever lasts more than three days, or any warning signs of hemorrhagic dengue are present, which include:

  • Continuous vomiting and an inability to take fluids by mouth
  • Severe pain in the abdomen
  • Difficulty breathing
  • Not passing urine for more than six hours
  • Cold hands and feet
  • Bleeding from the nose or gums, vomiting blood, or black, tarry faeces
  • Changes in behaviour, such as lethargy or drowsiness, often with inability to stand, sit up or get up from the bed; Restlessness or irritability (excessive crying in children, adults may have behavioural changes and use foul language)

The Epidemiology and Surveillance Unit of the Health Protection Agency is conducting weekly monitoring of dengue nationwide and is issuing weekly reports.

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