Hundreds mobilized in campaign against dengue

Hundreds of volunteers and staff at state owned companies and government offices began walking door-to-door in the capital Malé this morning with a checklist of activities to eliminate mosquito-breeding sites. At least four people have died this year from dengue fever,a mosquito-borne disease.

The Health Protection Agency (HPA) is advising the public to empty stagnant water from containers, throw trash into dustbins, and keep containers sealed to prevent water from accumulating.

“We would like to appeal to the public to take up dengue control as an individual responsibility. We are taking measures to eliminate mosquito breeding sites in public spaces, but we do not have access to households,” said Asma Ibrahim, director at the HPA.

Of the 475 cases reported this year, some 180 cases were reported in Malé. Schools have been closed indefinitely to control the spread of dengue. Deaths include a pregnant woman and a migrant worker.

Dengue is now endemic in the Maldives. Prevention and control of the illness solely depends on effective mosquito control measures. Symptoms include high fever, headache, muscle and joint pain.

The HPA has 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

An outbreak typically lasts six weeks, Asma said.

The virus is transmitted to humans through the bites of infected female Aedes aegypti mosquito. It’s peak biting periods are early in the morning and in the evening before dusk.

The Housing Ministry is fogging public areas with insecticides and has requested construction companies to eliminate mosquito breeding sites from construction sites.

The HPA has meanwhile launched a 24-hour ‘dengue hotline’ and urged the public to call or text 7548221 for information.

A severe outbreak of dengue in 2011 saw a record high of 12 deaths. There were 2909 reported cases of dengue that year. In 2006, 10 people died of dengue.

There are four known types of the dengue virus, and the strains responsible for the illness wax and wane cyclically. In regions where dengue is common, one or two strains tend to dominate for two to three years at a time.

People in the region appear to acquire immunity for those strains and the number of cases will dip for a few years before another strain takes over and infections flare up again.

Dengue fever cases worldwide have climbed dramatically since the 1960s, with some 50 million people infected annually.

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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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New HIV prevention strategy to target injecting drug users, gay men, sex workers

The Health Protection Agency’s (HPA) new national strategy on HIV prevention will scale up prevention programmes in key affected populations of injecting drug users, sex workers, men who have sex with men.

By 2016, the HPA aims to reach at least 60 percent of injecting drug users to promote the safe use of injecting equipment and consistent condom use with sexual partners.

The HPA aims to reach 80 percent of sex workers and men who are having sex with men to promote the consistent use of condoms.

The health ministry has previously said the Maldives was sitting on an HIV “time bomb” due to the lack of prevention programmes and specialised care for groups at risk.

The HPA has previously expressed concern over the prevalence of behaviors that increase risk of HIV spread such as promiscuity, unsafe sex and intravenous drug use.

There are nine individuals receiving treatment for HIV at present. The HPA estimates there are 32 individuals living with HIV in the Maldives. The figure could reach 123 by 2020 if prevention measures are not put in place, the agency said today.

Meanwhile, the Society for Health Education (SHE) has called for the integration of sexual reproductive health services and HIV prevention efforts.

“Integrating sexual reproductive and HIV prevention has the potential to stem an HIV pandemic. When vulnerable groups have increased access to and use sexual reproductive health services, it decreases the spread of HIV,” Shiyama Anwar of SHE said.

“Integration of these services provides a more comprehensive service that benefits both the clients and service providers,” she added.

According to the HPA, it currently only receives 15 percent of requested funds for HIV prevention, care, and treatment. The majority of the funds released from state budget are spent on treatment of infected individuals rather than on prevention.

The agency has called on the government to scale up sexual reproductive services and HIV prevention programmes, arguing interventions such as life skill programs for youth would only cost MVR350 per person while the state spends over MVR50,000 on each individual infected with HIV.

In the period between 2006 and 2013, 161 female victims of rape, which included underage girls became pregnant, HPA figures explain. The state spends MVR 174,000 on each child every year under state care. In comparison, providing quality contraceptives only costs MVR 1000 per person annually.

Meanwhile, the state spends MVR 22,900 per month on every individual receiving state care at drug rehabilitation centers. However, methadone or oral substitution treatment would only cost MVR14,400 and comprehensive awareness programmes would only cost MVR 800 per child, says the agency.

The HPA has called on the People’s Majlis to integrate services on HIV prevention, sexual reproductive health, and drug abuse, and grant service providers with adequate financial resources.



Related to this story

Health Ministry seeks to protect mothers and infants from HIV “time bomb”

“Worst fears over HIV coming true”: Health Minister

High-risk behaviour leaves Maldives at risk of HIV/AIDS “explosion”

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HPA warns of viral fever and common cold epidemic

The Health Protection Agency (HPA) has warned of a viral fever and common cold epidemic in the Maldives.

According to the agency, approximately 1600 cases of viral fever 2000 cases of common cold and diarrhea are being reported every week.

A health alert issued on Thursday also expressed concern over rising dengue fever cases. Approximately 20 cases of dengue fever are being reported every week in the past two weeks.

“There have been 20 cases of dengue fever, reported on average, every week in the past two weeks. This agency also notes the common cold cases being reported at the moment are stronger than usual.”

Noting that viral fever and common cold are highly contagious, the agency has called on individuals with symptoms such as fever, cough or cold to avoid public places.

The HPA has also instructed those infected to cover their mouths and noses when coughing and to increase fluid intake.

Increase in dengue is linked to increased mosquito breeding with the southwest monsoon in full swing, the agency said and has urged the public to eradicate mosquito breeding grounds and take steps such as applying mosquito repellant to decrease the risk of infection.

HPA also called on the public to pay attention to cleanliness, such as washing hands before preparing food and refrigerating food, to decrease risk of infection.

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Health Protection Agency plan youth services to bridge gap in sexual health education

A sexual health education pilot aimed at young people will be launched in Hulhumalé before the end of this year, the Health Protection Agency (HPA) has told Minivan News.

“There is no comprehensive sexual education in the schools,” said the source. “We have to keep talking about these issues, about how to keep young people safe.”

The pilot will provide a comprehensive sexual health and general health service to all young people aged 10-24 years old.

According to the agency’s Reproductive Health Unit (RHU), the the project will attempt to bridge gaps in sexual and reproductive health services for young people.

A member of an established health service provider, who wished to remain anonymous, highlighted age-appropriate guidelines as key barriers to sexual health education.

The comments come after the body of a new-born baby was discovered in a house in Maafanu earlier this week. Local media reported that the 18-year-old mother, currently in police custody, committed infanticide after having hidden her pregnancy.

National Guidelines

The national guidelines issued by the Ministry of Health and Gender prohibit some elements of sexual health education – including condoms and safe sex – until students are 18-years-old.

“There is a standard which is maintained by the health sector. There are a lot of cultural and religious barriers in providing this information,” the source told Minivan News.

“Unless those issues are not tackled, the stigma in accessing [health education] will not happen.”

Reticence in the health sector is mirrored in the family sphere, argued the source, who stated that family members are reluctant to speak candidly with their children about sexual health.

“There are some views of parents that if you talk about sexual health, they might go and do it.”

With no accurate information from schools or parents, the student will often turn to peers or the internet for support on sexual health, noted the source, which results in the rapid spread of mis-information.

Religious barriers

Under the 2008 constitution the Maldives is a 100 percent Muslim country, with national guidelines surrounding sexual and reproductive health being strongly influenced by religion.

A report conducted by the Department of National Planning in 2013 concluded that religious beliefs had been the reason behind an increase in trends such as a preference for home schooling, refusal of vaccination and other medical services for women.

Expressing a similar view, the health sector source noted that religion had contributed to some of the barriers in delivering sexual and reproductive health education.

“That’s a huge barrier actually on sexual health education, because there’s certain beliefs on providing information, or on family planning, on safe abortion,” stated the source.

“They [religious scholars] have a lot of myths related to sexual reproductive health.”

The source suggestion that there is support for the assimilation of religion into sexual health education delivery, but that disagreements between religious scholars had meant that progress was slow.

Next steps

The RHU project is underpinned by the imminent release of their new guidelines, National Standards for Adolescent and Youth Friendly Health Services for Young People.

These guidelines outlines the key standards for health education for all young people aged 10 – 24 years, ensuring that they will “enter the productive age in the fullest possible wellbeing.”

Noting the closure of previous similar projects, such as the Youth Health Café, the RHU noted that there are a number of difficulties in launching a new healthcare service.

The RHU source also wished to remain anonymous, reflecting the strong emotions provoked by discussion of sex education.

“Convincing people to initiate something in health facility is not easy,” they stated.

“It will be difficult. At present it is very difficult, unless the person is coming seeking the services it is difficult.”

When asked if they felt that young people are getting the right information at the right age, RHU representatives responded with a firm “no”.

“Not all. They are not getting that information. As far as access, there is no access.”

Issues regarding a lack of support services for sexual and reproductive health in the Maldives have been well-documented in the past.

A report entitled ‘Maldives Operational Review for the ICPD Beyond 2014‘, carried out by the Department of National Planning (DNP), claimed that incidents of infanticide and unsafe abortions are symptoms of a lack of sexual education in young Maldivians.

The report identified, “clear indicators of the imperative need to provide access to information on sexual reproductive health and reproductive health services to the sexually active adolescents

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New drug-resistant strain of TB found in Maldives “quite serious”: HPA

The Health Protection Agency (HPA) has warned that a new drug-resistant strain of tuberculosis (TB) that has appeared in the Maldives poses “quite a serious threat” to people’s health.

The agency’s comments follow a report released by the Ministry of Health on Sunday (March 24), revealing that it faces new challenges in order to control the disease in the Maldives.

According to the World Health Organisation (WHO), TB is an infectious bacterial disease that can be transmitted via droplets in the throat and lungs of the infected.

WHO states that drug-resistant strains of TB have become a major public health problem that has resulted from patients not fully completing the recommended six-month course of treatment.

HPA Public Health Program Officer Shina Ahmed told Minivan News today (March 25) that although the new strain of TB is “quite serious”, the particular strain found in the Maldives is not resistant to every drug available to patients.

“We have had a few cases come in now with the new strain. The most important thing we have to do is to continue and complete the course of treatment.

“Most of these drug-resistant strains are caused by patients stopping the treatment. We have enough drug supplies to give to them, but because the course goes on for six months, patients tend to go off taking the treatment towards the end,” Shina said.

Local media reported that the Health Ministry had revealed that 10,563 people had been registered to receive treatment for TB since 1963, out of which 5,256 people were said to have infected lungs.

Shina claimed that the majority of cases within the Maldives have been reported on the islands as opposed to Male’, and that in order to prevent the spread of the disease the HPA will be undertaking awareness programs.

An official from Indira Gandhi Memorial Hospital (IGMH) in Male’ stated that there was no need for the public to be concerned in regard to the spread of the disease, adding that there may have been only “one or two” cases found to have contracted the new strain.

“When we find a patient who is not responding to the prescribed course of treatment, there is always a second course they can take instead,” the official told Minivan News.

According to WHO, healthy individuals infected with TB are not often affected by any symptoms as the person’s immune system acts to “wall off” the bacteria.

The organisation states that symptoms of active TB are coughing, sometimes with blood, chest pains, weakness, weight loss, fever and night sweats.

The WHO Representative to the Maldives, Dr Akjemal Magtymova, Health Minister Dr Ahmed Jamsheed Mohamed and the Health Ministry were not responding to calls at time of press.

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Hand foot and mouth disease on the increase in Maldives

Health Protection Agency (HPA) has warned people of the spread of hand, foot and mouth disease in the Maldives, local media has reported.

HPA reported that the number of confirmed hand, foot and mouth disease cases had increased in some regions since January 2013.

The disease normally affects children aged between one and four, and is spread through direct contact with mucus, saliva or faeces of an infected person, local media reported.

According to the HPA, good hygiene is an effective way to prevent the disease. The first symptoms include fever, lack of appetite, fatigue and a sore throat.

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Livestock import ban following anthrax scare in Tamil Nadu

The Health Protection Agency (HPA) has enforced a ban on importing live animals and meat to the Maldives from Tamil Nadu in India following an anthrax outbreak, local media reports.

A statement from the HPA read that two towns in Tamil Nadu had reported an outbreak of anthrax, and as a precautionary measure the agency had banned live animal and meal imports from any state within Tamil Nadu.

The HPA has urged against using live animals and meat produced after December 31, 2012 imported from India.

“Normally anthrax affects animals such as goats and cows. However, humans can get the disease from animals. Humans contract the disease by coming in contact with infected animals, airborne germs and consuming meat of infected animals,” the HPA stated.

Anthrax is an acute disease caused by the bacterium Bacillus anthracis, according to the agency.

Orf virus found in Thilafushi goat

Prior to being abolished, the Centre for Community Health and Disease Control (CCHDC) reported that a goat in Thilafushi had tested positive for the Orf virus earlier this month.

Despite the Ministry of Agriculture earlier stating that Orf is a dangerous virus, as reported by local media, the CCHDC said it does not pose a great risk to humans.

Epidemiologist at CCHDC Dr Aishath Aruna said that a human can only contract the virus by coming into direct contact with an infected goat, Sun Online reported.

“Humans can contract the disease from goats, by coming into direct contact with an infected goat. It’s not a dangerous disease. Only people who tend and rear goats are at risk,” Aruna was quoted as saying by local media.

In regard to goats being reared in Thilafushi – otherwise known as “garbage island” – Dr Aruna told Sun Online that eating the meat from these goats could pose a risk to humans.

The Thilafushi Corporation said the island is used for industrial purposes, and that people who rear goats in the island do so without obtaining the necessary permits.

The CDHDC was abolished by President Mohamed Waheed Hassan Manik earlier this month. The President’s Office confirmed that functions and responsibilities of the CCHDC were to be transferred to the HPA.

The CCHDC had been working to identify diseases prevalent in the Maldives, and to prevent disease and increase health awareness.

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