Maldives hit by dengue fever in global epidemic

Dengue fever is on the rise across the Maldives, especially in Male’, and children are the main victims, according to the Maldivian Centre for Community Health and Disease Control (CHDC).

Official records show 473 cases have been reported for 2010 up to the first week of July, and children aged between one and nine years are the most effected by the virus. “There have been no fatalities reported so far,” says the CHDC.

“In January, we had 24 cases of dengue, and in April it climbed to 28,” says Zeenath Ali Habeeb, media co-ordinator for Indhira Gandhi Memorial Hospital (IGMH). Figures from IGMH show that cases almost doubled in May to 50, and by June they reached 57.

Each year with the onset of the monsoon, there is an increase in the number of people with dengue, according to Dr Solah, senior medical officer at CHDC. Rain water in containers of any kind can become mosquito breeding grounds, and this is the main reason for the increased incidence of dengue.

The vector control unit carries out regular programmes to ensure mosquito breeding grounds are controlled, says Dr Solah, who has confidence in the capacity of the country’s hospitals to handle dengue cases even though there is no specific cure.

“Hospitals can only give supportive treatment, like providing lots of fluids,” he explains. “The decline in fatalities over the years shows that our expertise has improved in handling dengue.”

Despite the regular occurrence of dengue, health authorities say it cannot be prevented. “We are managing it as best as possible,” claims Dr Solah, “with regular inspections by the vector control unit, and advising islands and atolls to destroy mosquito breeding grounds.”

Efforts to eradicate dengue are hampered by “the absence of any laws” to penalise people and owners of buildings who habitually refuse to clean out water containers that are fertile breeding grounds for mosquitoes, according to Dr Solah.

Few cases of dengue have been officially reported in the islands. Most of the known cases are in the capital. Numerous construction sites and congested living conditions mean the inhabitants of the capital are more likely to suffer from dengue, Dr Solah believes. “Lack of human resources to tackle the issue is another problem,” he says. Monitoring and constant surveillance of the situation requires trained entomologists.

“Collective efforts at the individual, social and government level are needed to tackle this public health issue.”

Shocking Global Dengue Infection Rates

The World Health Organisation estimates that each year 50 million adults and children are infected with dengue, although other estimates place the figure as high as 100 million. Deaths from the disease are estimated at 25,000 per year. It is endemic in more than 100 countries.

Dengue is a disease of urban and semi-urban environments – those favoured by its main mosquito vectors Aedes aegypti and the Aedes albopictus, both of which feed during daylight or when dwellings have their lights switched on. There are four dengue viruses and nearly 2.5 billion people, 40 percent of the world’s population, are at risk of infection.

The official statistics, relying on diagnoses by doctors at hospitals, only hint at the extent of the problem. In Africa, dengue infection and death rates are hidden by lack of statistical reporting, and the situation is similar in India.

In the Philippines this year nearly 26,000 cases have been treated in the country’s hospitals and 190 people have been killed by the virus. The province of Davao del Sur has been declared a “state of calamity”.

Malaysia is experiencing a resurgence of dengue with over 23,500 official cases so far this year and eight deaths. For the whole of 2009, there were 24,817 people diagnosed with the disease.

In Thailand, official statistics show over 26,000 dengue infection cases nationwide and 30 fatalities between January and June this year, with 6 deaths during a week in June.

Sri Lanka has had nearly 25,000 dengue victims and 132 deaths this year. On 15 July, Sri Lanka’s Education Ministry issued a circular to schools making it compulsory for every school to reserve half an hour for two days each week to clean school grounds and class rooms.

In Burma, there are reports of more than 900 people infected with six deaths in the Rangoon district, and outbreaks of plague and dengue fever spreading through military units in Naypyidaw, the Burmese military regime’s seat of government.

Vietnam has reported over 5,000 cases this year.

Statistics are scarce for India, but Bangalore city, which has spent millions of rupees on prevention campaigns, reports 159 dengue cases so far. In Delhi, there are concerns about spread of dengue when the city hosts the Commonwealth Games in October, a month when there is a high prevalence of vector-borne diseases.

Dengue infections are rising in Yemen and dozens of people have been killed there this year.

“I receive calls on a daily basis from patients and relatives of the dead seeking help… many people died at home as they were unable to cover the cost of treatment in hospitals,” said Abdulbari Dughaish, a member of parliament (MP) from the Aden, in a report from UN’s IRIN website.

In Central and South America, dengue epidemics are raging, with hundreds of deaths.

Brazil had nearly 750,000 official cases of dengue and 321 deaths from the disease in the first five months of 2010. Colombia has been reporting thousands of new cases each week. In Venezuela, nearly 50,000 people have caught dengue this year.

Other countries in that region are also experiencing severe dengue infection rates. Honduras reports over 15,000 cases with 19 deaths – a state of emergency due to dengue was declared in June. Guatemala – 4,400 cases. Martinique – 5,300 cases since the end of February. Dominican Republic – 4700 dengue cases with 24 deaths. French Guiana – 6300 cases, and Paraguay – nearly 11,000.


Pollution in water surrounding Malé poses serious health risks, warn doctors

Sewerage and contaminants infiltrating the water and reefs around Malé have been a concern for many years, but as the population grows, so does the amount of sewerage going into the water, and the health and environmental risks this could pose are spiralling.

Business Development Manager at the Malé Water and Sewerage Company (MWSC), Hassan Saeed, said waste in Malé is simply “disposed into the sea.”

He said at the moment there is no governing law that prohibits sewerage from being dumped into sea, and it is just being discharged at 50-100 metres below the surface.

Saeed said the seweage is not treated before being discharged, but is collected from households and then directed to the sea.

“So far it’s safe,” Saeed said. “We are discharging it into deep water and the currents take it away from the island.”

He said the MWSC has tested the waters near the swimming tract and artificial beach, and the Ministry of Health has also done independent studies.

He noted that the discharge pipes near the swimming areas have been extended up to 600 metres in length, to ensure they are taken further away from swimmers. “We have tested near the tract and we have found it is safe in that area,” he said.

The issue of safety had been raised before, he said, and added the government is looking into investing in treating the water.

“We are also ready to do that, the treatment of sewage,” he said, “but total investment is very high. We might have to ask the public to pay for it, it’s very costly.”

Saeed explained a lot of land space was needed for a water treatment plant and would require a high investment. He noted the project could also be carried out on a barge, if necessary, but said the cost for that would probably be higher than doing it on land.

“If we have to do it in a floating area, then we will need a lot of investment,” he added.

Garbage around Malé harbour
Garbage around Malé harbour

Medical concerns

Dr Abdul Azeez Yousuf from Malé Health Services Corporation said pollution in the water is a concern, since it is “a question of considerable contamination” and added there is “not an easy solution” to the problem.

He noted that since it’s not just sewerage in the water, but also many chemicals, it could cause many diseases, including ear and throat infections diarrhoeal diseases.

Dr Yousuf said the government had looked into the issue in the past and “have done some damage minimising” to improve the state of the water in the artificial beach and swimming tract.

The biggest problem, Dr Yousuf said, are all the boats in the harbour. “They don’t have proper sewerage disposal,” he said. “It goes straight into the sea.”

Medical doctor at the Central Clinic in Malé, Dr Ahmed Razee, said he has treated cases of gastro-enteritis caused by infections from the water.

“I am able to say very emphatically that yes, people can develop gastro-enteritis from swimming in Malé lagoon,” Dr Razee said.

He noted that “theoretically, the possibility [of getting gastro-enteritis] is very much real,” and “in medicine what we say is if something is possible, it will happen.”

But he added that “as far as the local population is concerned, and people who are continuing to go swimming, even if there was an infection, they would probably all have immunity to it, most of the common organisms.”

He explained it’s like traveller’s diarrhoea, “because you’re not [as vulnerable] to the germs that are in your surroundings.”

Dr Razee said the more “ominous thing is the presence of typhoid in the water and enteric organisms.” He said although enteric typhoid has been almost “wiped out” in Malé, “we do see some sporadic cases.”

He noted though, due to constant travelling between the Maldives and neighbouring Sri Lanka and India, “we cannot definitely say that the few cases we have seen have been locally infected.”

People get typhoid fever from contaminated water, Dr Razee explained, and noted it is a “bacteria which is excreted in the stool, so where the stool goes, the bacteria goes”.

He said “the waters are polluted with bacteria” that could cause digestive infections, and was mostly due to the boats in the customs area of Malé.

“There are a lot of boats which are more or less permanently moored there, and they are using the sea as a toilet,” he said. Additionally, “the sewage that is treated in Malé is not treated to eliminate bacteria, so it’s almost raw sewage, in an unrecognisable form, that is being let out into the sea.”

Dr Ramzee was considerably angry at those working in sewerage disposal. “These people are making so much profit, where is their social responsibility?”

“They, as professionals and scientists, know they are not doing what they are supposed to be scientifically doing,” he said, adding “it is the responsibility of the sewage company to ensure they do not pollute the water. They make millions of dollars out of these poor folks.”

Media Coordinator for Indira Gandhi Memorial Hospital (IGMH) Zeenath Ali Habib said “we haven’t got any cases regarding the matter” and it is “not a concern” for the hospital.

Environmental impact

fish feeding off sewerage which is discharged every half an hour
Fish feeding off sewerage vented from a Male outlet

Ali Rilwan from environmental NGO Bluepeace says his organisation is “concerned with the contamination from sewage” seeping into the coral around Malé reef.

Rilwan said “there are all sort of things” contaminating the water, including heavy metals. The contaminants are reaching Malé reef from five outlets, he said, noting that “the reef is decaying.”

Another major concern is these contaminants reaching people through the food chain; if the fish get infected, people who eat it could also be infected.

Photographs courtesy of