Maldives holds regional record as malaria-free zone

The Maldives holds South-East Asia’s record for being malaria-free. Meanwhile, the region is falling behind as one-third of affected countries show signs of eliminating the vector-borne disease over the next ten years.

Dr Robert Newman, director of the Global Malaria Program of World Health Organisation (WHO) said malaria control has improved significantly. “The world has made remarkable progress with malaria control. Better diagnostic testing and surveillance has shown that there are countries eliminating malaria in all endemic regions of the world.”

Malaria affects 40 percent of the world population. While the Maldives had a volatile track record in the 1970s, peaking at 1100 cases in 1976, virtually no cases of local origins have been reported since 1984.

Director General of Health Services Dr. Ibrahim Yasir said the only malaria cases have involved foreigners or Maldivians who have traveled to regions where the disease is endemic.

“A few times a year a foreigner might come who has been infected elsewhere, or in a recent case a Maldivian boat capsized near Africa and those on board contracted malaria and were treated here,” he said.

Yasir noted that the interiors of transport vehicles coming from malaria-infected locations are sprayed with a disinfectant to prevent accidental importing of the bug.

Certain countries that share regular traffic with the Maldives are showing worrisome resistance to malaria elimination.

According to an article published by Times of India today, Roll Back Malaria Partnership (RBM)’s latest report says that high rates in India, Indonesia and Myanmar have kept South East Asia’s malaria report rate stable while other regions see a declining report rate.

RBM’s report compares 5,200,000 probable and confirmed cases of malaria in 2000 in India against 5,000,000 in 2010. A WHO fact sheet, however, notes that 2 million fewer cases of death due to malaria were reported for the same time period.

Sri Lanka and Korea are in the pre-elimination phase.

Malaria elimination – the deliberate prevention of mosquito-borne malaria transmission resulting in zero incidence of infection in a defined geographical area – was first attempted at large scale during the Global Malaria Eradication Program from 1955 to 1972.

WHO certified 20 countries as malaria-free during this time, however in the 30 years that followed efforts to control the disease deteriorated and only four countries were certified.

During the 1970s, the Maldives successfully eliminated the malaria-carrying mosquito. It continues to combat the dengue-carrying mosquito, however, and several outbreaks have claimed 11 lives this year, making 2011 the worst year on record for dengue fatalities.

Among the factors that prevent the elimination of malaria, dengue and other viral diseases is the over-use of antibiotics. At the 64th meeting of the Regional Committee for South-East Asia in September, members suggested that overuse of antibiotics was making diseases harder to treat.

In 2010, WHO introduced a program combatting the reflexive practice of prescribing anti-malarials to any child with a fever. “Anti-malarial treatment without diagnostic confirmation means poor care for patients. It masks other deadly childhood illnesses, wastes precious medicines, hastens the inevitable emergence of drug-resistant parasites and makes it impossible to know the actual burden of malaria.”

In a previous interview with Minivan News, ADK Chief Operating Officer Ahmed Jamsheed called antibiotics “the most misused drug in the Maldives,” and warned that the trend could put Maldivians more at risk for dengue fever and chikungunya, as well as viral diseases.


Dengue hospital situation “stable”, despite high patient demand

Hospitals in the capital have said they continue to screen significant numbers of patients for dengue fever, yet claim that the situation remains “stable” as authorities raise fears that an ongoing outbreak of the virus may be more persistent than originally thought.

As officials today confirmed that a 41 year old man from Addu Atoll had become the eighth person to have died during the latest dengue outbreak, health care representatives in the capital have said that they remain “busy” dealing with cases and had not yet seen significant declines in patients coming through their doors suspected of contracting the virus.

After declaring this week that the current outbreak of the virus around Male’ and several islands was being treated as an “epidemic”, the government has since established a task force to try and coordinate its ministries, the military and NGOs in preventing further spreads of dengue. The task force was originally budgeted to run for seven days, by which time the situation was expected to be under control.

However, upon admitting yesterday that the suspected number of dengue cases in the country had slightly risen after a perceived fall in infection rates earlier during the week, a media spokesperson for the task force suggested that the operations were now likely to run beyond the original seven day time-frame.

Meanwhile, for hospitals on the front-line of dealing with the “epidemic,” the Clinic, a Male’-based private hospital, has said it has been busy collaborating with the task force in trying to identify infection cases.

A spokesperson for the Clinic, which begun offering free dengue fever screening services on Tuesday (July 5), said it was continuing to receive a steady number of patients looking for dengue testing and had been working to the emergency protocols recently imposed by the government.

“At the moment I don’t think we are seeing the number of patients [with suspected dengue] going down,” she said. “From the first day [of the screening service], we have received large number of pediatric enquiries regarding dengue infections among children, though adults are coming for testing now in large numbers.“

Panic fears

The Clinic spokesperson revealed that the medical centre remained concerned about the impact panic was having on the general public.  She said this this concern reflected the limited amount of knowledge about the symptoms and severity of dengue fever within Maldivian society as a whole.

“Trying to create knowledge [about dengue] among the public is one of the main challenges we are facing. People who may have symptoms are sometimes sitting at home and relaxing trying to overcome the fever, which means that some cases of the virus are being missed,” she said.

“Dengue fever has to be better managed by people. Members of the public with the virus need to take more fluids, but they are lacking awareness of this.”

The spokesperson added that the Clinic was currently working to put together a leaflet that she said would try and provide more details about the virus.  During the current panic over dengue infections, the Clinic spokesperson suggested that some members of the public were staying at home instead of coming to be checked.

Despite concerns that the public may begin inundating hospitals beyond their capacity as a result of panic over the virus, Cathy Waters, Chief Executive of Male’s Indira Gandhi Memorial Hospital (IGMH) said that increased patient numbers were to be expected during an outbreak like that presently taking place in the country.

“We have seen a lot of children being bought in by relatives because of the virus. I think that some panic is to be expected as people are concerned about dengue, but the situation is definitely stable here at the hospital,” she said. “I think the message has got out about the virus and its symptoms and people are responding to this.”

In trying to treat patients found to be suffering from the effects of dengue, Waters said that the hospital had moved to adapt additional wards and services to dealing specifically on trying to deal with the ongoing dengue outbreak, yet she added that the overall situation was under control.

“At the moment we would describe the situation as relatively stable, but definitely very busy here,” said the hospital chief executive. “We have set up an additional fever clinic, which means people can be seen relatively quickly for testing and then be given the necessary treatment.”

Waters added that the current dengue situation had required the hospital to develop contingency plans to allow for the provision of increased bed capacity as well as bringing in additional nurses to cope with demand.

The hospital chief executive said that this had in certain cases meant that some surgeries had to be cancelled to accommodate dengue testing and treatment, a situation that would continue to be reviewed regularly to ensure patient demands were being met as best fitted the situation.

The government taskforce has said that it is expecting to address members of the media concerning the latest developments later this evening.

While pledging to support efforts to try and cut dengue infection rates in the country, opposition politicians have been critical of the speed by which the government has responded to the present outbreak.

Ibrahim ‘Mavota’ Shareef, Spokesperson for the opposition Dhivehi Rayyithunge Party (DRP), saidthat he believed that the government had “bungled” their response to trying to control dengue fever.

“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.”