Dengue fever continues to be a dominant public health concern in Pakistan and health and agriculture experts have said that the disease could prove challenging to cope with.
Health providers in Pakistan have warned that dengue has the potential to spread in any urban population in a very short period of time. “The endemic dengue could cause public outcry if not controlled effectively,” said University of Agriculture Faisalabad (UAF) expert Dr Khurram Zia.
Last year an outbreak of the disease was witnessed in Pakistan and health experts from all over the country have expressed concern over the situation for this year. “It is a valid question. Is the worst over or is it still to come?” Zia said.
A team of experts, comprising Dr Aftab Hussain, Dr Waseem Akram, and Dr Khurram Zia, from the UAF recently conducted an in-depth study, “dengue Fever: Is the worst is over?”. The experts said that the local governments, municipalities, counties and city administrations were the major agencies involved in public health in developing countries and that these offices lacked the resources to effectively cope with such an epidemic. “The federal government needs to provide assistance and technical/financial resources to help health departments in the lesser developed areas to cope with such an outbreak,” Dr Hussain said.
“We lack such governmental structure in Pakistan. The provincial governmental health department did not anticipate the epidemic situation of dengue. Remedial supplies are insufficient and vector control planes are haphazard,” they added.
“The federal government had no plans to support provincial governments in this regard and there is no coordination between agencies responsible for its control. The Malaria Control Directorate, which works under the federal government health department was completely taken by surprise last year and it barely managed to cope with the epidemic,” the report stated.
“The directorate needs to have a dengue initiative plan this year or we will face the same situation. Given last year’s floods it is likely that the situation will be much worse this year if we are not prepared,” said Dr Waseem Akram.
The report warns that mosquito populations are very likely to increase in the next two years due to the remains of heavy rain and flood waters of 2010.
“The conditions are prime for mosquito breeding. We are likely to see a tangible increase in the mosquito population in the next few years. This can only be prevented by reducing and eliminating ponds and swamps.”
The experts noted that “somehow, possibly due to deforestation and development of urban dwellings by humans the virus has moved from jungles to the human population.
The dengue virus has been spreading from one population to another by a native mosquito species, the Aedes albopictus (Aisan Tiger mosquito) and Aedes aegypti mosquito epidemics occurred.”
They pointed out that “in both urban and suburban settings, dengue morbidity continues to rise for the last five years in Pakistan. This was facilitated by unplanned urbanisation in tropical developing countries, modern transportation, lack of effective mosquito control and globalization.
As we enter the 21st century, epidemic DF/DHF is one of the most notorious infectious diseases affecting tropical urban areas.”
The study revealed that “each year an estimated 50-100 million dengue infections have been reported from around the world and 20,000 to 25,000 deaths involve children.” Dengue has the potential to have an economic impact rivalling that of malaria, with regards to the economy of developing nations. “As of today, there are no vaccines or antiviral drugs available for dengue viruses. The only way to combat this disease is to control the mosquito vector by a well planned pest management strategy,” said Zia.
Referring to the 2010 floods in Pakistan and heavy rains, the experts opined that “it might contribute to the rise of dengue morbidity and mortalities this year.”
“There is no denying that we need to put measures in place to deal with Dengue now. We cannot wait for it to sideline us like last time,” said Dr Zubair, who works at the Faisalabad DHQ hospital.
In some communities, basic health facilities like rural health clinics are needed and an understanding of local community attitudes is also important to secure public involvement in combating the virus.
A strong public outreach message with a vigorous campaign is needed to address the issue. Involvement of students, private organizations, NGOs and other community groups can be of great asset to this cause.
Dengue control in Pakistan needs to be addressed the same way the Roll Back Malaria (RBM) initiative has been launched in different countries. This initiative is exceptional because it takes all communities and state bodies on board. The campaign involves schools, health departments, the media and policy makers to launch a comprehensive strategy. “That is what we need for Dengue. It is the only way we will be able to counter the tide,” the experts said.
“There is no denying that we will have to deal with the Dengue virus again this year and it could be worse than last year if we are not prepared,” said Zia.
Published in The Express Tribune, April 16th, 2011.
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