Dengue situation: Govt did not pay heed to WHO's advice

Dengue patients are seen inside mosquito curtains at a hospitalFile photo

World Health Organisation (WHO) consultant K Krishnamurthy had requested the Bangladesh government to make a concerted effort to mitigate dengue in 2017. The government did not take any initiative then. The agency's senior entomologist BN Nagpal also provided the government with several specific recommendations to curb Aedes mosquitoes in the country. The government did not pay heed to that advice as well.

Experts say, the Ministry of Local Government and the Ministry of Health have been working to control dengue, apparently to solve the problem as a stopgap measure. There is no coordination in their work. This has resulted in dengue spreading all over the country.

Earlier dengue was limited to Dhaka city only. Some dengue patients were diagnosed in big cities like Chattogram and Khulna. But the disease rapidly propagated in more than 50 districts across the country. More than 44 districts recorded dengue cases though the season when the disease peaks has not started as yet.

Public health experts say that dengue virus and vector mosquitoes are breeding all over the country. All the people are now at risk of contracting dengue across the country.

Where is the situation heading?

Bangladesh witnessed the first large-scale outbreak of dengue in 2000. The people of the country, the medical community and the government were not prepared for this. According to the government, 5,551 people were infected with dengue that year and 93 people died. Dengue cases and deaths have been rampant since then. However, no deaths were recorded from 2007 to 2011. Last year recorded the highest number of deaths, at 281.

According to government accounts, the situation has exacerbated compared to last year. In the first five months of last year, from January to May, 352 people were infected with no deaths recorded. In less than five months this year, a total of 1,487 people have been infected, and the death toll has already reached 13. The dengue season has not yet started. Public health experts fear that the situation will worsen after the monsoon begins.

According to the Department of Health, 46 people were admitted to the hospital with dengue in the previous 24 hours till 8:00 am on Tuesday. Of them 41 are from Dhaka.

Public health professor Be-Nazir Ahmed told Prothom Alo, entomologists and laboratories are required in city corporations and municipalities to contain Aedes mosquitoes. The quality of insecticides used to repel mosquitoes has always been a matter of question. Third, the methods used to control mosquitoes in the country have not been scientifically proven to be effective. He also said that the dengue virus is transmitted through mosquitoes all over the country. Currently, reining in both mosquitoes and dengue has become increasingly challenging.

Health directorate’s initiatives

According to the disease control department of the Directorate General of Health Services (DGHS), at the end of this month, they will conduct a survey to assess the population density of Aedes mosquitoes and identify areas with a higher density. They conduct this survey every year at the beginning of the monsoon.

Md Ekramul Haque, deputy programme manager (DPM) of the malaria elimination programme under DGHS, said that the directors of all the government hospitals in Dhaka have been called to attend a meeting at the Directorate on Thursday. The meeting will discuss the preparation of the hospitals for dengue treatment and management.

Officials of the directorate say that physicians from all over the country are being trained on dengue treatment online. Apart from this, preparations have been made to train physicians by bringing them to Dhaka.

Two city corporations of Dhaka are conducting awareness programmes, campaigns and pest control activities to control dengue. However, the effectiveness of these activities has been limited. The number of effective initiatives at the district and upazila levels of the country is significantly lower.

Suggestions by WHO experts

Ekramul Haque, an official of the DGHS, said that due to climate change, there is a favourable environment for the survival of Aedes mosquitoes like other pests. Alleviating Aedes mosquito or dengue has therefore become harder. However, the government is moving towards long-term planning.

In 2017, WHO consultant K Krishnamurthy submitted a 22-page report to the government. The report contained measures to be taken at the national and local level. There were more than 20 recommendations as well. The report specified measures to be taken by 12 ministries separately. It also had suggestions on how to engage journalists and the media in the event of a dengue outbreak. These recommendations were to be implemented by 2019.

Dengue spread widely in the country in 2019 before the start of the Covid outbreak. Then the World Health Organization sent its senior entomologist BN Nagpal to Dhaka to advise the government. He addressed several meetings on the characteristics of Aedes mosquito and methods of eliminating this mosquito. Referring to the significance of making the people aware, he said that many people work together in the construction project area. Dengue spreads rapidly through infected workers. Dengue can be reduced by 40 per cent if it is possible to destroy the breeding grounds of mosquitoes in construction project areas.

Aedes mosquitoes and dengue cannot be eradicated and controlled by acting on an ad hoc basis or in response to particular incidents, said public health professor Be-Nazir Ahmed. If the government listens to the advice of local and foreign experts, the risk of dengue will be mitigated.

* The report, originally published in the print edition of Prothom Alo, has been rewritten in English by Farjana Liakat