Ecosystem approach to dengue control
- 1. ECOSYSTEM APPROACH TO DENGUE CONTROL PETALING DISTRICT DR.MOHAMED PAID YUSOF PUBLIC HEALTH MEDICINE SPECIALIST
- 2. PROBLEM: DENGUE ▪ Dengue is a common tropical disease affecting many different countries globally and is a major public health burden worldwide. ▪ Malaysia is among those countries that are worse affected, with recorded cases rising from 32 cases per 100,000 population in 2000 to 361 cases per 100,000 population in 2014. ▪ Until June 2016, Selangor state was the major contributor to the national burden with more than half of the cases recorded belonging to Selangor.
- 3. DENGUE SITUATION IN MALAYSIA, UP TO EPIDEMIOLOGY WEEK 22, 2016 State Case Death Perlis 83 1 Kedah 356 1 Penang 1,765 10 Perak 1,945 4 Selangor 27,166 44 Federal Territory of Kuala Lumpur & Putrajaya 3,712 5 Negeri Sembilan 1,358 10 Melaka 1,029 1 Johor 6,857 10 Pahang 1,231 6 Terengganu 1,519 13 Kelantan 1,064 1 Sarawak 1,216 4 Sabah 1,296 1 Labuan 3 0 Malaysia 50,600 111
- 4. DENGUE CONTROL ▪ Dengue control programmes consist of 3 major components; ▪ Vector control, ▪ Monitoring and surveillance ▪ Community participation and enforcement ▪ Monitoring and surveillance has led to better reporting of the disease, more widespread public knowledge an early treatment-seeking behaviour. ▪ Community participation and community education campaigns and enforcement via premise inspections for mosquito breeding sites have been introduced to increase dengue awareness and preventive efforts
- 5. DENGUE CONTROL ▪ However, the efforts has not diminished the mosquito population nor disease burden. ▪ Most of the dengue cases reported were mainly from the urbanites where factors such as high density population and rapid development favour dengue transmission.
- 6. THE CHALLENGES OF DENGUE CONTROL PROGRAMME IN PETALING DISTRICT ▪ Mainly due to the effect of urbanisation and rapid development which includes: ▪ Indiscriminate dumping of garbage results from poor garbage maintenance particularly in the low to medium cost apartments. ▪ Construction site acts as a breeding ground for the mosquitoes. ▪ Difficulty in starting and sustaining community mobilization programme among the community. ▪ Intermittent rain and hot weather that promote good environment for mosquitoes breeding.
- 7. SETTING: PETALING DISTRICT ▪ Petaling District is a district located in the state of Selangor in Malaysia. ▪ Middle of Klang Valley. ▪ Hub of Malaysian industries and commerce. ▪ Encompasses an area of 484.32 km², population in 2014 1,928,900; Malays (51%); China (35%); India (12%); Others (2%) and a population density of 3,700/km². ▪ Highly urbanized district Divided and delegated into the three local municipalities: ▪ Majlis Bandaraya Shah Alam; Majlis Bandaraya Petaling Jaya and Majlis Perbandaran Subang Jaya
- 8. BURDEN OF DISEASE ▪ The dengue incidence in Petaling District is almost four times that of the national figure, which is 1,205 cases per 100,000 population. ▪ The dengue cases also continued to rise exponentially in 2014 onwards as shown in Figure 1. 0 5000 10000 15000 20000 25000 30000 2011 2012 2013 2014 2015 Denggi Denggi Berdarah Mati Dengue Fever Dengue Hemorrhagic Fever Figure 1: Number of dengue cases from 2011 to 2015 in Petaling district.
- 9. BURDEN OF DISEASE ▪ In comparison with all the health districts in Malaysia, Petaling district was at the top rank with 233 case reported in epid week 22 0 50 100 150 200 250 Petaling Hulu Langat Johor Bahru Klang Gombak Sibu Kepong Sepang Seremban Titiwangsa Lembah Pantai Hulu Selangor Kuantan Kinta Cheras Total Case Figure 2 : Top 15 Dengue Cases reported according to district in Malaysia, Epid week 22, 2016.
- 10. APPROACH PRIOR TO 2015…. ▪ Case based approach ▪ Control activities carried out were according to number of cases notified to the District Health Office. ▪ Problem: ▪ Coverage was; Scattered According to cases Geographically limited. ▪ There were no preventive measures in place. ▪ Successful broad scale application was a challenge for the health office. ▪ Approach to dengue control was more reactive than preventive.
- 11. “GREATER EMPHASIS SHOULD BE PLACED ON PROACTIVE STRATEGIES THAT AIM TO PREVENT, DIMINISH, OR ELIMINATE TRANSMISSION” ACHEE ET AL, CRITICAL ASSESSMENT OF VECTOR CONTROL FOR DENGUE PREVENTION 2015
- 12. AFTER 2015… ▪ The ecosystem approach was introduced in Petaling District. ▪ Novel approach to combat dengue due to the rising incidence of the disease. ▪ Petaling was the sole health office that applied this system in a district wide scale. ▪ Under this approach, the district was divided into 17 ecosystems in its 3 town councils: i. Shah Alam Town Council - 5 ecosystems ii. Petaling Jaya Town Council - 7 ecosystems iii. Subang Jaya Town Council - 5 ecosystems
- 13. ECOSYSTEM APPROACH TO DENGUE CONTROL ▪ Each ecosystem is further divided into localities. District of Petaling has 2,023 localities and each ecosystem has different number of localities. ▪ For example, ecosystem 1 has 138 localities and ecosystem 2 has 85 localities. PBT Ecosystem No. of locality MBSA 5 702 MBPJ 7 538 MPSJ 5 783 Total 17 2,023
- 14. LOCALITIES IN SHAH ALAM TOWN COUNCIL ECO 4 (171 Localities) ECO 5 (260 Localities) ECO 1 (138 Localities) ECO 2 (85 Localities) ECO 3 (47 Localities)
- 15. ECOSYSTEM APPROACH TO DENGUE CONTROL ▪ Each ecosystem is placed under an Assistant Officer of Environmental Health ▪ Who plans and coordinates prevention and control activities ▪ Need to be familiar and well equipped with knowledge of their respective ecosystem ▪ Identify problematic localities. ▪ Each officer is supported by a team of Public Health Assistants and a General Assistant
- 16. ECOSYSTEM APPROACH TO DENGUE CONTROL ▪ This decentralized, community based approach centres around environmental management based on risk assessment. ▪ The risk assessment for each ecosystem identifies the locality at risk by spotting conditions such as; ▪ Open land ▪ Abandoned house ▪ Blocked drainage ▪ Common public area ▪ Construction sites ▪ Stores
- 17. ECOSYSTEM APPROACH: MAIN ACTIVITIES ▪ The main activities in the ecosystem approach focuses on prevention, rather than control. ▪ Preventive activities include; ▪ Destruction of breeding sites ▪ Larvaciding ▪ Ultra-low volume fogging ▪ Community clean up ▪ Health education and awareness ▪ The planned preventive activities involve multiple agencies including health authorities, town council, enforcement officers, volunteers, non- governmental organizations and community in the specific locality.
- 18. ECOSYSTEM APPROACH: RELEVANT CHANGES 0 200 400 600 800 1000 1200 1400 1600 1800 2000 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 2014 2015 2016 Figure 3: Number of dengue cases notification from 2014 to 2016 according to Epidemiological Week, Petaling district, Selangor
- 19. ECOSYSTEM APPROACH: RELEVANT CHANGES ▪ Vector control teams provided personalized and comprehensive care according to ecosystem needs ▪ Expected to know the environment, community and its risks well enough to coordinate activities. ▪ Encourages and improves community participation which is vital for the battle against dengue. ▪ There was a shift away from a standard nationwide ‘top-down’ approach to ▪ Risk based ▪ Multi-agency and community partnership ▪ To resolve environmental sanitation and vector control problems.
- 20. LESSONS LEARNT ▪ Preventive and control activities should be flexible and tailored according to the geographical suitability. ▪ Despite large geographical and different municipalities, sufficient human resource and good logistics support makes it possible to implement the ecosystem approach. ▪ Ideally, each ecosystem has an officer in charge with adequate assistants to carry out respective preventive and control activities. However, due to limited staffing, roles are sometimes interchangeable which may increase workload.
- 21. LESSONS LEARNT ▪ Dengue control is complex, due to factors external to the health sector, which are important measures in improving disease and dispersal of its vector. ▪ The effectiveness of an ecosystem approach can also be measured through peoples’ knowledge, attitude and willingness to participate in preventive programmes. ▪ An overall feedback mechanism on the implemented programme could also be established to gauge effectiveness of the programme.
- 22. CONCLUSION ▪ Many of the conventional methods to dengue control are not applicable in high endemic areas ▪ The approach to dengue control should be flexible and tailored according to geographical suitability. ▪ Therefore, the ecosystem approach to dengue control is highly recommended in these areas.