News
Dengue battle costs billions – so why the soaring deaths?
At the age of 27, K.D. Niroshini from Ferguson’s Road, Colombo 15 has been left a widow with a nine-year old son and is expecting another child. Her husband, 29 year-old R.K. Ranjith, lovingly called Ranji, died of dengue haemorrhagic fever.
The illness took his life last week when both he and Niroshini were distracted with worry over their only son Ravindu Dilshan who was suffering from dengue fever.
“I was with our son as he was being treated at the Lady Ridgeway Hospital. But Ranjith made sure he saw us during the morning,
Niroshini: In mourning
afternoon and evening visiting hours. He also had fever and was taking medicine for this but ignored his own health concerns because he was worried about our son,” said the mourning wife.
Following a blood test, Ranjith was admitted to the National Hospital in Colombo. Just a day after being admitted he was moved to the Intensive Care Unit where he died, leaving his pregnant wife and child alone.
Dengue has killed more than 700 adults and children since 2010. Last year there were 85 recorded dengue deaths. During the past four years, 138,910 positive dengue cases have been reported to the Epidemiology Unit of the Health Ministry. Last year there were 31,876 dengue cases reported. In January this year alone there were 3,200 cases recorded.
Associations and unions in the health sector charge that despite major financial allocations both by the Treasury and international bodies such as the European Union and World Health Organisation, lack of co-ordination among local institutions has resulted in the high mortality rate.
President of the Health Services Trade Union Alliance, Saman Ratnapriya said dengue control programmes had been unsuccessful as they had not been carried out in many government institutions, abandoned properties, construction sites, schools, flats and apartments that are providing larger breeding spaces. He said the hospital system was well equipped with facilities to treat dengue patients but the weakness was the poor quality of prevention mechanisms.
“Fogging, distribution of leaflets to residents and having a prevention week with inspections is not enough in order to control a disease that has a risk of reaching epidemic proportions. It should be a continuous programme, especially prior to the rainy season and thorough checking and monitoring should be done,” Mr. Ratnapriya said, adding that there was a lack of co-ordination among the health, education, environment ministries and local governments.
When will we ever learn: Mosquito breeding grounds in Colombo. Pix by M.A. Pushpa Kumara
“Within the Health Ministry, there is the National Dengue Control Unit, the epidemiology unit, the malaria and communicable diseases units, there are local government Medical Officers of Health and Public Health Inspectors as well as the ministry’s own Public Health Inspectors. But there is lack of co-ordination among these units and they are working independently,” he said.
The lack of co-ordination and planning on prevention measures among the institutions led authorities to spend only Rs. 97 million out of the Rs. 300 million allocated for dengue control in 2012.
Mr Ratnapriya said that research and studies on data had not been given importance.
“The efforts of research teams at the Dengue Research Centre at Sri Jayawardenapura University and the faculties of medicine in Kelaniya, the Industrial Technology Institute (ITI) and Peradeniya University should be given more prominence,” he said.
The Sunday Times learns that the country is also short on entomologists specialising in vector-borne disease. (entomology is the scientific study of insects).
Entomology Officers Association Secretary K.D.N. Sumanasena said the country has only five qualified entomologists and 107 assistant
entomologists.
Assistant entomologists are those who have completed their Advanced Level studies in the science stream and followed a two-year diploma in medical entomology. Sri Lanka does not have a medical entomology degree with vector-borne disease entomology as specialty. Here, an entomologist is one who has a special degree in zoology with entomology as a subject.
Colombo district, which recorded 10, 783 dengue cases last year, has only two entomological assistants; Gampaha district has three and five entomology assistants are attached to the Medical Research Institute (MRI).
“Entomologists should be deployed in high-risk areas to collect mosquito larvae and conduct tests and assist in research. They also carry out studies on the usage of larvicides such as Bacillus thuringiensis israelensis (Bti), mosquito repellents etc. Despite having financial allocation, there is a need of human resources and more research,”Mr Sumanasena said.
He said the main breeding spots in Colombo district are water receptacles varying from yogurt cups to rain gutters, air conditioning and refrigerator trays while in Gampaha district they are natural breeding spots such as water retention plants and trees.
He said mosquito larvae had been found in government institutions, schools, construction sites, hostels and even hospitals.
The Western Province is the most affected by the dengue menace. Most of the deaths and cases have been reported in the Colombo and Gampaha districts with thousands of cases reporting annually.
According to Western Province Director of Health Dr. Amal Harsha de Silva, the annual social cost incurred due to dengue is Rs. 7 billion. This includes man-hours spent in hospitals and costs incurred in the treatment of dengue patients, mosquito coils, air-condition machines to prevent mosquitoes, import of Bti and other larvicide, spraying, fogging and fumigating equipment, awareness programmes and recruiting labourers for dengue control work. “There is a need to strengthen monitoring of apartment complexes and construction sites. Government flats with sunshades hold a lot of dry leaves and debris that trigger mosquito breeding. Recently a construction site near the BMICH was warned as there were 60 dengue cases. The public should be cautious when there are building sites in the neighbourhood,” he said.
Dr. de Silva said government institutions such as the Kolonnawa oil refinery and Railways Department had been warned.
He said that under a new strategy “Land for sale” notices would be put up on abandoned lands in order to get a response from ignorant owners.
Plans were in train to import and spray Bti in order to control the menace especially ahead of the possible mid-year outbreak. The Health Ministry has stated the annual cost of Bti would be more than Rs. 2 billion for ground spraying and aerial fogging.
The ministry said imports of Bti had been halted due to both costs and opposition from local producers.
“Local production is not sufficient in order to have an impact. Therefore imports of Bti are under discussion again,” he said. “But,” he added, the effect of Bti does not last long. The only way is to prevent breeding and destroying breeding spots.”
According to Dr. de Silva, the cost to the government for treating a dengue patient in the Intensive Care Unit is about Rs. 50,000-60,000 a day.