Recently we have been listening a lot about dengue fever in Bangladesh, especially in Dhaka, and the situation seems to be out of control. According to fresh data from DGHS, a total of 24,804 people were admitted to different hospitals across the country including Dhaka between January 1 and August 3 while 17,388 of them were released from hospitals. A total of 7,398 patients are treating treatment at different hospitals across the country right now, according to health emergency operation centre and control room of the DGHS. The viral disease, dengue, has spread in all the 64 districts of Bangladesh.
Everyday hundreds of patients are being admitted in different hospitals as those are running out of accommodations for new patients. Many hospitals have arranged new wards or beds for dengue patients. It seems to be turning towards becoming an epidemic. Dengue is not new in 2019 as we are experiencing the severity of this disease for quite a few years. Not only dengue fever but also several other diseases like; chikungunya, malaria etc have made outbreak during the last few years on several instances. Hence, along with fighting this disease reactively, creating awareness among the citizens with proactive plans got highly required in Bangladesh.
Bangladesh is struggling with its worst outburst of dengue fever in 2019, with hospitals packed with patients as the disease spreads rapidly in the densely-populated country. Dengue is common in South Asia, especially during the monsoon season which runs from June to September and there is no specific treatment but with early detection and access to proper medical care less than 1 per cent of sufferers die from the disease.
Globally, the number of dengue case had dropped in 2017-2018, but there has been a sharp increase in 2019, especially in Australia, Cambodia, China, Laos, Malaysia, Philippines, Singapore, Vietnam and especially Bangladesh. The dengue virus is spread by the Aedes aegypti mosquito which has grown rapidly along with urbanization and globalization because it thrives in tropical mega-cities and is easily spread in goods containing small puddles of water.
Dengue occurred intermittently in Bangladesh from 1964 until a large outbreak in 2000 established the virus. The endemic in 2000 was likely due to introduction of a dengue virus strain from a nearby endemic country, probably Thailand. Cessation of dichlorodiphenyltrichloroethane (DDT) spraying, climatic, socio-demographic and lifestyle factors also contributed to epidemic transmission. The largest number of cases was notified in 2002 and since then reported outbreaks have generally declined, although with increased notifications in alternate years.
The apparent decline might be partially due to public awareness with consequent reduction in mosquito breeding and increased prevalence of immunity. Further, a large number of cases remain undetected because only patients with severe dengue require hospitalization. Thus, the reduction in notification numbers may be a result of the observation system. This year, in 2019, dengue has come out as a great threat and in the future, the nonappearance of active interventions, unplanned urbanization, environmental deterioration, increasing population mobility and economic factors will heighten dengue risk. Projected increases in temperature and rainfall may aggravate this scenario.
Like dengue, chikungunya is another mosquito-borne disease which wrecked the lives of the citizens during the last few years. Chikungunya is a viral infection caused by the CHIK virus belonging to the Togaviridae family. The virus is transmitted through the bite of infected daytime biting female–primarily Aedes aegypti and Aedes albopictus mosquitoes. A major outbreak of chikungunya virus occurred for the first time in Dhaka, Bangladesh between May and September 2017. Many cases were also found in 2018 also and apparently will continue its havoc in the upcoming years also.
CHIKV infection has emerged as a major public health concern since it often affects a large proportion of the population within an outbreak area and causes considerable pain, distress, and anxiety as well as significant economic burden due to severe clinical manifestations. Symptoms of chikungunya include sudden fever and severe muscle and joint pain. They can be accompanied by headache, fatigue nausea, vomiting, and a rash. Other persistent problems may include eye, gastrointestinal, neurological, and heart complications. Persons with chronic health conditions, a weakened immune system, infants, and older persons are at risk of developing complications with this infection. Chikungunya is rarely fatal. Treatment includes supportive care of symptoms. There is no antiviral treatment available.
Malaria, another mosquito-borne disease, is a parasitic infection transmitted by the female Anopheles mosquito, infecting humans and insects alternatively. Caused by four Plasmodium species (P vivax, P falciparum, P ovale and P malariae), malaria is a public health problem in 90 countries around the world, affecting 300 million people and responsible directly for about one million deaths annually. Bangladesh is considered as one of the malaria endemic countries in South Asia.
World Health Organization (WHO) considers malaria to be a major public health concern in Bangladesh. Malaria was nearly wiped out from the country by 1970s but never disappeared in the eastern regions which are associated with tea gardens and forests. It re-emerged as one of the major public health concern in the 1990s and remains so. Malaria transmission is mostly seasonal and concentrated in the border regions of Bangladesh. But with globalization and urbanization, people now frequently move to different parts of the country and the disease cannot be contained at a particular region.
We are lucky that other than the mosquito-borne diseases, no other animal or creature borne diseases like; mad cow disease were found as endemic in Bangladesh till now. But other than these mosquito-borne diseases many other communicable and non-communicable diseases are increasing rapidly in Bangladesh. Among them tuberculosis, chronic kidney diseases, heart attacks, brain strokes, lungs infections, respiratory diseases continues to spread their claws in Bangladesh due to different environmental factors.
Though in the case of dengue in 2019, many lapses from the side of the government were identified, especially from the part of two Dhaka city mayors, it is true that eliminating dengue or chikungunya like diseases is very difficult. But with good intent and commitment to the people, the two mayors could have controlled the severity. The court as well as the Prime Minister Sheikh Hasina had to intervene to make them work which was very unfortunate and more unfortunate was the mayors’ media stunt where they were found to get involved in the mosquito cleaning process by themselves.
Even during the British rule, anti-mosquito medicines were sprayed even at the remotest villages. Awareness was created by throwing leaflets from the helicopters. Almost every household of the country was covered by anti-mosquito drives. We had seen such drives in our childhood. But many of us, in this era of modernization have never seen any such drives though we pay several types of city corporation taxes. The city corporation workers were rarely found during the last few years to spray anti-mosquito medicines. Moreover, their medicines are completely outdated considering the breed of today’s mosquitoes. Added to that, the city corporations even do not use the prescribed quantity of the outdated medicines and hence city corporations cannot make us win the war against mosquitoes. After more than 50 deaths, they are now in the process of evaluation and purchase of modern medicines.
Creating awareness among the citizens has become the top most priority to fight epidemics like dengue or chikungunya. But due to weather and geological factors added with unplanned urbanization, we cannot eliminate these diseases completely. Hence, we need to familiarize our people especially the next generation with different aspects of these diseases – how these diseases spread, which mosquitoes cause these disease and where these are born, what preventive measures should be taken etc.
In USA, the government has already declared alert for EEE (Eastern Equine Encephalitis virus) – a rare and potentially fatal disease transmitted from animals to humans via mosquito bites. It causes inflammation of the brain. The government there is trying to aware the citizens of the causes, effects and measures to fight EEE even before it turned serious. Unfortunately our children and even elders are not familiar with this sort of knowledge until and unless severely harmed. A child in Japan, for example, is well aware of different types of insects or animals which cause harm for the humans as they are taught these matters in schools. But we do not have such education for our children.
We should prepare a curriculum which will inform the children over common but critical diseases and the necessary preventive measures. Then these children can alter the plans of these diseases in the future. Here sharing the knowledge and creating a mindset to become alert is the key. Many of us received several instructions to save ourselves from dengue through social media but we rarely follow any of those. Hence we lack intent to fight these diseases inside. Moreover, we need to prepare teams at every locality to run cleanliness drives to eliminate breeding zones of dengue or chikungunya causing mosquitoes. We need to involve ourselves as we cannot rely on our mayors and our Prime Minister cannot fight all battles by herself.
We must educate ourselves and take actions as required to eliminate and contain the threats of diseases like dengue and also create awareness against environmental and food hazards as we are continuously getting victimized by pollutions and food adulteration. Our medical cost is going above the cost of our food and clothing. We are turning into an unhealthy nation and the scenario is much worse for our future generation.
We have been achieving tremendous success in different fields of development under the leadership of Prime Minister Sheikh Hasina. But to secure, safeguard and sustain these developments, we need to secure our health. If we do not better in human indices, we will not be able to sustain our progress. Hence, we hope people will turn into human assets with good health and sound mind with the defeat of diseases like dengue.
The writer is Chief Editor at Mohammadi News Agency (MNA), Editor at Kishore Bangla and Vice-Chairman, Democracy Research Center (DRC)