ecosystem approach to dengue control
TRANSCRIPT
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ECOSYSTEM APPROACH TO DENGUE CONTROLPETALING DISTRICT
DR.MOHAMED PAID YUSOFPUBLIC HEALTH MEDICINE SPECIALIST
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PROBLEM: DENGUE
▪ Dengue is a common tropical disease affecting many different countriesglobally and is a major public health burden worldwide.
▪ Malaysia is among those countries that are worse affected, withrecorded cases rising from 32 cases per 100,000 population in 2000 to361 cases per 100,000 population in 2014.
▪ Until June 2016, Selangor state was the major contributor to the nationalburden with more than half of the cases recorded belonging to Selangor.
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DENGUE SITUATION IN MALAYSIA, UP TO EPIDEMIOLOGY WEEK 22, 2016
State Case DeathPerlis 83 1Kedah 356 1Penang 1,765 10Perak 1,945 4Selangor 27,166 44Federal Territory of Kuala Lumpur & Putrajaya 3,712 5Negeri Sembilan 1,358 10Melaka 1,029 1Johor 6,857 10Pahang 1,231 6Terengganu 1,519 13Kelantan 1,064 1Sarawak 1,216 4Sabah 1,296 1Labuan 3 0Malaysia 50,600 111
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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-seekingbehaviour.
▪ Community participation and community education campaigns andenforcement via premise inspections for mosquito breeding sites havebeen introduced to increase dengue awareness and preventive efforts
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DENGUE CONTROL
▪ However, the efforts has not diminished the mosquitopopulation nor disease burden.
▪ Most of the dengue cases reported were mainly fromthe urbanites where factors such as high densitypopulation and rapid development favour denguetransmission.
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THE CHALLENGES OF DENGUE CONTROL PROGRAMME IN PETALING DISTRICT
▪ Mainly due to the effect of urbanisation and rapiddevelopment 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.
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SETTING: PETALING DISTRICT
▪ Petaling District is a district located in the state of Selangorin Malaysia.
▪ Middle of Klang Valley.
▪ Hub of Malaysian industries and commerce.
▪ Encompasses an area of 484.32 km², population in 20141,928,900; Malays (51%); China (35%); India (12%); Others (2%)and a population density of 3,700/km².
▪ Highly urbanized district Divided and delegated into thethree local municipalities:▪ Majlis Bandaraya Shah Alam; Majlis Bandaraya Petaling
Jaya and Majlis Perbandaran Subang Jaya
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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 inFigure 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.
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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.
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APPROACH PRIOR TO 2015….
▪ Case based approach
▪ Control activities carried out were according to number of casesnotified to the District Health Office.
▪ Problem:
▪ Coverage was; ScatteredAccording to casesGeographically 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.
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“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
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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 ecosystemsii. Petaling Jaya Town Council - 7 ecosystemsiii. Subang Jaya Town Council - 5 ecosystems
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ECOSYSTEM APPROACH TO DENGUE CONTROL
▪ Each ecosystem is further divided into localities. District of Petaling has2,023 localities and each ecosystem has different number of localities.
▪ For example, ecosystem 1 has 138 localities and ecosystem 2 has 85localities.
PBT Ecosystem No. of locality
MBSA 5 702
MBPJ 7 538
MPSJ 5 783
Total 17 2,023
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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)
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ECOSYSTEM APPROACH TO DENGUE CONTROL
▪ Each ecosystem is placed under an Assistant Officer ofEnvironmental 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 Assistantsand a General Assistant
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ECOSYSTEM APPROACH TO DENGUE CONTROL
▪ This decentralized, community based approach centres aroundenvironmental management based on risk assessment.
▪ The risk assessment for each ecosystem identifies the localityat risk by spotting conditions such as;▪ Open land▪ Abandoned house▪ Blocked drainage▪ Common public area▪ Construction sites▪ Stores
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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 includinghealth authorities, town council, enforcement officers, volunteers, non-governmental organizations and community in the specific locality.
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ECOSYSTEM APPROACH: RELEVANT CHANGES
0
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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
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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.
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LESSONS LEARNT
▪ Preventive and control activities should be flexible and tailoredaccording to the geographical suitability.
▪ Despite large geographical and different municipalities,sufficient human resource and good logistics support makes itpossible to implement the ecosystem approach.
▪ Ideally, each ecosystem has an officer in charge with adequateassistants to carry out respective preventive and controlactivities. However, due to limited staffing, roles are sometimesinterchangeable which may increase workload.
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LESSONS LEARNT
▪ Dengue control is complex, due to factors external to thehealth sector, which are important measures in improvingdisease and dispersal of its vector.
▪ The effectiveness of an ecosystem approach can also bemeasured through peoples’ knowledge, attitude andwillingness to participate in preventive programmes.▪ An overall feedback mechanism on the implemented
programme could also be established to gauge effectivenessof the programme.
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CONCLUSION
▪ Many of the conventional methods to dengue controlare not applicable in high endemic areas
▪ The approach to dengue control should be flexible andtailored according to geographical suitability.
▪ Therefore, the ecosystem approach to dengue control ishighly recommended in these areas.
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