Institutional Profile of 2013 - National Dengue Control Unit

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National Dengue Control Unit

2013Institutional Profile

Ministry of Health , Sri Lanka


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Contributors

Dr.Hasitha Tissera

Dr.Nimalka Pannila Hetti

Dr.Nayana De Alwis

Dr. M.P.Pubudu U. Chulasiri

Editors

Dr.B.Deepal W.Jayamanne

Dr.Nayana De Alwis

Cover

Dr.B.Deepal W.Jayamanne


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i

Preface

The National Dengue Control Unit (NDCU) was established in 2005 as a decision taken by

the Ministry of Health following a major DF/DHF outbreak occurred in 2004. It is

responsible for the coordination of control and preventive activities related to dengue at

central level between different stakeholders.

Our Vision

Tominimize the health, economic and social impact of the disease by reversing the rising

trend of dengue

Our Mission

To enhance the capacity at the national, Provincial, district and divisional levels for

better planning, prediction and early detection and prompt control and

containment of outbreaks and epidemics through partnerships and application of

coordinated efforts in a sustainable manner


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Contents

Preface ................................................................................................................................. i

01.Introduction ..................................................................................................................... 1

Technical staff .................................................................................................................. 3

Supportive Staff................................................................................................................ 4

02. Disease Surveillance ..................................................................................................... 6

02. Integrated Vector Management ................................................................................... 10

03. Case Management ...................................................................................................... 15

04 .Intersectoral Coordination & Social mobilization ......................................................... 17

05. Emergency Preparedness: Mitigating outbreaks ......................................................... 19

06. Research ..................................................................................................................... 20
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01.Introduction

Dengue fever has emerged as the leading public health problem with expanding

geographical boundaries and severity. The mosquito Aedes aegypti and Aedes

albopictus are the two vectors of dengue illness which breed mainly in water

holding containers in domestic and peri-domestic localities.

The National Dengue Control Unit is the focal point for the national dengue control

programme in Ministry of Health, Sri Lanka. It was established in year 2005 as a

decision taken by the Ministry of Health following the major DF/DHF outbreak in

year 2004. It is responsible for the coordination and implementation of dengue

control / prevention activities with different stakeholders.

Former National Coordinators and Directors

Dr.Lakshmi De Silva 2005 - 2008

Dr.Lakmini Magodarathna(Actg) 20082009

Dr.Nimalka Pannila Hetti 20092011

Dr.R.Batuwantudawe 2011 - 2013

Dr.N. Pannila Hetti (Actg) 2013

Dr.U.Ranasignhe (Actg) 2013

Dr.Hasitha Tissera 2013 to date


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Organogram of NDCU

Technical Staff

Consultant Communit Ph sicians

Medical Officers

Entomologists

PHHI

Entomology Assistants

Director NDCU

Supportive staff

Development Assistants

Drivers, SKS &

Laborers


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Technical staff

Director

Dr.Hasitha Tissera

Consultant Community Physicians

Dr.Nimalka Pannila Hetti

Dr.Nayana De Alwis

Medical Officers

Dr.K.A.Sunith D. Kumarapperuma (Biomedical Informatics)

Dr.P.C.SamaraweeraDr.M.B.Azar Ghouse

Dr.M.P.Pubudu U. Chulasiri

Dr.Iroshini Abeysekara

Dr.B.Deepal W. Jayamanne (Biomedical Informatics)

Entomologists

Ms.M.D.Sakunthala Janaki

Public Health Inspectors

Mr.J.A.D.R. Alwis (SPHI)

Mr.D.M.P.K.Karunarathne

Mr.W.R.A.I.Ranasinghe

Entomological Assistants

Mr.I.D.Hemantha

Ms.G.A.T.A.Rajathilake


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Supportive Staff

Development Officers/Programme Assistants :

Ms.H.M.D.Herath (Program Assistant)

Ms.P.K.K.Jayarathne (Development Officer)

Ms.U.M.M.Sanathanadevi (Development Officer)

Ms.H.M.P.U.Herath (Development Officer)

Ms.H.D.M.G.Dassanayake (Development Officer)

Ms.M.D.N.Karunarathne (Development Officer)

Ms. J.P.Jasinghe (Development Officer)

Ms.M.D.K.Mahadurage (Development Officer)

Drivers

Mr.W.D.Chandrasena

Mr.S.L.Withanarachchi

Mr.K.A.B.L.Ridmal

SKSS

Ms.D.K.A.Srimathi

Ms.P.K.S.Kumari

Mr.I.A.G.P.Kumara

Mr.P.Darmathilake


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Profile of the National Dengue Control Unit

Goal: To reduce endemicity to such an extent that it is no longer a major public

health problem in Sri Lanka.

General objective: To reduce morbidity and mortality due to dengue fever (DF)

and dengue haemorrhagic fever (DHF) by 50% of that in 2009, by 2015.

Specific objectives:

To increase the capacity of the health sector to monitor trends and reduce

dengue transmission

To strengthen the capacity to implement effective integrated vector

management.

To increase health workers capacity to diagnose and treat patients and

improve health-seeking behaviour of communities

To promote collaboration among communities, national health agencies and

stakeholders to implement dengue programmes for behavioural change

To increase the capacity to predict, detect early and respond to dengue

outbreaks

To address programmatic issues and gaps that requires new or improved

tools for effective dengue prevention and control


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02. Disease Surveillance

Epidemiological (disease) surveillance is carried out through the Epidemiology

Unit and data is communicated to National dengue control Unit to monitor

control activities in RDHS and divisional levels. A web based surveillance in

collaboration with the Epidemiology Unit has established in 50 sentinel

hospitals in 2013.It has been further expanded by providing access to MOOH.

In 2013 a total of 31,200 dengue cases were reported from the entire country.

Although the number of cases were high in 2012, the number of deaths were

89 with a case fatality rate of 0.28 which was a marked reduction compared to

previous years (Table 1).

Table 1 :

Case Fatality rate from 2009 to 2013

(SourceEpidemiology Unit)

Year Dengue Cases Reported Dengue Deaths Case Fatality Rate

2009 35,095 346 0.98

2010 34,105 246 0.72

2011 28,473 184 0.65

2012 44,456 181 0.41

2013 31,975 89 0.28


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Reported incidence by districts - 2013

Figure 1

Two distinct peaks of case reporting in May July and Oct Jan are identified

over the years associated with South-West and North-East monsoon rains

respectively. Therefore it is evident that preventive activities should be initiated

before the increase of cases as such, bi-annual mosquito control weeks are

conducted in April and September.


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Sentinel Site Surveillance

Figure 2

Establishment of web based system to enhance disease surveillance in

collaboration with the Epidemiology Unit in 50 sentinel hospitals. In 2013 DGH

Matale, BH Kuliyapitiya, BH Dambadeniya, BH Wathupitiwala, BH Marawila , BH

Karawanalla, BH Kamburupitiya .


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High Risk Districts 2013 - Based on notified cases

Figure 3


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02. Integrated Vector Management

Entomolo gical survei l lance

Entomological surveillance is carried out under the purview of the National Dengue

Control Unit, Anti Malaria Campaign, Anti Filariasis Campaign and Medical

Research Institute through their counterparts at regional level.

Districts under purview of different campaigns

Figure 4


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Summary of Entomological surveys 2013Premises and found positive

Figure 5

Vector surveillance is important to forecast possible outbreaks and initiate early

measures to prevent the occurrence of outbreaks and to limit the spread. Vector

indices are calculated (Breteau Index-BI, Premise index-PI and Container Index-

CI) for assessment of risk and impact of control activities.

In 2013 a total of 185,090 premises were inspected, where Aedes larvae were

found positive in 15,860(8.6%)containers. The types of examined containers are

illustrated below (Figure 6).

15505 15174

1347711398

14167

16818

14210

15936 15215 14865

13388

15425

1051 773 761 650 1032 946 676 788 680 735 1098 1179

0

2000

4000

6000

8000

10000

12000

1400016000

18000

Premises Inspected Premises Positive


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Summary of Entomological surveys 2013% positive of the type of Containers

Figure 6

Vector Con trol

Vector control interventions including source reduction (Elimination of breeding

places), biological and chemical vector control activities are carried out by the

health authorities with all relevant stakeholders and the community in accordance

with the guidelines of the Ministry of Health . Vector control activities are carried

out on a high risk approach based on epidemiological and entomological

parameters.

Vector Control activities are conducted through the field health staff attached to

the Medical Officer of Health offices in the country in collaboration with the

Regional Malaria officers (RMO) Medical officer AFC, entomologists and their

teams at district level

DiscardedReceptacles

47%

Waterstorage

containers15%

Miscellaneous

9%

Cement

Tanks7%

Tyres7%

Natural6%

A/C,

Refrigerators3%

Gutters2%

Ornamentals2%

Wells

1%Concrete slab

1%Ponds

0%

Other4%


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Major Activities in 2013

Facilitating district and divisional level vector management staff to perform

optimally to control dengue vectors by providing training, equipment,

chemicals, technical guidance and other resources

o 09 Vehicle Mount Fogging machines were distributed away high risk

districts. (Colombo AFU, Gampaha, Kalutara, Galle , Matara,

Kegalle,Rathnapura,Kurunegala,Puttalam )

o 100 Hand held Fogging machines were distributed (based on

requirement among all RDHS divisions) (Table 02)

o 496 sets of Personal protective equipment were distributed to vector

control personnel which included pair of boots, Goggles ,Gloves, Ear

Plugs, Respirators and Helmets

Insecticide resistance monitoring

Development of training manuals and guidelines on vector surveillance and

control

Monitoring & Evaluation of district level activities

Conduct of monthly Review meetings

Reviewing weekly entomology returns and sending alerts whenever

entomology indices are high

Distribution of Fogging Machines 2013

Province District Unit Distributed

Western

Colombo AF Unit 3

KalutaraDGH Kalutara 1

RDHS Kaluara 5

ColomboRapid Deployment Force 5

NDCU Entomology Team 5

Gampaha RDHS Gampaha 5

Kalutara NIHS Kalutara 2

UvaBadulla RDHS Badulla 3

Monaragala RDHS Monaragala 3


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Southern

Galle RDHS Galle 5

Matara RDHS Matara 5

Hambantota RDHS Hambantota 3

SabaragamuwaKegalle RDHS Kegalle 4

Rathnapura RDHS Ratnapura 6

Nothern

Killinochchi RDHS Killinochchi 1

Mullativu RDHS Mullaitivu 1

Vavuniya RDHS Vavuniya 2

Jaffna RDHS Jaffna 3

Mannar RDHS Mannar 3

North WesternKurunagala RDHS Kurunegala 4

Puttlum RDHS Puttalam 4

North CentralAnuradhapura RDHS Anuradhapura 3

Polonnaruwa RDHS Polonnaruwa 4

Eastern

Ampara RDHS Amapara 3Kalmunai RDHS Kalmunai 1

Batticoloa RDHS Batticaloa 3

Trincomalee RDHS Trincomalee 3

Central

Nuwara Eliya RDHS Nuwara Eliya 2

Matale RDHS Matale 3

Kandy RDHS Kandy 5

Total 100

Table 2


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03. Case Management

During 2013, curative health care personal were trained on proper management of

dengue patients based on National guidelines coordinated by the Epidemiology

Unit and Education, Training & Research unit, Ministry of Health.

Management of dengue cases was further enhanced by establishing 24 new High

Dependency Units (HDU) in selected hospitals. In addition equipments for existing

HDUs were also provided during 2013.

Table 2: HD Units of Health Institutions provided with equipments in 2013

Type of Hospital No. of HDUs facilitated in 2013Teaching Hospitals 06

Provincial General Hospitals 03

District General Hospitals 07

A Grade Base Hospitals 05

B Grade Base Hospitals 14

Total 35Table 3

All HDUs Established New HDU establishments In 2013

Figure 7


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Distribution of Microhaematocrit centrifuges for Hospitals:

157 devices distributed up to 2013 among 68 institutions and 21 devices

distributed to selected hospitals among 11 districts. (Table 4)

Province District Hospital Distributed

Western

Colombo Lady Ridgeway Hospital for Children3

NHSL4

KalurataRDHS Kalutara

1

Uva BadullaPGH Badulla

2

UP MonaragalaBH Embilipitiya

2

Southern GalleBH Elpitiya

1

Northern JaffnaTH Jaffna

1

North Western KurunagalaPGH Kurunegala

4

EP AmparaBH Sammanthurai

1

Central Kandy TH Peradeniya1

BH Gampola

1

Total 21

Table 4

Provision of Portable ultra sound scanners for selected hospitals.

Distributed 10 colour Doppler portable US scan machines among Major Hospitals

for the first time (Table 5) (NHSL, Teaching Hospitals-06, Provincial General

Hospitals -02, Base Hospitals-01)

Province District Hospital

Western

Colombo TH Kalubowila

Gampaha TH Ragama

Colombo BH Angoda (IDH)

Colombo NHSL

Southern Galle TH Karapitiya

Sabaragamuwa Rathnapura PGH Ratnapura

Northern Jaffna TH Jaffna

North Western Kurunagala PGH Kurunegala

North Central Anuradhapura TH AnuradhapuraCentral Kandy TH Kandy


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04 .Intersectoral Coordination & Social mobilization

The Presidential Task Force was appointed by H.E. the President to strengthen

mulitisectoral collaboration and implementation of strategies at the

National/Provincial/District levels. The first meeting was convened on 25. 05.2010

chaired by H.E. the President.

Members of the Task Force

Ministry of Health

Ministry of Public Administration

Ministry of Education

Ministry of Environment

Ministry of Local Government

Ministry of Media

Ministry of Disaster Management

Ministry of Defence & Ministry of Law & Order

Major activities carried out in 2013

Declaration of Mosquito Prevention Weeks and media seminars

o 1st from 06

thto 12 February

o 2nd

from 01stto 06

thJuly

o 3rdfrom 07thto 13thOctober

Production of IEC materials

Advertising campaigns through electronic and print media to create

awareness of public on control / prevention strategies and to promote

health seeking behaviour

Teacher Training programmmes Kaduwela, Kalutara, Kandy, Galle


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Participation for the exhibitions

1.Deyata Kirula 2013

2. Other Places (10)

1. Aluthwela Maha Vidyalaya2. Private Institution (Bodyline),Horana3. Urubokka National School4. Zahira College, Gampola5. MC Nawalapitiya6. Vesak Zone ,Dehiwala7. International School,Kohuwala (Colombo South)8. Bamunugama Central College, Mulatiyana9. International School,Moratuwa (Asian)10.Rivisanda Maha Vidyalaya, Aranayaka


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05. Emergency Preparedness: Mitigating outbreaks

Harnessing activities at district & divisional level

Emergency response includes measures to reduce the number of infective

mosquitoes rapidly and proper management of patients

Based on notification,

Early detection of increasing fever cases at treatment facilities Analyze data by district/ MOH areas/smaller localities Anticipating/predicting outbreaks using surveillance data Use of entomological surveillance data timely to forecast / Identify high risk

areas Develop plans for vector control Set targets Identify strategies/ resources Monitoring & evaluation


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06. Research

One of the major research activities done by the National dengue Control unit is

conducting a research on Effectiveness of using Bacillus thuringiensis israelensis

briquette formulation (Mosquito dunk) in Dengue control and Prevention activities

in selected MOH areas in the Western Province Sri Lanka.

An interventional study with pre and post intervention (Application of Bti dunks)

observations and with control to the experiment was done in selected MOH aeras

in Colombo and Gamaha RDHS areas. Vector densities and incidence of dengue

cases were compared as outcome variables before and after the intervention

within the individual intervention areas and in comparison to selected control

areas.

Majority (>60%) of potential and positive breeding places were removable and

there were no places for application of mosquito dunks in all study areas. Places

where mosquito dunks can be applied remained few in number throughout and

there was no considerable difference in container index or Breteau index even

after application of Bti dunks in comparison to the same in controled areas. Of the

households that have received the dunks, majority have applied them into roof

gutters drains or gullies.

The cost of application of mosquito dunk through health system is enormous.


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Institutional Profile of 2013 - National Dengue Control Unit