CHAPTER 3:HOW DO WE DEAL WITH IT?

WHAT WILL WE LEARN THROUGHOUT THE CHAPTER 3?

CHAPTER 3: HOW DO WE DEAL WITH IT?

i. ACTION!ii. THE CONSTRAINTSiii. MANAGEMENT (MEDICALLY)

CHAPTER 3: HOW DO WE DEAL WITH IT?

I- ACTIONS!1) Action of People and Community

against Dengue (Prevention and Control)

At present, there is no vaccine for preventing dengue. Therefore,

the best preventive measure is to combat the mosquitoes.

Removal of stagnant water

Get rid of sources or areas where mosquitoes breed, such as standing water in flower pots, tins, bottles or discarded tires

Always clean and check drains to ensure they are not blocked especially during the rainy season.

Appropriate insecticides, such as larvicide's can be added to water containers. The insecticides can prevent mosquitoes breeding for several weeks.

Top up uneven surfaces of the floor to prevent water from accumulating

In addition to the above, here are some ways to

help prevent the mosquitoes being attracted to

human prey. Wear loose, light coloured clothing that

covers the whole body Apply mosquito repellents. Sleep under mosquito nets or in a room

which has mosquito screens on the doors and windows.

Avoid outdoor activities during morning and late afternoon

2) Action of Health Personnel against Dengue (Primary Health Care and Dengue Prevention and Control)

The ultimate goal of controlling dengue is to prevent its transmission and contain the spread of the disease as soon as possible

Community participation

Community participation involves active voluntary engagement of individuals and groups to change problematic conditions and influence policies and programmes that affect the quality of their lives or the lives of others.

This entails several tasks:• Raising community awareness:• Initiating community dialogue• Identifying and involving community health volunteers/workers• Identifying key stakeholders for local planning and actions• Empowering stakeholders by building capacity

Baseline data collection

health workers and supported by technical experts to collect baseline data on the nature and extent of vector problems, breeding sites, location of human habitats, disease outbreaks, the number of dengue cases which turned severe and complicated within a certain period, and sociobehavioural

data related to disease transmission, treatment-seeking, etc

Comprehensive Guidelines for Prevention and Control of Dengue and Dengue Haemorrhagic Fever

(a) Promotion and prevention activities: -Health education and empowerment:

-Campaigns -Integrated programmes

(b) Surveillance (vector and disease) and treatment

(c) Containment of disease (e) Social support and social network (d) Monitoring and evaluation

Action by The Government Against Dengue

ASEAN Dengue Day was launched on 16 June 2011 by Deputy Prime Minister The Most Honourable Tan Sri Muhyiddin bin Hj Mohd Yassin. The event, held at the HGH Convention Centre Kuala Lumpur, was also attended by Dr Corinne Capuano, WHO Representative for Brunei Darussalam, Malaysia and Singapore and Dr Harpal Singh. Both were there to demonstrate WHO’s commitment against dengue.

anti-dengue campaign, the Health Ministry also enlisted Malaysian celebrity and TV host Aznil Haji Nawawi to be the Ministry’s anti-dengue ambassador and to headline its anti-dengue campaign, called Jom Ganyang Aedes (Let’s Crush Aedes)

“gotong-royong’’ (cooperative action to attain a shared goal) programme, as well as other general dengue awareness campaigns, such as buses with advocacy body wraps placement of advocacy billboards in communities, schools, bus stations and mobile exhibitions at hot spot areas.

CHAPTER 3: HOW DO WE DEAL WITH IT?

II- THE CONSTRAINTS

Several problems facing us lead to decrease effeciency to counter the problem.

1. Geography- The disease itself is endemic in Malaysia as one of the tropical countries

2. Climate and Weather Pattern- Average temperature and rainfall (high humidity) are the most suitable for mosquitoes breeding- High temperature also will increase biting and feeding frequency

3. Population- Population growth and poor urban planning where there is over crowding resulting in poor sanitation and limited water resources to it

4. Awareness- Lack of knowledge among the community about dengue fever- Insufficient practice of the disease control- Misconception: a thought of having a virus that the body will build immunity to it

5. Legislative control- Incomprehensive legislative control on Aedes breeding through inspection and destruction of breeding habitats as in housing area, premises, dumping area, factories and construction sites

6. Management- Doctors have low threshold to diagnose dengue during interepidemic period- There is no vaccine approved yet for use and no specific medication for treatment - Lack of neither expertise nor the political will to implement sustainable and effective vector control measures

7. Economic- Constraint in funding lead to loss of technical expertise and limitation in health resources either for treatment or research

CHAPTER 3: HOW DO WE DEAL WITH IT?

III- MANAGEMENT (MEDICALLY) Dengue fever is usually a self-limited

illness. The management of dengue is

symptomatic and supportive. There is no specific antiviral treatment

currently available for dengue fever.

Supportive care with analgesics, fluid replacement, and bed rest is usually sufficient.

Acetaminophen may be used to treat fever and relieve other symptoms.

Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids should be avoided. Management of severe dengue requires

careful attention to fluid management and proactive treatment of hemorrhage.

Patient who does not require admission must be advised to take adequate fluids (minimum of five glasses

of isotonic drinks or juice).

Intravenous (IV) fluid is indicated in patients who are

vomiting, unable to tolerate oral fluids or having an increasing HCT (indicating on-going plasma leakage) despite increasing oral intake.

All patients with warning signs should be considered for monitoring in hospitals. Patients can be started with IV fluid 5-7 ml/kg/hour for 1-2 hours, then reduce to 3-5 ml/kg/hour for 2-4 hours, and then reduce to 2-3 ml/kg/hour or less according to the clinical response.

Crystalloid (such as 0.9% saline) is the fluid of choice for non-shock and Dengue Shock Syndrome patients.