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Dengue control: Dhaka North shows the way

Published : 31 Oct 2020 09:48 PM | Updated : 01 Nov 2020 05:11 AM

It was a “big surprise” for Mohammed Noman that he did not feel the presence of mosquitoes in his area at Mohammadpur during the pandemic.

“This is for the first time in my three years of living in Dhaka I had such mosquito-free experience,” he said.

He observed that municipal workers - Dhaka North City Corporation (DNCC) - fumigated his area at regular intervals against Aedes Aegypti mosquitoes as a measure to control a dengue outbreak amid Covid-19.  “They even came to my home”.

The same goes to Nayon Mia of Rampura. “Sometimes I even woke up from the afternoon nap with the sounds of fogging machines,” Nayon said, as the DNCC has a different story to tell to the world when it comes to dengue control amid pandemic.

Until this month of October, there had been almost no cases of dengue in this part of Dhaka despite having ‘629 hotspots’ identified for mosquito breeding.

In October, of the total 116 dengue cases in Dhaka, the North side had only 11 patients. Mayor Md. Atiqul Islam swung into action. He has already announced 10-day ‘combing operations’ from November 10 to reach home to home.

From October 17 to October 31, they applied a long acting fourth generation medicine called ‘Novaluron’ in all the breeding grounds to kill the larvae.

“Leadership matters,” said Brig Gen Mominur Rahman Mamun who was the chief health officer of the DNCC during the entire period, before taking up his new assignment as the Inspector General of Prisons recently.

“We had a detailed plan with the leadership of our Mayor - from home to home visit to destroying breeding grounds. And all we could do during the high time of pandemic when people were staying at home,” he told Bangladesh Post.

“He (Mayor) has been on the ground during the pandemic time instructing our workers what to do.”

“He came to us, sat with us, ate with us and heard from us what we are doing and what is our need,” said Faridul, a mosquito control worker of Ward 19. “That’s really encouraging for us. It was a terrible time. But we were not afraid because we knew our Mayor is with us”.

Dengue fever could have been another infectious disease outbreak, like many Southeast Asian countries such as Singapore, Malaysia and Thailand, along with the pandemic that put the healthcare systems under strain.

With Covid-19, Singapore, Malaysia and Thailand are grappling with dengue like the previous year. Bangladesh also suffered from a massive dengue outbreak in 2019. The experts have been apprehending another spell in 2020. But the story is different now.

Holistic measures pay off

“We learnt a lot last year. Virtually we had nothing in terms of scientific knowledge, proper drugs and technologies when I took the charge last year,” the Mayor, Atiqul Islam, told Bangladesh Post.

“Now we have almost everything,” he said.

He first took up the office of the Dhaka North Mayor for a brief period from March 2019 following a by-election after the death of his predecessor Annisul Haq. The month of March is also the beginning of the dengue season in Bangladesh.

After re-election, he again assumed the office in May this year for a full five-year term.

In dengue control, the public perception is that fogging insecticides outside the houses by the municipal workers kill the Aedes mosquito.

But, according to the WHO, this mosquito stays inside the home in a relatively dark place such as under the cot, and behind the clothes or curtains. This mosquito does not sit on the walls inside the home and breed in a small collection of clean water such inside the cap of a 500ml water bottle. So fogging outside cannot kill this mosquito.

The city corporation got the knowledge from the WHO last year when the High Court expressed its displeasure over the mosquito control measures in Dhaka following hundreds of thousands of patients being admitted into the hospitals.

“This time we utilized that knowledge,” the Mayor said.

“In city corporation there had been no entomologists who actually knew about the mosquito. So we formed an 11-member team with expert entomologists who are helping us this year. We started disseminating the knowledge among the city dwellers. We sent our team even inside the houses. People cooperated with us in this pandemic,” he said.

“Last year when I took the responsibility I was very new. Mosquito control takes time. It's a round the year job. Suddenly I found that a syndicate of importers was bringing in the same drugs year after year despite being resistant to the mosquito.

 “We had to break that nexus and we have been successful in doing that. Now as a result we are getting this success. Now we could import the latest generation medicines to kill larvae,” he said.

“When we went deep into the problem, we realized the real problem. And we solved that.”

“It needs a holistic approach. It's teamwork. We engaged our engineering group who helped us spraying inside the drains, and footpaths. We engaged our entire health team, cleaners, and everyone. It’s a complete team work that eventually paid off,” he said.

“When all worked together like research and only then we could identify our weakness. Now we can kill the mosquito at the source,” the Mayor said, adding that he had also taken lessons from Kolkata where municipal workers visit homes of the dengue patients to trace the source of breeding.

“We are also using technology to monitor our workers real-time.”

New drug joins

New drugs have been added to the anti-dengue armoury with the help of experts. “We brought fourth generation larvicide from the UK,” Lt Col Md Golam Mostafa Sarwar, deputy chief health officer, told Bangladesh Post.

“Novaluron is a fantastic drug which is slow-releasing and long acting. We apply this tablet in water and it remains effective for 90 days,” he said, adding that this drug works exactly on the mosquito larvae and that’s why it does not affect the fishes or other creatures underwater.

“It’s environmentally friendly. It’s a proven drug in the UK and Canada. Even then we tested this here in Dhaka since our weather is different, and we found it effective and then we applied it in all the hotspots,” he said.

“Today (Saturday) we have completed all the 629 hotspots,” he said as some experts were apprehending an unusual rise of dengue cases in winter.

Combing operations

“Now we are preparing for the combing operations,” the deputy chief of health said, referring to the 10-day special home to home drive which will start on Nov 2 following the identification of 11 cases in October.

“Our Mayor held a meeting with all the relevant officials on Thursday. We have 54 wards in DNCC. We’ll divide each ward in 10 sub-zones. In each zone we will deploy five staff – four cleaners and one mosquito control worker. So in each ward, 50 people will work extensively as part of our special emergency campaign for 10 days. They will work from 9am to 12pm,” he said.

What’s next?

The Mayor is sanguine. “We have seen that when we work as a team with proper knowledge then it really pays off. So, now I have a bigger plan. Now I am planning to take an ‘integrated vector management’ programme,” he said.

This approach seeks to improve the ‘efficacy, cost-effectiveness, ecological soundness and sustainability’ of disease-vector control, according to the WHO, as all appropriate technological and management techniques are being used in the integrated vector management to bring about an effective degree of vector suppression in a cost-effective manner.

 “We could tackle Aedes this year. If we can tackle the Culex mosquito, then we can easily take up an integrated vector management programme,” said the Mayor.