HEALTH WATCH

Dengue: Killing the killer at large

Nadira Gunatilleke

We just ended the National Dengue Control Week. The time is 8.30 am. I started to write this feature. But I cannot concentrate. Two or three mosquitoes flying around me singing the deadly dengue song. I am writing about dengue fever while chasing away the deadly (may be dengue) mosquitoes! The mosquitoes are not from the Colombo city.

The city is now cleaner than ever, thanks to the armed forces. The mosquitoes have come from one of our air conditioners or some such internal hide outs ! My home and garden (located out of Colombo) is free of mosquito breeding sites but still I am not safe. This is the pathetic situation we are going to talk about today.

During the National Dengue Control Week ended some time back, the health authorities found dengue mosquito larvae from 1015 state and private institutions countrywide. How about the employees of those institutions? How about their safety and health? This is something very important that needs to be focused on. The total number of places found with dengue mosquito larvae was 19525. This is an alarming number when it comes to dengue which is deadly.

There were dengue mosquito larvae in 793 schools. It is the children who suffer most from dengue. So how about the safety of the children who study in those schools? Who takes the responsibility for their lives? BTI or nothing will work without responsible citizens and accountable land lords/heads of institutions.

This year 227 persons have already died from dengue while over 31800 persons affected. The number of deaths reported in August was 24 and it was eight deaths in September. No deaths have been reported in the month of October. It shows the success of the National Dengue Control Week and the hard work done by armed forces, Presidential Task Force set up to control dengue and the all the other mosquito related illness.

Only 623 dengue cases have been reported in October and the number of dengue cases reported last month (September) was 1818. There were 4119 dengue cases in August. The highest number of dengue cases which is 5555 had been reported from the Colombo district. The number of dengue cases reported from Gampaha district was 3684. There were 2662 dengue cases reported from Ratnapura district.

What we talk about all the time? We talk about dengue, symptoms, treatment, mosquitoes, cleaning mosquito breeding sites, etc. But there are many important things that we never talk about. Now the time has come to talk about such things. It is all about dengue fever. Here are some facts that did not catch much attention so far. Basic information about dengue fever, symptoms and prevention can be found in everywhere. Therefore it is useful to pay attention to the facts that not highlighted so far.

According to the Media Coordinator to the Health Ministry, W M D Wanninayake, when a person get fever, he or she needs to seek medical treatment without any delay. It is better to seek medical treatment from a state hospital or a Government dispensary. This is because such institutions have a proper follow up program for suspected dengue patients. Seeking medical treatment early from a state hospital is vital. All essential life saving drugs are now freely available at state hospitals to treat dengue patients.

Wanninayake pointed out the importance of cleaning hidden mosquito breeding sites such as fallen tree leaves, especially the parts of banana trees and similar trees. Live trees like banana trees also holds clean water which is the breeding ground of dengue mosquitoes. In some houses tables are being kept on small water pots in order to prevent ants climbing to the table.

These water pots are another good place to breed dengue mosquitoes. Dengue larvae can survive in a dry environment for a period of one year. Even after one year these larvae can produce dengue mosquitoes when they receive water. This shows the danger of keeping unclean surroundings. Last year Ratnapura district hit by Chikungunya, another type of fever caused by mosquitoes. It was discovered that gem mines scattered all over Ratnapura district created excellent mosquito breeding grounds.

This shows the attitude of people. They are only interested in digging the valuable gem stones and selling lands to dig mines but nothing else. Here the people have totally ignored their responsibility. But at the end all blame the Government!

Sri Lanka is about to eradicate Malaria. Sri Lanka has almost eradicated Malaria and no Malaria deaths have been reported from Sri Lanka during last three years. It is also resulted in an unprecedented 99 percent of decrease in the reported Malaria burden during the last ten years. This is the latest situation about Malaria in Sri Lanka and it shows how good Sri Lanka is doing when it comes to controlling Malaria.

The other important fact is, 35 percent of the dengue patients are women and 25 percent of them are school children which means they had been infected when they are at home or school. The dengue mosquito can fly only 500 meters.

According to the World Health Organization (WHO), Dengue is transmitted by the bite of an Aedes mosquito infected with any one of the four dengue viruses. It occurs in tropical and sub-tropical areas of the world. Symptoms appear three to 14 days after the infective bite. Dengue fever is a febrile illness that affects infants, young children and adults.

Symptoms range from a mild fever, to incapacitating high fever, with severe headache, pain behind the eyes, muscle and joint pain, and rash. There are no specific antiviral medicines for dengue. It is important to maintain hydration. Use of acetylsalicylic acid such as aspirin and non steroidal anti-inflammatory drugs such as Ibuprofen is not recommended.

Dengue hemorrhagic fever (fever, abdominal pain, vomiting, bleeding) is a potentially lethal complication, affecting mainly children. Early clinical diagnosis and careful clinical management by experienced physicians and nurses increase survival of patients.

Medically unexplained symptoms

A burden to individual, family and health services:

Dr SHANTHA HETTIARACHCHI

He had come to seek advice for his unresolved physical feelings of numbness, body aches lasting for over an year. An unhappiness and hopelessness could be seen very clearly on the face of this middle aged gentleman.

He was not feeling well for several months. A lady accompanied him. After a few minutes silence they disclosed incidents in the recent past that changed their life.

He was a father of a little child and was living with his wife. The lady, who accompanied him was not his wife but met him fifteen months back. According to her, he had got those manifestations, just three months after starting their relationship.

He was keeping a file of medical investigations and prescriptions written by different doctors during this period. No abnormalities were noted in medical investigation reports. No abnormal signs, detected on physical examination either but he looked like a patient with many ailments.

This story is a common occurrence, reported worldwide today. There is a difficulty in categorizing or listing the relevant clinical entity, under the heading of physical illness or mental illness. Therefore it has been named as Medically Unexplained Symptoms in the field of medicine.

Such manifestations are defined as medically unexplained when the clinical presentation is incompatible with a known physical illness with the absence of relevant physical signs and laboratory investigations, supporting a diagnosis of a physical illness.

Today, this medical entity is responsible for psychological and financial burden to an individual and the family. As people with medically unexplained symptoms are representing a major proportion of out patient clinic attendees that it has become a major burden to the free health services of the country.

The expenditure on care, treatment and repeated investigations are up, while these people are attending different clinics at different health institutions without getting a satisfactory answer to their problem. It has lead to over utilization of services and disproportionate consumption of resources especially in the public sector. They come with chest pain, abdominal pain, bloating or cramp, pain in the limbs or joints, headache, backache, shortness of breadth, numbness or burning sensation of the body, loss of appetite, fatigue, faint feeling or lifelessness.

Doctors’ Wives Association Sri Lanka 25th Anniversary

Doctors Wives Association Sri Lanka will be celebrating their 25th anniversary on Sunday October 31st at 7 pm at the Galle Face Hotel.

The Association President Chrissy Aloysius told the Health Watch - key figure in organizing this Association 25 years ago - said that so far Sri Lanka remains the only country in the world where doctors’ wives have got together to form a Doctors’ Wives Association.

EA

Entire From Parliment For Medical Crossword No:43

Edward Arembewela

For the first time Health Watch received two entries from Parliament staff in Kotte for the Medical Crossword No 43.

* Both entries have been sent by Parliament Officer Dharmapriya Rajapakse.

* Among other entries received so far is one from a doctor, Dr. Vasantha Velumylum 63 yrs from No 20 2/1, Palmyrah Court, Palmyrah Avenue, Colombo 3.

* This is a health education crossword and this is the first time we have received an entry from a very senior doctor.

* The grid of the crossword is prepared by Dr Kelum Palpola of Lanka Hospital, former Apollo, Narahenpita, Colombo.

* The Crossword is sponsored by the Wish Institute, Delkanda, Nugegoda.

Preventing HIV in Women

Presidential Address 2010 College of Venereologists :

Dr CHANDRKA WICKRAMASOORIYA Consultant Venereologist

Working in the Central STD Clinic in Colombo which is the central clinic of the National STD/AIDS Control Program where most of the HIV positive cases in the country are detected, managed and reported, my observations over the last 10 years prompted me to talk on this topic today mainly because the number of women and children detected with HIV are increasing.

By the end of September 2010, 506 women with HIV were diagnosed and 46 children were born with HIV. Although the numbers are small, this may be only the tip of the iceberg.

To date, 26 of 46 children with HIV have survived and 15 are on anti retroviral medicine. The availability of anti-retroviral therapy (ART) prolongs their lives and improves their physical quality of life, but the social and psychological problems they will have to face cannot be compensated for by medical management alone.

We as health care providers can play an active role in preventing HIV in children. ‘We need to protect women to protect children.’ The need to protect women from HIV is not only to protect children but also to the reduce the serious impact of HIV on the lives of women themselves. Women with HIV are:

* Often stigmatized and blamed for causing HIV/AIDS and other STDs.

* Dismissed from their jobs or not hired, Evicted from their homes, abandoned by their husbands or other long-term partners, and denied the custody of their children.

* Sometimes pressured not to become pregnant or to be sterilized, or if they are already pregnant, to terminate their pregnancies. Being the caregivers of families, when their health fail the families get affected badly

HIV in women: the global situation

Even 28 years after the onset of the epidemic HIV infection still continues to remain a serious public health problem affecting women. For the past two decades, HIV infection has affected women worldwide, more than any other life-threatening infectious disease. Women who were at the periphery at the beginning of the epidemic in 1980s are at the centre of concern today.

Currently women account for 50 percent of the estimated 33.4 million people living with HIV globally.

This proportion varies from 27 percent in the Region of the Americas, 35 percent in the Region of Asia, to as much as 58 percent in the African Region. For young women, the figures are even more alarming. Globally, 75 percent of young people infected with HIV are women and girls. Even after implementation of preventive measures for more than 28 years, in 2008 of the estimated 7400 new infections a day 97 percent were in low and middle-income countries. Of the 6200 new infection among adults 48 percent are among women.

What is the situation in Asia ?

A total 4.7 million adults are living with HIV in Asia, of them, women account for 35 percent. India contributes to the bulk of the HIV burden in Asia. Of an estimated 2.4 million HIV infections in India, women account for 39.3 percent of the infections.

The epidemic in the South-East Asia Region has grown alarmingly.

Today, HIV has been reported from 10 of 11 countries in the Region (except North Korea). Of the estimated 3.5 million people living with HIV/AIDS in the Region, women account for 33 percent of the total.

Five countries account for the majority of HIV infections - India, Indonesia, Myanmar, Nepal and Thailand. Bangladesh, Bhutan, Maldives, Sri Lanka and Timor-Leste together represent less than 1 percent of the total HIV burden in the Region.

What is the situation in Sri Lanka ?

At the end of September 2010, a cumulative total of 1,285 HIV cases were reported to the NSACP, of which 767 were men and 518 women; 46 were children. The main mode of transmission was due to unprotected sex between men and women (82.8 percent). Men who have sex with men accounted for 11.2 percent of the transmission, while mother-to-child transmission accounted for 5.4 percent. Transmission through blood and blood products was only 0.4 percent. However, the percentage of HIV infected women has increased over the last three decades.

Profile of HIV infected women in Sri Lanka

Most infections were seen between the ages of 30 and 44 years.

This pattern has persisted for the last three decades.

However during past few years the number detected in the 20-30 year group has also increased. This is a matter of grave concern.

Is this an indication that young people are getting infected in spite of the many preventive activities carried out during last three decades due to programs not being targeted at this group?

Probable source of infection

Available data indicate that 67 percent women had sexual relationships only with a single partner ( either the marital partner or a single stable partner) 20 percent with a casual partner, 11 percent had more than one male partner and 4 percent had sex with their clients .

Similar situations have been reported in other countries. More than 40 percent of new infections in Cambodia and Thailand were among women whose only sexual partner was their husband.

A study in India found that 90 percent of the HIV infected women were married and their only sexual partner was the husband. This reflects how sexual subordination makes women vulnerable to HIV.

In many societies, there is a significant power differential between men and women, which is supported by social and cultural systems giving the control to males.

Males are expected to initiate relationships. Sexual assertiveness in women is unacceptable and often stigmatized. Even in countries that promote monogamy and mutual fidelity, and discourage multiple casual partners as a societal norm only women are expected to adhere strictly.

This raises the question of reliance on monogamy or mutual fidelity as a principal solution for HIV prevention, as this can be misleading to some women, because fidelity protects against HIV/AIDS only if it is completely mutual and life-long.

To be continued