Health Watch

Dengue Out of sight out of mind

Nadira Gunatilleke

Can you forget something that is very important to you? How about forgetting a life threatening disease that can be given to you by a small mosquito? Its better to memorized it and act promptly than being sorry after it takes away one of your loved ones.

What is the point of handing over the responsibility of protecting your life to somebody else if you cant take care of yourself? Don't think somebody else will take care of your life even if you ask to because we are talking about dengue here.

What do we talk about when it comes to dengue? We talk about symptoms, treatment, mosquitoes, cleaning mosquito breeding sites and more. But there are many other important facts that we never talk about. Now the time has come to talk about what you can do as an ordinary responsible citizen of Sri Lanka to protect yourself from dengue. If you protect yourself you protect others automatically. If you clean your garden you protect yourself and your neighbour at the same time.

When a person - especially a child gets fever - medical treatment should be given promptly without unnecessary 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. Negligence of fever in children can be very dangerous.

The dengue mosquito can fly only 500 meters. Around 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. Cleaning hidden mosquito breeding sites such as bromeliads, fallen palm fronds, cut bamboo trees, parts of banana trees and tree holes are also important. But people very rarely pay attention towards this type of tasks.

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. In one instance the health authorities found dengue mosquitoes inside a water tank fixed to a commode.

Another type of fever was caused by mosquitoes when the Ratnapura district was hit by Chikungunya. It was discovered that gem mines scattered all over Ratnapura district created excellent mosquito breeding grounds.

This shows the attitude of people. There were thousands of chikungunya patients. The people were only interested in digging the valuable gem stones and selling lands to dig mines but nothing else. Filling up and closing down mines are more important than digging them! This is same everywhere in the country.

Ignorance can cost your life or the life of your loved one.

Therefore better to be vigilant than being sorry when dengue kills your family members. We do not need National Dengue Control Weeks, institutions or organizations to do this. Every single citizen is responsible for the life of another citizen or their own.

The garbage mountain located five miles away from your home does not bring the dengue mosquito to your door step. It was born in your refrigerator water tray and now happily living inside the broken cupboard! So clean the water tray instead of blaming to the garbage mountain.

Doses for children

Neonates (infants less than 30 days old) are especially vulnerable to the adverse effects of medicinal drugs as their bodies’ systems for metabolizing, detoxifying and excreting them are immature and great care is needed in prescribing for, and administering medicines to neonates.

All prescriptions for infants and children must, in addition to being written according to certain standard guidelines, state the age of the child in years and months. Liquid preparations are particularly suitable for children, but many older children may prefer tablets or capsules.

When the dose of a liquid preparation is less than 5ml an oral syringe must be supplied, that has 0.5 markings from 1ml to 5ml. When the dose is 5ml or multiples of 5ml, a 5ml spoon must be supplied. Medicines must not be added to an infant’s feed or to children’s food or drink. Children’s doses are usually based either on the body weight in kilograms, or in accordance with the following age ranges: (i) first month (neonate), (ii) one month to 12 months (infant), (iii) one to five years and (iv) six to 12 years. The doctor’s instructions regarding the dose, frequency of administration (times per 24 hours) and duration of treatment, should be carefully followed, but some flexibility is allowed to avoid disturbing a child’s sleep at night. For instance, the last dose may be given at the parents’ bedtime.

Doses for the elderly

Many old people tend to be forgetful, tremble, slow, hard of hearing and going blind, and not able to swallow tablets and capsules. They are also more susceptible than younger folk to the effects of drugs that act on the nervous system such as hypnotics (medicines that induce sleep - temazepam), anxiolytics (drugs that reduce anxiety - diazepam), and antipsychotics (clozapine).

Their liver and kidney functions may be reduced so that excretion of medicines may be impaired. Frequently, they have multiple diseases needing treatment with several medicinal drugs at the same time, greatly raising the risk of drug interactions, adverse reactions, and side-effects. Doses for elderly people are generally smaller than for younger adults. It is usual to start treatment with one quarter or half the adult dose, and increase it gradually (if necessary), with most medicinal drugs.

Ideally, dosing of very old people must be assisted by a responsible adult. Caregivers should see that tablets and capsules are taken with enough fluid, preferably with the patient standing or seated. Liquid preparations (if available) may be preferred if swallowing of solid dose forms is difficult.

Prescribers must ensure that instructions are written clearly in large letters, treatment regimens are simplified, doses are appropriately reduced and adverse reactions and side-effects are looked for at regular intervals during long term treatment. In very old people, features of normal ageing, such as mild joint pains, gravitational ankle swelling, difficulty in maintaining balance, lightheadedness (unrelated to a drop in blood pressure), and slightly reduced appetite are sometimes mistaken for disease, and unnecessarily treated with medications.

Professor Colvin Gooneratne writing to the Health Watch on this chapter says that it deals with among other matters, the condition for which the very old people are treated to and some of these conditions are mild joint pains, gravitational ankle swelling and slightly reduced appetites.

This is an extract from The Sri Lanka Patients’ Formulary, which can be purchased from the Rajya Osu Sala (Colombo 7, Lipton Circus Branch, on all days) and the Pharmacology Department, Faculty of Medicine, Kynsey Road, Colombo 8.

World Cancer Day :

Fight cancer through prevention and early detection

World Cancer Day was marked on February 4, 2011 around the world, drawing attention to the significant rise in cancer - with 72 percent of deaths from cancer in low and middle income countries.

Worldwide it is estimated that, 84 million people will die of cancer between 2005 and 2015 without intervention. What is significant is that about 30 percent of such cancer deaths can be prevented.

Union for International Cancer Control (UICC), in this year’s Cancer Day message, stresses, ‘Cancer can be prevented - protect yourself and your family, 30-40 percent of cancers can be potentially prevented’. World Cancer Day this year is promoting ways of preventing cancer, particularly being physically active. All this highlights the urgent and immediate need to focus on fighting cancer through Prevention and Early Detection. As pointed out by WHO, prevention and control of Non Communicable Diseases will have a major positive impact, not only on international health but also on global development.

For Sri Lanka, too, looking ahead at rapid development in the coming years, prevention and control of NCD’s including cancer is vital, and steps are being taken to address this area. Every year approximately 15,000 new cases of cancer are detected and the incidence of cancer has been increasing over the years.

In this regard, the Rotary Club of Colombo has come forward to support this vital area of Prevention and Early Detection. Partnering with the National Cancer Control Program (NCCP) of the Health Ministry they have set up a facility for screening and early detection, diagnosis, lab investigation and counselling, as well as prevention and awareness building activities, all under one roof. The project is also supported by Dialog Axiata PLC, who has undertaken to construct the permanent Centre to house this facility.

Meanwhile, the Cancer Early Detection Centre at Elvitigala Mawatha, Narahenpita, set up by the Club, 6 years ago, has been facilitating the screening and early detection activities as well as awareness building programs both in Colombo and around the country by the National Cancer Control Program.

Screening is carried out for several cancers including breast cervical and oral cancer. To date, over 10,000 people, mainly females, have been seen through this program and over a thousand detections made highlighting the importance of screening and early detection

The recent donation of a mammography machine by the Club, together with the Rotary Club of Birmingham, Alabama USA, commissioned by Health Minister Maithripala Sirisena, will further improve the effectiveness of the facility, enabling a greater number of cases of breast cancer to be detected at an early stage.

Breast Cancer accounts for 25 percent of all cancers in Sri Lanka, and is the leading cause of death in women in the age group 40 to 50 years.

First Lady Shiranthi Rajapaksa has also strongly championed this cause, and attended several events to create awareness and promote screening and early detection of breast cancer.

The recent Awareness Building Workshop on breast cancer held by NCCP, with Rotary Club of Colombo to mark Breast Cancer Day, was graced by First Lady Rajapaksa.