dengue control strategy in pakistan

8/4/2019 Dengue Control Strategy in Pakistan

1/49

1

Dengue FeverA situation analysis in PakistanDENGUE CONTROL STRATEGY INPAKISTAN

Shahid YusufMD, MPH (Student) Walden University

4/17/2012


2/49

2

Purpose of this presentationBarely able to recuperate after the devastating earthquake of2006 the worlds most populous region went into another

crisis of dengue fever. In 2006 alone Pakistan had over 4000cases of dengue fever and more than 50 deaths.

Later years are being more daunting as the number of denguefever cases are increasing each year. The dengue scare isgripping the public while little or no efforts are being done bythe government to ameliorate the situation.

This presentation walks-through the perils of dengue fever,its burden, causes of failure and methods to ameliorate the

situation.

4/17/2012


3/49

3

The audience for this presentation are intendedbut not limited to:

Public Health Professionals atthe federal and provincial levels of Pakistan.

Public Health Nursing community at the federaland provincial levels.

4/17/2012


4/49

4

AGENDAAgenda of this presentation is aimed at:

Profile of Pakistan.

Clinical manifestation of Dengue fever.

Burden of the disease in Pakistani population.

Measures adopted by governmental and public healthagencies to reduce the incidence and prevalence of the

disease.

Tracing the causes of failure and discussing options toadopt an effective strategy for controlling dengue fever inPakistan

4/17/20124


5/49

5GOVERNMENT SECRETARIAT ISLAMABADTHE FEDERAL CAPITAL

4/17/2012


6/49

6

SHAHLAMAR GARDENSPUNJAB PROVINCE4/17/2012


7/49

7Karachi's Mazar-e-Quaid MausoleumSINDH PROVINCE

4/17/2012


8/49

8MOUNTAINOUS NWFP

KHYBER PROVINCE4/17/2012


9/49

9BLAUCHISTAN PROVINCE4/17/2012


10/49

10

OFFICIAL INSIGNIA OFMINISTRY OF HEALTH

PAKISTAN

4/17/2012


11/49

11WHO Maps http://www.who.int/countries/en

MAP OF PAKISTAN

4/17/2012


12/49

12

PROFILE OF PAKISTAN Situated in South Asia Pakistan borders India

on its East, Afghanistan and Iran on its West,and China in the North.

Total area of the country is 796,095 sq km

Total population of the country as in July 2011is estimated at 187,342,721.

4/17/2012


13/49

13

HEALTH DEVELOPMENT INPAKISTAN Poor maternal and child health profile High maternal mortality rate 276/100,000 live births Low ante-natal coverage (61%) High under five, infant, and neonatal mortality

( 94, 78, and 54/1000 live births respectively).

Double burden of diseaseThe burden of disease is heavily dominated bycommunicable diseases, reproductive healthproblems, and malnutrition which together account forabout 50% of the total.

world health organization, May 2011

http://www.who.int/country focus

4/17/2012


14/49

14

HEALTH DEVELOPMENT .. Cont. Low health expenditures and low public investment

in health sector; low focus on prevention; mainexpenditures for salaries an inequity in allocation ofresources.

Insufficient health district mapping and planning,Inadequately planned human resources for health.

Transfer of critical responsibilities from federal toprovincial level.

Health referral pyramid not respected.

World health organization, May 2011

http://www.who.int/country focus

4/17/2012


15/49

15

DENGUE FEVER :entomology Dengue fever is causedby an arthropod-borne viruswhich is transmitted tohumans through a mosquito

Aedes Aegypti.

Dengue is the most commonmosquito-borne viral disease of humans that is recentlybecoming a major international public health concern.

Globally 2.5 billion people live in areas where dengueviruses can be transmitted (WHO Dengue/dengue hemorrhagic fever, 2011)

4/17/2012


16/49

16

Aedes Mosquito

Aedes Aegypti Aedes Albopictus

4/17/2012


17/49

17A mosquito sucking blood courtesy of National Geographic

4/17/2012


18/49

18

DENGUE FEVER: world distribution

2006Red: Epidemic dengue (wikipedia, www.wikipedia.org)

4/17/2012


19/49

19

DENGUE FEVER: endemicity Dengue is endemic in more than 100 countries. It

infects 50-110 million people worldwide a year,leading to a half a million hospitalizations, andapproximately 12,500 to 25,000 deaths.

This disease has a burden estimated to be 1600disability-adjusted life years per million population,similar to tropical diseases like Tuberculosis.

WHO counts dengue as one of the sixteen neglectedtropical diseases.

(WHO Dengue/dengue hemorrhagic fever, 2011).(Wikipedia, Dengue).

4/17/2012


20/49

20

DENGUE FEVER : Clinical manifestations Dengue fever is also known as break bone fever or dengue hemorrhagic

fever.

Majority of the cases (80%) with dengue remain asymptomatic havingmild fever, a small proportion develop life threatening illness termed as

dengue hemorrhagic fever.

Occurs when a mosquito carrying an arbovirus bites a human, passingthe virus to the new host. The virus travels to various glands in the bodywhere it multiplies. Acute viremia is manifested by bleeding, low levels ofblood platelets, and blood plasma leakage resulting in dengue shocksyndrome, where dangerously low blood pressure occurs.

Wikipedia, dengue, http://en.wikipedia.org/wiki/Dengue_fever

4/17/2012


21/49

21

Clinical manifestationscont. Incubation of the diseases ranges from 4-7

days.

The course of infection is divided into threephases: febrile, critical and recovery.

Febrile phased is spanned by a fever over 40C (104 F), associated with generalized pains andheadache, flushed skin, measles like rash, andsmall petechiae. The fever is classically biphasicin nature, breaking than returning for one or twodays.

Critical phase of the disease is manifested byhigh grade fever which lasts for one or two days,fluid accumulation in chest and abdominal cavitydue to capillary permeability. Shock (dengueshock syndrome) and hemorrhage (denguehemorrhagic fever) may occur in less than 5% ofcases.

4/17/2012


22/49

22

Clinical manifestations.. cont. The recovery phaseis

heralded by resorption of theleaked fluid into the bloodstream. This lasts for two-three

days.

A typical rash seen in dengue fever

Hemorrhages in the eyes4/17/2012


23/49

23

DENGUE FEVER : with mild form of disease High fever , up to 105 F (40.6 C)

A rash over most of the body, which maysubside after a couple of days, thenreappear.

Severe headache, backache or both.

Pain behind the eyes

Severe joint and muscle pain

Nausea and vomiting

Mild bleeding manifestations (e.g. nose orgum bleed, petechiae, or easy bruising).

4/17/2012


24/49

24

DENGUE FEVER with severe form of disease Severe abdominal pain or persistent

vomiting

Red spots or patches on the skin

Bleeding from nose or gums

Vomiting blood

Black tarry stools ( feces,excrement)

Drowsiness or irritability

Pale, cold or clammy skin

Breathing difficulty

4/17/2012


25/49

25

LABORATORY CRITERIAFOR DIAGNOSIS Isolation of dengue virus from serum,

plasma, leukocytes, or autopsy samples

Demonstration of a 4-fold or greaterchange in reciprocal immunoglobulin G(IgG) or immunoglobulin M (IgM) antibodytiters to one or more dengue virusantigens in paired serum samples.

Demonstration of dengue virus in tissuevia immunohistochemistry orimmunofluorescence or in serum samplesvia enzyme immunoassay (EIA) .

4/17/2012


26/49

26

CLASSIFICATIONOF DENGUE CASES Cases are classified as suspectedif they are

compatible with the clinical description.

Cases are classified as probable if they arecompatible with the clinical definition and satisfy one or

more of the following criteria:

Occurrence at the same location and time as otherconfirmed cases of dengue fever

Supportive serology: antibody titer greater than 1280,comparable IgG EIA titers, or positive IgM antibody testin late acute or convalescent-phase serum specimen.

A confirmed case is one that is compatible with theclinical definition and is confirmed by the laboratory.

Shepherd, S. M. & Cunha, B. A. 2009emedicine.medscape.com

4/17/2012


27/49

27

DIAGNOSIS CRITERIADENGUE HEMORRHAGIC FEVER

A positive result from the tourniquet test

Petechiae, ecchymoses, or purpura

Bleeding from the mucosa, gastrointestinal tract,injection sites, or other sites

Hematemesis or melena, thrombocytopenia (

dengue control strategy in pakistan

Documents