AFTER the outbreak of dengue fever in the country there is a barrage of messages and technical advice on how to defend yourself against its attack. The electronic media has taken the lead in reaching out people with horrifying tales and threatening consequences in case of neglect.
The intentions seem to be good but the outcome is contrary to what is aimed at. There are more than 50 television channels and each is trying to excel in its efforts to tell the people about dengue, mysterious mosquito called Aedes aegypti, its methods of attacks and the exact timing it comes out of its hideout in search of its prey. People are told that it attacks in the morning or at about the sunset time. It rests in the afternoon.
There is a general debate that this particular mosquito breeds in and around fresh water. There is no need of ponds as it can do the work of procreation even on dewdrops if it is fresh. The prerequisite for this killer mosquito to breed and multiply, as is being said, is fresh water.
People are therefore advised to cover all water containers in the house and dry all such spots where water deposits after watering plants, lawn and grown up trees. But the fact is that it can breed in any kind of water. It is advisable to keep your surrounding clean - no water, no dampness and no garbage.
Representatives of the civic agencies appearing on the TV screen have told people that spray was being done in the cities, town and villages to minimise chances of dengue fever. In layman terms dengue fever is defined as a tropical disease caused by a virus that is transmitted by mosquitoes and marked by high fever, rash, headache, and severe muscle and joint pains.
The job that the Sindh Health Department or the city governments in the province are doing to protect people against dengue has not proved effective so far. It has many reasons and the Pakistan Medical Association has already pointed out weaknesses in the system. Choked sewers and overflowing gutters, stagnant water in open grounds, unclean rainwater drains and unmindful disposal of garbage by the people and poor waste management by the city governments have contributed toward the spread of dengue in Sindh.
The city governments' mobile units engaged in fumigation and sprays are using ineffective chemicals as far as mosquito is concerned. This is polluting atmosphere and making it difficult for the people to breathe. The smoke-like substance foggers emit blinds people momentarily and deposit dust-like substance on their clothes. It is ineffective for mosquito and harmful for the human beings. So far more than 3000 cases of dengue have been reported. These numbers are collected only from public sector hospitals. Data from private sector hospitals and from some of the far away located government hospitals are not available.
However, the Aga Khan University Hospital, which is issuing daily update in respect of dengue, is restricted to its facility. DR. Afia Zafar, associate professor, department of pathology and head of infection control committee, AKU, is of the view that attention toward environment, which facilitate breeding of Aedes aegypti is the only way to effectively control its growth.
In her opinion use of organophosphate insecticide including fenthion, malathion, fenitrothion and temephos - all larvicide agents - seems to be the best options to control breeding of this and many other kinds of mosquito.
To a question about the cost factor of this method of control she said that since these larvicidal agents were being used in Africa and India, these must not be costly. As far as DDT was concerned it had been recommended by the WHO but it was not without its harmful effect. In 1960s the WHO found that mosquito had developed resistance against DDT. Advice to use it again should be looked into carefully.
She said that in 1994-95 dengue virus serotype-2 was detected for the first time. It had infected people but the scale of its attack was not noticed on a large scale. But this year it is serotype-3. It has spread fast and has affected many people across the country.
Aedes aegypti is an interesting mosquito. It breeds fast and transmits its lethal effects into its offspring. Once infected, an Aedes aegypti lives an infected life as long it survives measures to kill it. It continues its trans-ovarian transmission to its next generation. In other words, the eggs and the larvae of infected mosquito grow as a carrier and should be destroyed in its initial stages of growth.
Dr Zafar is of the view that Aedes aegypti can breed anywhere, may it be fresh or dirty water pond. Since it is adaptable to environment and therefore it can breed and grow near open water pots. It is necessary to keep water containers closed, dry out wet places and avoid accumulation of even small quantity of water whenever it is possible. All cesspools should be cleaned and dried.
She said it attacks in the early morning and in the evening at about the sunset time. It rests in the afternoon.
But this should not be taken as granted. The very presence of this mosquito is harmful and it may otherwise attack at anytime, given the right opportunity to do so. Diagnosis of the infection at the right time is necessary for proper treatment, but cleanliness and precautionary measures would necessarily save you from a doctor's bill, which is at times more lethal than the aedes aegypti itself.
DENGUE DEFINED: It is a viral infection caused by a vector, which is in this case, is an infected mosquito.
PRECAUTIONS: For the prevention from dengue fever it is important to keep environment free of mosquito, which is the responsibility of the government. Common man should give attention to hygiene and maintain general cleanliness. People have the responsibility to keep their house clean and dry out stagnant water. If it is inevitable to store water, which is always, store it in covered containers. It is necessary to prevent from mosquito-bites. Body parts that remain exposed should be covered.
Put on clothes with long sleeves, use insects repellant, carryout screening of windows, and scrub the pot or vessel, undertake weekly spray of insecticide and try to kill indoor mosquito regular.
INFECTED PATIENT: Since an infected patient suffering from fever is a source of virus so it is important to prevent him from mosquito bites. These bites will make so far a harmful mosquito a carrier.
SYMPTOMS: Usually it is a non specific flue-like illness with severe body ache, head ache, eye pain, muscular and joint pain and in the later part of the disease there may be hemorrhagic symptoms.
DIAGNOSIS: For the diagnosis patients are advised to visit family physician. The clinical diagnosis is confirmed by blood picture (low platelet count and leucopenia), and blood test for serum immunoglobulin (IgM) and IgG type of anti body first appear in the blood after infection. Presence of IgG indicates infection in the past.
TREATMENT: There is no anti viral drug to treat this infection and the main stay of treatment is supportive care such as rest, anti pyretic (paracetamol) and proper re-hyderation of patient.
COST: It depends weather the patient is being managed at home or has been admitted to a hospital. The cost will vary from case to case and severity of the condition.