City corporations need to fortify capacity now

The city authorities across the country need to strengthen their capacity as well as conduct drive immediately to avoid further deteriorating of the present dengue outbreak, as a growing number of cases are now reported outside Dhaka.
Entomologists and health specialists made the suggestion while talking to the FE against the backdrop of a fast rise in dengue hospitalisation outside Dhaka and remote areas amid an ill preparation of the authorities concerned to fight the mosquito-borne disease.
They also suggested adopting a recognised and successful model to handle the outbreak in Dhaka and other cities, and running a massive anti-dengue campaign in a scientific manner.
They also feared that the dengue menace would spread across other cities and remote areas at similar pace like that of Dhaka city in the last few years.
The Directorate General of Health Services (DGHS), meanwhile, reported nine more dengue deaths on Friday, including seven in Dhaka. The total deaths rose to 453, including 343 in Dhaka.
It also reported 1,565 new hospitalisations, including 804 in Dhaka. A number of listed hospitals did not send their dengue data to the DGHS on Friday, as it was a weekly holiday.
On Thursday, the DGHS recorded 2,288 hospitalisations across the country, including 1,389 outside Dhaka. The total number of cases rose to 95,877 this year, of which 48,944 were outside Dhaka.
Entomologist and Professor of Zoology at Jahangirnagar University Dr Kabirul Bashar told the FE that mosquito-controlling drives must be scientific to be successful.
"Like, fogging can only be effective in confined spaces, like lab, household, office, etc, but it hardly kills mosquitoes in an open environment."
The available insecticides and larvicides are effective as tested in lab. However, these would be effective outside, if applied in a proper mixing with water before spray, Dr Bashar explained.
"The dengue outbreak has spread across 64 districts. We are only talking about the Dhaka city corporations' capacity, whereas the city corporations in other cities do not even have necessary understanding of how to fight the dengue-bearing mosquitoes."
"Therefore, we need to conduct an effective mass or social campaign across the country. We have become tired of telling these, but the authorities seem careless so far," he noted.
Dr. Mushtaq Hossain, Adviser to the Institute of Epidemiology, Disease Control and Research (IEDCR), said the healthcare system is a total disorder in the cities across the country.
He suggested active communication between specialists (physicians) in Dhaka and other cities to get updated information on dengue and ensure proper treatment to tackle the growing number of cases outside Dhaka.
Prof. Dr. Be-Nazir Ahmed, a public health strategist and former director (disease control) of the DGHS, told the FE that the health authorities failed to focus on technical capacity improvement.
"The Dhaka city corporation authorities still do not have the minimum requirement of an entomologist. There is one entomologist in the DNCC, while there is no entomologist in the DSCC. Raising entomological capacity is a must to control the mosquito-borne fever."
All the four dengue serotypes have been identified in Bangladesh, which means an individual can be infected four times.
"The dengue situation has already shown its worst scenario in Dhaka due to lack of necessary surveillance. But now it has spread across other cities. Now we are going to see similar infection rates there in the coming years," he projected.
Dr Bashar suggested adopting the 'Kolkata model' for dengue prevention.
"Health staffers need to dedicate themselves to each household in a city. They should visit every household in a routine manner, keep the health-related data, analyse it, and make the city dwellers aware of dengue."
To this effect, the health and city corporation authorities have to implement a zone-wise plan, train health workers, and ensure adequate manpower.
Dr. Hossain suggested the authorities to install a proper design surveillance system.
"The Dhaka city corporation authorities should implement a system to monitor where the mosquito infestation is on rise, and analyse the infection rate if it changes in line with the dengue infestation."
"Besides, we will also follow up whether the used larvicides are effective and resistant or not. If we can keep and properly analyse these records, we can control the growing infection of dengue," he mentioned.
He also advised dedicating a government health institution or introducing a new one to take care of the dengue outbreak, as it has now become a public health emergency.

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