IT IS possible to get the desired results only if we can find out the real reasons behind the spread of dengue in the past decades. A plan must be formulated, considering as many risk factors as there are. For example, if planning is made with vector control, then the density of people in a particular place, the nature of the habitat, and the quality of life should also be considered. A mosquito breeding ground (artificial and natural) can never be completely eliminated until and unless the abundance and effects of various elements of climate and the lifestyle of people are taken into account when planning the mosquito control drives. Similarly, if there is no well-planned team for the proper treatment of affected patients, it is not possible to ensure treatment. Therefore, it is very important to ensure the availability of specialised doctors and necessary diagnostic facilities in public hospitals. Let me elaborate on the comprehensive dengue prevention strategies:
Planning: Dengue-infested countries that have been able to properly control the dengue-carrying Aedes mosquito have an intellectual plan to implement with far-reaching effect. The first thing that needs to be taken into account in order to carry out the long-term plan is to ensure adequate specialised human resources. To go a little deeper, it is necessary to establish educational institutions and research stations to prepare those who will study and research the ecology, biology, physiology, and behavioural aspects of the vector osquito. For kidney, heart, mental health diseases, and so on, there are specific institutes for higher education and research. They have accreditation with international organisations. Along the same lines, adequate human resources must be mobilised through training and developing research expertise. In a mosquito-borne disease control plan, there is no alternative to building educational institutions and research institutes and generating local context-specific knowledge on the endemic nature of dengue fever.听
Application or implementation of the plan: No matter how far-reaching the plan is, if its implementation is not proper, the prevention plan will fall flat. The most important step for proper implementation is to consider the time, place, and method of implementation. An example will make it clear. Any place in our country that is prone to the spread of Aedes mosquitoes should be identified and selected as an implementation site. Methods include the destruction of mosquito breeding sites, the conservation of natural enemies, biological methods, or the application of predators, parasites, pathogens, or biological agents. Rational use of chemical pesticides (adulticide or larvicide application). Each responsible person will create awareness among the general public about their own responsibility and increase the involvement of the people to make their area free of aedes. If a patient is detected in any place, a robust programme should be implemented by involving everyone in that area. The spontaneous participation of all should be ensured in the implementation of any method. In the selection of methods, the best advice from specialised experts must be considered with due importance because in no way should any method cause any damage to the environment or other organisms.
Supervision: All activities will be supervised using advanced systems or technology. The density of vector mosquitoes must be ascertained through the GIS system. The implementation of the dengue prevention programme should be thoroughly monitored, and it must be done at every step of the way. It must be done following scientific protocols and by an expert and skilled team.听
Evaluation: Success in this case would mean saving lives from the wrath of dengue. The evaluation of the activities conducted to prevent the spread of dengue must be done, as stated in the earlier paragraphs, following standard scientific protocols and involving expert knowledge and human resources. All those who are implementing and monitoring the plan must be brought under evaluation and given due incentives, when they are successful. The evaluation process must be considered an opportunity to correct the weaknesses in the planning and implementation processes.听
Unless these steps are properly followed in Bangladesh, the dengue menace will continue to remain a major public health concern.听
听
Professor Dr Md Golam Sharower is head of the department of entomology at the National Institute of Preventive and Social Medicine.
