Steep rise in dengue cases worrying

Mar 07, 2011 News

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– vectors must be tackled from all fronts – Health Minister warns

“I believe the time has come for us to abandon one-dimensional approaches.  The time has come for us to have an approach where we tackle the issue from all  fronts,” said Minister of Health, Dr Leslie Ramsammy, as he addressed the impact of vector-related diseases.  He pointed out that often this health challenge is looked at in a one-dimensional manner but rather it is a very complex issue. He highlighted that the increase use of fertilisers, for instance, can have a daunting impact on the proliferation of mosquitoes while the use of insecticides could have the opposite effect.  “How do you balance those things? The increase in urbanisation and the changing of rural communities to look more like urban communities can have huge impacts on the niches that we create and the ecology of the distribution of mosquitoes.” This state of affairs, the Minister asserted, will no doubt have an impact on mosquito borne diseases even as he stressed that “there can be absolutely no equivocation at his point that the main vector in this Region for dengue is the Ades Aegypti which is currently spread across the country in all 10 Regions.”
According to Minister Ramsammy, last year it was Regions Nine and 10 that led the country in terms of how many dengue cases were recorded. Health statistics, he said, have since indicated that there have been a significant number of dengue cases being recorded in Regions Seven and Eight dispelling the assumption embraced by many that the Ades Aegypti mosquito is a Coastal mosquito.  “This is a mistaken impression…and the cases we are seeing have proven this assumption wrong. It (Ades Aegypti) is across the board and we must deal with it,” the Minister insisted.
He explained that it was while the Ministry was engaging a battle against malaria and was convinced that mosquito borne disease the likes of filaria and dengue could have been “placed behind us, what we see today is the re-emergence of dengue.” This development, the Minister added, comes at a time when the public health sector is striving for the elimination of filariasis, but is currently faced with threats along the way. It is for this reason, he intimated, that the time has come for the health sector to abandon one-dimensional approaches in its fight which will boost attempts to ensure early diagnosis and treatment to help reduce and even eliminate the parasite reservoir.  “I seriously doubt that a one-dimensional approach will work.  I believe that the vector control strategies of olden days need to be revisited and we need to add a robust vector control strategy to go along with our diagnosis and treatment.”
“There is a genuine increase in dengue in Guyana. We should not put our heads in the sand…We in Guyana have to do something now,” the Minister asserted last week as he addressed a sub-regional workshop at the Ocean View International Hotel.  The workshop represented a collaborative effort between the local Health Ministry and the Pan American Health Organisation which was geared at promoting an integrated management strategy for dengue prevention and control in Guyana. The participants included various levels of health care providers.
Minister Ramsammy observed that the increase in dengue is a common development across the Region, even as he asserted that all countries have seen increases in dengue. He pointed out that it is true to say that from 2007 to date there have been a consistence increase in the number of cases of dengue in the incidence rate.  “I believe when we recorded the numbers in 2007, the incidence rate for Guyana was 46 per 100,000. And the incidence rate at the end of 2010 was about 196 per 100,000 so there has been a rise.”  He noted though that while “not all of that rise can be accounted by the real increase in cases, I do believe that there has been an increase.”
For this reason, he revealed that Guyana has improved its testing capacity and therefore there are more confirmed cases today than in the past. He noted that it is likely that there were cases in the past that were never recorded. “I believe this steep rise is a combination of two things – genuine increase in numbers and also an increase in the capacity. We need to be aware of that, we need to acknowledge that.”
According to the Minister whatever strategy is derived it must include building capacity for early diagnosis of dengue cases. He warned though that the capacity cannot be one that is centralised but rather one that sees the Ministry of Health having the capacity to deal with cases countrywide. “It goes without saying that while every health worker is familiar with the vector borne disease called dengue not all of them are adept at diagnosis, not all of them are competent in even recognition so that we have to ensure that our health care providers can screen competently so that people suspected of having dengue can be managed and a proper diagnosis be made.”
In terms of the diagnosis, Minister Ramsammy, said that there is need to build capacity for testing in all 10 administrative regions. In addition, he noted that the clinical management of dengue must be a competency that resides across the board of health care providers. Accordingly, he pointed out that standard treatment guidelines should be developed and every health care provider should be trained in the use of such guidelines.

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