Dengue In Mumbai Research Paper

INTRODUCTION

Dengue is a disease of the tropical countries mainly. The countries most affected with the
disease are the Indian subcontinent, South eastern part of Asia, Southern part of China, Taiwan, the islands in the Pacific, the Carribean (with the exceptions of Cuba and Cayman), Mexico, Africa, Central and South America.It is caused by the bite of an Aedes mosquito which is already infected with the dengue virus. The mosquito becomes infected when it bites a person who is already suffering from dengue fever. The disease is not directly communicable from one person to another. Any individual can get affected with dengue, although the chances of being affected are higher in persons with a weaker immune system. Unlike many other diseases, dengue cannot be called as once in a life time disease. The disease is caused by one of the five serotypes of virus. Although an affected person will develop immunity against that particular type of dengue virus serotype he is affected with, but there are chances that he still may receive the infection caused by any of the other four serotypes.
The symptoms of dengue last for ten days since the day of the mosquito bite. They start appearing approximately from the fourth day after the bite by the infected Aedes mosquito. The presenting features are very high and a sudden type of fever, very severe headache, orbital pain, pain in the joints and muscles, nausea, vomiting, rashes on the skin (these appear around on the third or fourth day post the infected mosquito bite), and hemorrhagic tendency could also be an important symptom. The hemorrhages will be occurring in the form of epistaxis, gum bleeding or bruising of the skin. At times the symptoms can be too mild to make a diagnosis on the basis of them only, they may mimic viral infections. Like in younger children the symptoms are very mild and deceptive in nature. They do not crop up as evidently as in the older children or in the grown up adults. However, if left untreated, the disease may progress further leading to complications. Initially, the complications will be related to high fever, lymphatic and bleeding disorders, liver abnormalities and bleeding from various parts of the body. This is known as dengue hemorrhagic fever. The condition may further complicate leading to shock, and then it is known as dengue shock syndrome. Currently there is no particular medicinal treatment for dengue. Medications given are mostly pain killers along with acetaminophen, aspirin is advised to be avoided. It can promote further bleeding. The general management consists of rest and proper fluid intake (WebMD, 2015).

GLOBAL BURDEN OF THE DISEASE

According to WHO, more than 100 countries are at risk of developing dengue. However, a large number of cases are either not reported or are misdiagnosed. A study shows that around 3900 million people across 128 countries are under the risk of developing the disease. in 2013, more than 3 million cases were registered in America, South eastern Asia and the western Pacific region. As high as 500,000 people very year need to be hospitalized for the treatment of severe dengue, a good number of these cases belong to the children. Also 2.5% of these affected cases become fatal. The death rates from dengue hemorrhagic fever may reach 20% if it is left untreated. Proper treatment and care of these cases can bring the number down to less than 1% (World Health Organisation, 2015).
Being a city in a tropical country, India, Mumbai gets badly affected by dengue every year. Its proximity to the sea and the temperature that favors the breeding of the Aedes mosquito makes Mumbai more prone to the disease. The number of people being affected keeps increasing every year. As per the Brihanmumbai Municipal Corporation records, the figure was 927 with 11 fatal cases in 2003, which rose to 1008 and 5 fatalities in 2014 and crossed 700 this year with 12 fatalities. The number is still increasing further (The Hindustan Times, 2014). People living in the slum areas of the Mumbai suburbs are more prone to develop the disease. It is said that even a spoonful of water can lead to breeding of dengue mosquitoes, and the slum areas thus are the best breeding grounds for them. The accumulation of water here and there, formation of puddles, and stagnant water at various places provide the best breeding ground for the mosquitoes. In Mumbai, the cost of dengue medication is 900-6000 rupees without the hospital stay charges. And the preventive measures for dengue cost between 200-500 rupees per household. Pest control measures on the other hand are not a sustainable method in relation to the other measures. Government strategies that are planned to prevent the spread of the disease take very long time to come into play and hence are not really dependable. The time taken to enforce these strategies to the fullest makes the effort futile in the long run.
Certain interventions by different organizations are aiming at reducing the number of dengue cases and Aedes aegypti mosquito. An organization, namely, Elite Corporation, has been working effortlessly to eradicate mosquitoes from Mumbai; the project is also approved by the Mumbai Municipal Corporation (Elite Corporation, 2015). BMC on the other hand has started fogging sessions to curb the menace of dengue mosquitoes. The fogging drive is not confined to the slums only, it is targeted to the areas where there are possibilities of water stagnation and mosquito breeding (Mid day, 2012).

METHODOLOGY

In order to control the disease spread, an initiative can be formulated in which a package will be devised, called as Dendie Package, and it will be a 500 rupees package which will be provided as a recurring delivery for three consecutive months. The cost effectiveness will encourage the people to consider giving the package a try. It will be more suitable for the people if the amount can be collected in smaller EMIs every month during the delivery of the kit. The package will consist of sealed plastic lid anti larvae containers, non toxic mosquito coils and double grained mosquito nets. These will be supplied to the areas where maximum cases of dengue are recorded, that are, in slums and areas where water is found to be stagnant. This may encourage the people to use the articles in the package; they may start using the coils and the net in order to prevent them from the mosquito bites. The package can prove to be a great success and help in preventing the disease.
The main issues that need to be solved in the context of dengue need complete mitigation in Mumbai, a sustainable method needs to be integrated in order to keep dengue at an “invisible level”, people need to be educated about the hygienic standards in Mumbai so that every household can perform their own responsibility towards removing the dengue menace from the city, finally, what is needed to be done is removal of Aedes aegypti mosquito from the residential areas of Mumbai.
The targeted population should be the lower socio economic group, living in the Mumbai slums. The risk of the disease is maximum among these people, the cause is poor hygienic conditions, stagnation of water at different places, congested living atmosphere. All these factors make the area and the people more prone to incur the disease. also living in such conditions leads to a compromised immune state and hence increasing proneness to diseases. The proposed Dendie packages can be made available to these people by door- to – door delivery system. The people need to be educated about the disease and its repercussions and then convinced about the utility of the product that is being sold to them.
The progress can be monitored by keeping a check on the number of dengue cases, by comparing the data of the previous year obtained from BMC records or from the hospitals of the affected areas. How successful the intervention plan has proved to be can be determined from the difference in the results obtained and their comparisons with the last few years. The Mumbai Government should come forward in the support of the effort and help financially to initiate the intervention program. The companies responsible for providing the plastic container, coils and nets can also be asked to extend a supportive arm, it would not only be a deal which will give them good returns in the longer term, but it also is an act towards the benefit of the mankind. Some other organizations who work towards the betterment of the human lives can also become a part of the initiative, such an organization could be Reliance India foundation who have been working towards the betterment of the country by indulging in various philanthropic activities (Reliance Foundation, 2015).

References

Elite Corporation,. (2015). Mosquito Control Services - Elite Corporation professional service provider approved by Mumbai Municipal Corporation. Retrieved 24 April 2015, from http://www.elitecorporation.in/mosquito-control-services.html
Mid day,. (2012). BMC faces flak over erratic fogging sessions. Retrieved from http://www.mid-day.com/articles/bmc-faces-flak-over-erratic-fogging-sessions/186195
Reliance Foundation,. (2015). Reliance Foundation - philanthropic organization to transform India. Retrieved 24 April 2015, from http://www.reliancefoundation.org/
The Hindustan Times,. (2014). Mumbai worst-affected by dengue in Maharashtra. Retrieved from http://www.hindustantimes.com/mumbai/mumbai-worst-affected-by-dengue-in-state/article1-1284378.aspx
Webmd.com,. (2015). Dengue Fever: Symptoms, Causes, and Treatments. Retrieved 24 April 2015, from http://www.webmd.com/a-to-z-guides/dengue-fever-reference?page=2
World Health Organisation,. (2015). Dengue and Severe Dengue. Retrieved 24 April 2015, from http://www.who.int/mediacentre/factsheets/fs117/en/
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