Dengue Fever

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10 Hafte 10 Baje 10 Minute Dengue Campaign

10 Hafte 10 Baje 10 Minute Dengue Campaign

How the Campaign Was Promoted

  • The 10 Hafte 10 Baje 10 Minute Dengue campaign was launched on September 8, 2019 when Delhi Chief Minister Arvind Kejriwal shared a video on Twitter.
  • 10 Hafte-10 Baje-10 Minute means "10 weeks-10 o'clock-10 minutes."
  • The campaign encourages Delhi residents to spend ten minutes every Sunday for ten weeks, from September 1-November 15, ensuring their houses and surroundings are free from stagnant water.
  • The video shows Kejriwal inspecting his own house for standing water, which is a breeding ground for mosquitoes, and then replacing it with fresh water to help fight the mosquito-borne illness, urging his fellow Delhites to do the same.
  • Over the next four weeks, the video gained in popularity as Delhites shared pictures of themselves on social media, using the hashtag '#10Hafte10Baje10Minute,' as they participated in the campaign.
  • Former cricket player Virender Sehwag is backing the campaign with his own video, which was thought to help reach younger people. He encouraged people to tell ten of their friends about the campaign to spread the word.
  • Government ministers, such as Rajendra Pal Gautam and Gopal Rai, have supported the campaign with their own social media posts.
  • Government agencies and departments were encouraged to "convert the fight against dengue into a mass movement" to include school children and welfare associations.
  • School children will receive kits that include stickers they can use to declare their homes "dengue-free." Kejriwal interacted via video conference with school children to tell them about the campaign.

Level of Participation

  • According to a November 9, 2019 article at The Pioneer, the campaign has been successful in engaging all Delhi residents with "people from all walks of life actively participating in it."
  • As part of the 10 Hafte-10 Baje-10 Minute campaign and in an effort to reach all Delhi citizens, Kejriwal announced his five-point action plan to fight dengue, which includes having Resident Welfare Associations (RWAs) ensure that 1) the government's dengue prevention pamphlet and 2) dengue free stickers reach every household, 3) that they spread the message about the campaign through their WhatsApp groups, 4) that they issue circulars to ask residents to check their homes, and 5) that they go into their local areas to convince residents to participate.

Direct or Indirect Impacts of the Campaign

  • The campaign has dramatically reduced the incidences of dengue in Delhi with only 356 cases, as of the first week in October, compared to 650 cases at the same time the previous year.
  • However, in the week ending November 4, dengue cases again increased, causing some to question the campaign's success.
  • On November 9, however, Delhi Health Minister Satyendra Jain said that "the city has reported the lowest number of dengue patients in five years" with 1,069 cases and no deaths.
  • Sujit Pawar, leader of the opposition Delhi Municipal Corporation, said that the campaign combated dengue but neglected malaria, which has seen a recent increase.
  • Building on the success of the 10 Hafte 10 Baje 10 Minute Dengue campaign, the Kejriwal administration implemented the Odd-Even scheme to "combat smoke and air pollution."

Research Strategy

As the "10 Hafte 10 Baje 10 Minute" dengue campaign is ongoing, we relied heavily on recent news reports to ascertain the campaign's goals, reach, and level of success. Our research found no evidence of low participation among those less well-educated, as the campaign specifically sought to reach all Delhi citizens. In addition to our press search, we also searched the Delhi government website to look for data or statistics on the campaign that might shed light on those who did or did not participate, but there were only two references to the campaign at the website, and they did not offer any insights into who did or did not participate in the campaign. Finally, we examined the Twitter posts using the hashtag #10Hafte10Baje10Minute to search for evidence of the education level of those posting, but the posts did not provide sufficient data to determine this information.
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Dengue Fever in India (2015-Present)

The reason for the decline in cases of Dengue Fever in Delhi, India was the creation of robust primary healthcare infrastructure as well as the focus on citizen awareness for prevention and early detection.

Dengue Fever in India (2015-Present)

  • In its worst-ever outbreak record of Dengue, in the year 2015 Delhi recorded over 15,867 cases and 60 deaths.
  • Delhi recorded 4,431 cases in the year 2016, 4,726 cases in the year 2017, and 2,798 cases in the year 2018 resulting to a reduction of about 80%.
  • As of November 4, 2019, 1,069 cases of the mosquito-borne viral disease have been reported in Delhi in that year.

Factors that Drove the Decline of Dengue Fever from 2015-2018

#1. Creation of a Robust Healthcare Infrastructure

  • The state government led all stakeholders which included health and sanitary department, hospitals, public, school children, as well as youths and women groups to focus on the goal of reducing the cases of Dengue in the city.
  • The government decided to launch a world-class community primary healthcare hub in Delhi by opening the first Mohalla clinic in 2015.
  • The Mohalla clinics are run by a panel of well-trained and qualified doctors that distribute 109 essential medicines and are air-conditioned with a private hospital-like atmosphere, as well as conduct 212 diagnostic tests which include mosquito-borne diseases.
  • As of today, 203 Mohalla clinics are fully functional.
  • There were dedicated fever corners in all the 33 government hospitals, 262 dispensaries, and 106 clinics with sensitized and trained medical staff regarding management and prevention of Dengue.
  • The government issued a circular that allowed private hospitals and nursing homes to increase their bed strength by 10-20% which saw 1,000 be earmarked for fever cases in Delhi's government hospitals.
  • There have been increased workshops set up to sensitize doctors regarding Dengue management and control and the government added all polio coordinators to help in this fight.
  • There have been no denied admissions in regard to Dengue with such patients being given a priority in the hospitals.
  • Adequate logistics such as medicines, IV fluids, and bed nets were arranged in quantity as per directives provided to Hospitals.
  • The government went further and capped prices to curb arbitrary pricing for the platelet count test and the NS1 Elisa test.

#2. Focus on Public Awareness

  • A dedicated Dengue Control Cell was formed to conduct activities in the capital such as identifying high-risk areas with regard to the prevention.
  • The government and local bodies came together began to raise awareness on prevention of Dengue to ensure that there was no breeding through the anti-dengue campaign ''10Hafte, 10Baje, 10Minute''
  • Every person in Delhi was tasked to inspect and check that there were no breeding of mosquitoes at their homes and workplaces.
  • Many of the residents in Delhi were urged to wear full-sleeves and use mosquito nets.
  • According to Delhi chief minister Arvind Kejriwal, the key to prevention of the Dengue fever was to ensure that there were no stagnant waters at home and around which prevented the breeding of the mosquitoes.
  • In the year 2019, the campaign ''10Hafte, 10Baje, 10Minute'' ran from September 1st to November 15th.

Dengue Fever from 2018-2019

  • Delhi has so far reported 1,069 cases of the mosquito-borne viral disease as of November 4th.
  • According to South Delhi Municipal Corporation which tabulates the Dengue data, there were 236 fresh cases in November while only 833 cases were reported up to October.
  • According to Delhi health minister Satyendar Jai, the 1,069 cases of Dengue reported so far is the lowest in the past five years.
  • The low numbers are being attributed to less rainfall at the start of monsoon season but there is the expectation that once the water accumulation increases there will be a favorable breeding ground for the diseases spreading mosquitoes.
  • In the coming weeks, there seems to be an expectation of a rise in the number of Dengue cases.
  • Around the clock helpline number — 155303 has been set up to report any water logging, collapse of buildings or the falling of trees and branches.
  • The government also reports that public school and government office premises are being penalized by civil authorities. In the past five months more than 72 institutions have been penalized for breeding mosquito larvae in their premises.

Research Strategy:

We began our research by scanning through recent news reports since the government continues to raise awareness and prevention of the disease. We relied heavenly on news reports which gave detailed analysis of the level of success in Delhi since the year 2015 and how this was achieved by a concerted effort.

Our research found no evidence of an increase in Dengue fever from the year 2018 to 2019 as the current figures on Dengue cases were 1,069 in the year 2019 compared to 2,798 cases in the year 2018. We, therefore, gave details of the current campaign being done by the government to ensure that Dengue fever is kept at its lowest. All information has been provided below.
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Dengue Fever Reporting Accuracy: Delhi

South Delhi Municipal corporation is the authorized body that tabulates the data on vector-borne diseases in the national capital of Delhi.

DENGUE CASES REPORTING AGENCY IN DELHI

  • South Delhi Municipal corporation is the authorized body that tabulates the data on vector-borne diseases in the national capital of Delhi.
  • "With a view to control Vector Borne Diseases, Delhi Municipal Corporation (Malaria, Dengue and other vector borne diseases) Bye laws 1975 are in force throughout the year in areas under the jurisdiction of MCD.Dengue fever/DHF/DSS have been declared as dangerous diseases under section 2(9)(b) of DMC Act."
  • South Delhi Municipal Corporation is an important and integral part of the Health Department and is closely related to medical institutions and to public health programs. The Bureau, headed by the CMO (HI)/OIVS who is the respective HOD for the Hospital Administration Unit and Public Health Unit of MCD, primarily works on the collection, compilation and publication of reports on various health activities for the corporation.

PROCESS OF REPORTING/TRACKING DENGUE CASES FOLLOWED

  • The SDMC has a process to publish periodical reports, with data from all the medical facilities in Delhi, including dispensaries, polyclinics, and hospitals, related to various vector bourne diseases such as Dengue fever, Malaria, and Cholera.
  • "According to the official process, once a hospital receives a suspected case of dengue, the patient is required to get an NS1 antigen test. If the test comes out to be positive, the report is sent to the municipal corporation that adds the details in its records. The record is further maintained to carry out the treatment of the patient."

CONSIDERATION OF THE DATA PRESENTED, BY MEDICAL COMMUNITY/GOV AUTHORITIES

Directorate General of Health Services (DGHS)

  • The Directorate General of Health Services (DGHS) of Government NCT of Delhi is a major agency related to healthcare delivery in Delhi.
  • The DGHS is also the largest department that distributes to primary and secondary healthcare facilities of Delhi. The institution works with dispensaries, health centers, school health clinics, and mobile health clinics.
  • The DGHS is responsible for tracking and reporting vector borne cases, including Dengue fever, evaluate high risk areas, and provide zone mapping.

International Society of Infectious Disease

  • A recent study on the "epidemiological study of dengue and its coinfections in Delhi," conducted by the International Society of Infectious Disease and published through the International Journal of Infectious Diseases, reports that it has considered the records on the Vector Borne Disease, including Dengue fever, based on reports presented by the Indian Council of Medical Research, National Vector Borne Disease Control Programme, the Government of India, and the South Delhi Municipal Corporation.

Health & Family Welfare Department of Govt. of NCT

  • The Health and Family Welfare Department of NCT of Delhi, headed by the Principal Secretary, is the controlling authority that regulates healthcare services and other autonomous bodies in the state.
  • Shri Satyedar Jain is the Delhi health minister.
  • Shri Jain has verified the South Delhi Municipal Corporation (SDMC) reports on Dengue fever in Delhi, saying that, "the national capital has so far recorded the lowest number of cases of dengue this year, in comparison to the last five years, and appealed the people of Delhi to keep up the collective efforts till the next month."


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Eliminate Dengue: Our Challenge

The Eliminate Dengue Campaign from the World Mosquito Program measures success by monitoring and evaluating the population of Wolbachia-carrying mosquitoes in an area. The program involves partners and local communities by directly engaging with them. Below is an overview of the findings.

Eliminate Dengue

  • To help protect communities against mosquito-borne diseases such as Zika, dengue, chikungunya and yellow fever, the World Mosquito Program (WMP) uses Wolbachia, a naturally occurring bacteria.
  • Wolbachia can be found in approximately 60% of all insect species. The Aedes aegypti mosquito, the main insect species that transmits Zika, dengue and chikungunya viruses, is not one of them.
  • WMP, through research, "successfully transferred Wolbachia from other insects into Aedes aegypti mosquitoes." This reduced the mosquitoes' ability to transmit these viruses.
  • WMP's method, therefore, consists of "controlled releases of mosquitoes carrying Wolbachia in areas where mosquito-borne diseases such as Zika, dengue and chikungunya are endemic."
  • Over time mosquitoes carrying Wolbachia breed with wild mosquitoes. It is expected that over time the majority of mosquitoes will carry Wolbachia thereby reducing their ability to transmit viruses to people and decreasing the risk of mosquito-borne diseases.

Campaign Measures of Success


Involving Local Communities in the Campaign

  • Designing WMP's engagement framework involved both qualitative and quantitative methods that were "tailored to the concerns, expectations, and sociopolitical settings of the trial release."
  • The first phase involved training staff, especially entomologists and anthropologists.
  • The second phase was sociopolitical and involved approaching the government of the country through workshops to be able to identify senior national, provincial, district and community leaders as well as scientists and health providers that could provide authorization.
  • The third phase involved collecting feedback and updating the leaders through workshops to address any advice/inputs, engagements, authorizations, communications, and responses. After this was done and authorization and acceptance were given, the research with residents commences.
  • The fourth phase involved updating leaders on the progress of the social research, science and feedback results.
  • The fifth and final phase is implementing the design and engagement strategy, which includes involving the key stakeholders identified in the research and engaging at least one person from each household.
  • The campaign also involved giving presentations to community groups, informing and working with local leaders, informing and working with health workers, providing school education programs, and holding public meetings.
  • To ensure success, the public needed to be involved, their concerns needed to be addressed and their participation encouraged. Equally important was receiving the necessary authorization.

Partners

  • The program works with government agencies such as the United States Agency for International Development, the U.K. government, the Brazilian government, the Australian government, the Queensland government, and the New Zealand Aid Programme to help distribute treatment.
  • It is important to note that the World Mosquito Program is supported by governments, philanthropic and corporate partners, and research institutes around the world.
  • Some of those who funded the campaign include the Bill and Melinda Gates Foundation, Welcome, Tahija Family Foundation, The Gillespie Family Foundation, Christy Walton’s Candeo Fund via the International Community Foundation, the Rotary Foundation and local clubs, and the Foundation for the National Institutes of Health. (Source 3)
  • Some corporate funders include KPMG and New Englands Bio Labs Inc.

Asia Hub - Vietnam

  • Eliminate Dengue Vietnam is part of the World Mosquito Program and was chosen since dengue is prevalent in the country with more than one million cases reported between 1998 and 2010.
  • The program is overseen by the Ministry of Health and began in 2006 when the first phase of releasing Wolbachia carrying Aedes aegypti mosquitoes took place on Tri Nguyen Island, near the port of Nha Trang in Khanh Hoa province.
  • Twenty-seven weeks after releasing Wolbachia mosquitoes on Tri Nguyen island more than 80% of the local Aedes aegypti mosquito population carries Wolbachia.
  • The first release of Wolbachia carrying mosquitoes on mainland Vietnam took place from March 2018 up to June 2018 in Vinh Luong.
  • Eight hamlets of Wolbachia carrying mosquitoes were released over several months in Vinh Luong, a community north of Nha Trang, the coastal capital of Khanh Hoa province.
  • The mosquito population is being monitored and the progress is being evaluated in Vinh Luong, to ensure that mosquitoes with Wolbachia are successfully establishing themselves in the local mosquito population.

Oceania Hub - Australia

  • The World Mosquito Program (WMP) in Australia can be found in Northern Queensland, which is a dengue-prone area.
  • The program commenced in 2011 in the Townville and Cairns region with support from the community and covers Townsville, Charters Towers, Douglas Shire, Cairns, and the Cassowary Coast.
  • Where high levels of Wolbachia are present, there has been no evidence of local dengue transmission.
  • After eight years of monitoring, the results reveal that Wolbachia is self-sustaining at high levels.
  • Through the project at Townville, researchers learned that Wolbachia could be deployed at a city-wide scale as there was no occurrence of local dengue transmission after four rainy seasons.
  • This project has revealed that it is possible to prevent the transmission of mosquito-borne diseases by using "low-cost and sustainable tools".
  • The Australian research has gained government and community support and has helped craft and refine the approach to adapt it for implementation internationally.
  • The government of Australia has adopted this innovative Wolbachia method and new projects will be implemented in Ingham and the Northern Peninsula Area while the work at Queensland is continuing.
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Dengue Awareness Campaign by Red Cross

Red Cross Dengue Awareness Campaign

Volunteer Training

  • According to the International Federation of Red Cross and Red Crescent Societies (IFRC) "Emergency Plan of Action" for the Solomon Islands dengue outbreak awareness campaign, volunteers were trained to use the Zika, Dengue and Chikungunya (ZDC) Prevention Toolkit and the Epidemic Control for Volunteers (ECV) Toolkit.
  • According to Cameron Vudi, the Community Disaster Risk Manager of the Solomon Islands Red Cross Society (SIRC), volunteers were trained "in emergency response, logistics and provision of Water, Sanitation and Hygiene (WASH) in emergencies, but will undergo a refresher training in dengue and behaviour change communication before going out into communities."
  • The Solomon Islands Red Cross Society (SIRC) deployed 50 of its 200 volunteers to support the dengue awareness campaign in "40 communities and 30 schools (or 69,000 people), namely Guadalcanal (including Honiara), Malaita and Western provinces that have an approximate population of 372,000."

Messaging and Communications

  • The volunteer teams used "posters, pamphlets, radio programmes, songs and drama to educate communities about dengue, going door to door and into schools and churches."
  • Volunteers performed skits that illustrated the signs, symptoms, treatments, and prevention methods associated with dengue.
  • Volunteers went to public areas such as markets and clinics, as well as to individual households, to share information on dengue and to work to eliminate mosquito breeding areas by educating the communities on cleaning problem areas.
  • One pastor noted that gathering the community after their church services proved effective in reaching everyone in the area.
  • Because some locations are remote and difficult to access in the rainy season, "the Red Cross turned to social media, the local press, radio, and text messaging" in the Vanuatu region of the Pacific islands. A four-week Digicel SMS campaign was initiated in March 2017, sending messages to 8,500 people, who were given a number they could call for further advice.

Campaign Tracking

  • According to the official "Emergency Plan of Action," the FIRC would provide "routine monitoring, coaching support and feedback to SIRC staff and volunteers to ensure that the operation is conducted effectively."
  • One of the identified outcomes of the "Emergency Plan of Action" was to assess the number of people reached in communities and schools with the goal of reaching 69,000 people.

Direct or Indirect Impacts of Campaign

  • The campaign ultimately mobilized 75 volunteers and reached more than 16,000 people, according to one source. While this is far fewer than the 69,000 the campaign sought to reach, the article calls the campaign a success and does not offer any insights into why the campaign reached fewer people than the original goal.
  • Dengue cases decreased in the months during the campaign, though reports do not specifically state a relationship between the campaign efforts and the decreased incidence rate.
  • People who were reached by the campaign, some of whom walk three days to reach the program site, reported more confidence in knowing how to respond to dengue outbreaks with people keeping their households clean and "taking preventive measures like sleeping under mosquito nets during daylight hours of dawn to dusk."

Research Strategy

Information on volunteer training and campaign messaging was readily available via news channels. Data on campaign tracking was less forthcoming. We did an initial press search, which garnered some statistics and references to the campaign's success, but they did not provide data on how the campaign tracked the number of people reached. We then looked at the actual action plan for the dengue awareness campaign, and it provided good information on volunteer training but limited references on how the Red Cross would track the reach of the campaign. Finally, we looked at the 2017 and 2018 IFRC annual reports to look for results of the campaign that might suggest the tracking protocol, but the reports only provided figures related to the number of people reached in terms of the overall water, sanitation, and hygiene efforts and nothing specific to the campaign in question.

Since the campaign in question occurred in 2017, some sources used are outside our typical two-year research window.
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Anti-Dengue, Clean-Up Campaign

The Anti-Dengue Clean-Up Campaign in the Miri District of Malaysia helped to educate and socially mobilize the community towards destruction of mosquito-breeding grounds. Our findings on how this campaign has impacted the community is detailed below.

Anti-Dengue Clean-Up Campaign in the Miri District of Malaysia

How the Campaign Helped the Community

  • According to the Miri City Council this campaign is to raise the awareness of the residents so that they can be alert and take precautionary actions against dengue outbreak in Miri.
  • Through the campaign, residents have been able to ensure that no stagnant water (which can be a breeding ground of mosquitoes) is found by focusing on drain flushing as well as taking actions against illegal extensions.
  • Through weekly clean-ups as recommended by the State Health Department Director, Dr Jamilah Hashim, the community is able to eradicate any potential breeding ground for the Aedes mosquitoes.
  • The residents, through the campaign, are informed that they should check or seek treatment at the nearest health clinic or follow the guidelines recommended by the Health Ministry.
  • The campaign has helped the residents to understand that they should focus their clean-ups in clogged drains and rubbish dumps where stagnant water can be found.
  • The community has been helped to focus on breeding grounds of the mosquitoes through the campaign.

The Effectiveness of the Campaign

  • Through the campaign the community has been able to understand and recognize that breeding grounds for mosquitoes are mostly rubbish-dumps, clogged drains and unkempt compounds.
  • The Miri City Council says that this campaign is an effective way to promote dengue prevention activities among the communities to curb the dengue outbreak in the city.
  • The campaign is also providing an opportunity to enhance health education by seeking public cooperation and participation.
  • However, by looking at the number of 800 volunteers and comparing it to the 120,000 residents in Taman Tunku and Tudan housing estates, there is a disparity in terms of public participation.
  • The cleaning campaign happened in Taman Tunku and Tudan housing estates, which were areas already confirmed to be dengue-outbreak zones and thus revealed the reactionary measure by the city council.

Impact of Campaign on the Community

  • By collecting more than 18 tonnes of rubbish, the campaign was able to help the residents eliminate breeding grounds for mosquitoes.
  • With the State Health Department asking the residents and community to continue with the campaign on a weekly basis, this is helping the community to take preventative measures against dengue.
  • The Miri City Council through its mayor have now formed MCC Dengue Outbreak Group to help tackle the dengue disease in the city.
  • Through the campaign the community has been able to focus on trash clean up including old oil drums, bottles and cans.
  • Residents are continually asked to take ten minutes of every day to ensure there is clear stagnant water within their homes and to discard items that can become breeding grounds for mosquitoes. This has become a social mobilization and communication program.
  • Another impact on residents is that now they focus on removing stagnant water in places such as flower pots, exposed water tanks, fridge trays, septic tanks and discarded polystyrene containers to ensure no Aedes larvae can thrive.

Research Strategy:

The research team began by looking at press releases by Miri City Council, newspaper reports and publications done by non-governmental organizations to find information on the Anti-Dengue Clean-Up Campaign in the Miri District of Malaysia. We were able to find relevant details about the campaign and these have been provided in the findings.
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Dengue Awareness, Part 2

An ineffective education system, lack of government funding, poor socio-economic backgrounds and distrust of information/sources of information are some primary reasons that people in high risk areas have a lack of awareness of dengue fever.

Primary reasons that people in high risk areas have a lack of awareness of Dengue Fever

1. Education System

  • The education system used while conducting public health awareness towards dengue fever has at times been hampered by linguistic challenges that fail to put into consideration the dynamics of the target population.
  • This therefore creates limited understanding, despite most dengue awareness sessions being arranged in local languages and subsequently leaves a gap in the overall comprehension of dengue fever.
  • Given that dengue fever epidemiology is strongly associated with human habits and lifestyle, there is a gap in terms of the evaluation of people's knowledge, attitude, and practices (KAP) in disseminating public health awareness.
  • In most cultures in the high risk areas of dengue fever, the population consists of people with various language backgrounds which therefore creates a challenge in the implementation of effective health education programs.
  • Bilingual educational facilitators are also at times limited in multi-cultural areas in terms of proper presentation of culturally appropriate and medically accurate descriptions to use during health education sessions.

2. Lack of Government Funding

  • Limited funding from the government has resulted in situations whereby there is unsustainable financial, technological, and workforce resources necessary to properly implement robust awareness programs.
  • Poor financing and government support has also led to programs that fail to accommodate lengthy travel times, availability of (or lack of) transportation, childcare needs, and site availability, thus hampering proper program roll out.

3. Distrust of Information/Sources of Information

  • Unique cultural and social norms have also affected public awareness, in the sense that many rural communities have deeply rooted traditions and cultures and lack of trust for medical professionals and outsiders and the information they disseminate.
  • Religion, culture, beliefs, and ethnic customs have also negatively influenced how people in high risk areas of dengue fever understand health concepts, take care of their health, as well as how they make decisions related to their health.
  • Limited understanding of people's religion, culture, and ethnic customs has led to public engagement challenges and difficulty in implementing programs that are consistent with the values of those in dengue high risk areas.
  • In these communities, illness is perceived to have supernatural (e.g. spirits, and agents of the supernatural), and/or violation of social taboos as causative agents. This mentality therefore impedes proper awareness and understanding of dengue fever.

4. Poor Socio-economic Backgrounds

  • Mass media such as television/radio and social media are some of the most important sources of information in dengue fever educational campaigns. This results in limitations in outreach to those who cannot afford these gadgets.
  • Lack of access to internet also hampers social media outreach, and any other subsequent interactive conversation that would have helped create more awareness of dengue fever in high risk areas.

Research Strategy:

To commence our research, we scoured through media articles and research studies especially published in the high areas for dengue fever. The rationale was to pull out information from industry experts that would give some insight to the reasons why people in high risk areas lack awareness of dengue fever.

We then leveraged information from cross-sectional studies that have been conducted in high risk zones such as Brazil, Mexico, Malaysia and Thailand in the form of questionnaires. In most of those areas the target population were members of the public studying, working, or living in the high risk areas of dengue fever. We then compiled the reasons that were repeatedly mentioned in the cross-sectional studies conducted in the high risk areas, to come up with a list of four. This led us to the information we detailed in the findings.
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Dengue Fever Treatment Outcomes

There is currently no effective therapy for dengue fever and treatment focuses on managing the symptoms of the disease. However, the disease is usually self-limiting and a vaccine that was recently approved by the FDA has an estimated efficacy of between 44% and 76%.

Current Treatment Success

Success Rate of Vaccine

  • In May 2019, "the U.S. Food and Drug Administration announced today the approval of Dengvaxia, the first vaccine approved for the prevention of dengue disease caused by all dengue virus serotypes (1, 2, 3 and 4) in people ages 9 through 16 who have laboratory-confirmed previous dengue infection and who live in endemic areas."
  • According to the FDA, "the vaccine was determined to be approximately 76 percent effective in preventing symptomatic, laboratory-confirmed dengue disease in individuals 9 through 16 years of age who previously had laboratory-confirmed dengue disease."
  • A study that reviewed seven clinical trials on the efficacy of the vaccine with a total of 36,371 participants "estimated the efficacy of the vaccine at 44%, with a range from 25 to 59% and high heterogeneity (I^2 = 80.1%)." This efficacy is quite
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Dengue Fever In High Risk Zones

Prior to 1970, only nine countries in the world had experienced Dengue outbreaks, while today, more than 100 countries are considered “endemic.” These early years began the greatest rises in income inequality, urbanization, climate change, and international trade and travel, all of which are factors which have historically driven (and currently drive) the increasing incidences (and deaths) from the Dengue virus.

Income Inequality & Urbanization

  • The “transmission cycle of the virus is mainly urban,” and is significantly affected “by poor urban conditions in terms of sanitation, water storage, and housing”. This is especially significant because the majority of the world’s population is expected to live within urban areas by the end of this century.
  • According to a 2019 study conducted on Brazil’s Dengue outbreaks between 1986 and 2015, “Brazil is experiencing a hyperendemic scenario, which has resulted in the co-circulation of the four DENV serotypes and with the increasing occurrence of severe and fatal cases.” Unfortunately, the actual illness and death count cannot be accurately calculated because of the presence of the other co-occurring arboviruses (and possible subsequent misdiagnosis) “Zika, Yellow Fever, and Chikungunya.”
  • This study also found that increased mortality rates from 2001 to 2011 were driven by three factors: “inequality, high income per capita, and higher populations inhabiting urban areas.” The disease proved fatal in 70% of the cases found in the Southeast and Northeast regions of Brazil. These factors are attributed to the continued (and current) spread and rise of the disease.
  • Current studies of Dengue in Brazil’s 558 microregions noted that lower income per capita and issues with sewer and water systems led to higher incidences of the disease.
  • Increases in Dengue fever incidences could be, in part, due to population growth and urbanization, as well as other co-occurring factors.
  • Unchecked population growth, especially in tropical and urban areas, as well as the dramatic rise of urbanization, “have greatly influenced the epidemiology of Dengue,” as well as its widespread distribution.

Climate Change

  • Current and "future rises in temperatures and rainfall has and is expected to continue to exacerbate the rise of Dengue fever, especially in high risk zones.
  • Current studies of Dengue in Brazil’s microregions also noted that higher temperatures and higher precipitation has led to higher incidences of the disease.
  • The geographic “distribution, reproduction, and feeding patterns of mosquito populations” are greatly affected by “ambient air temperatures, precipitation, and humidity.” These factors also affect the incubation period of the Dengue virus. The past decades (and recent) global increases in incidences of the disease could be, in part, due to changes in climate.

International Travel & Trade

  • Historical spread of the virus was largely due to expanding air travel after World War II (and the subsequent decades), which established particular Dengue serotypes in regions that had never before been exposed to the disease. This is also true of the current spread of the disease.
  • The spread of the disease has been greatly increased due to international trade, especially with countries that trade with high-risk areas. Often-shipped items like tires and bamboo are breeding grounds for Dengue-infected mosquitoes, whose eggs remain viable for several months after they are laid (and hatch when they come into contact with water).
  • One longitudinal study showed that increases in Dengue fever incidences could be, in part, due to increased travel, as well as other co-occurring factors.

Other Notable Findings

  • Age may also be a factor. Between 1986 and 2006 in Brazil, mortality rates for those over age 15 were higher, though in 2007-2008, that changed with 53% of the deaths from the disease occurring in children under age 15. After 2009, the concentration reverted back to seeing more deaths in those older than 15; this reoccurred in the years 2010, 2013, and 2015. In the years with increases in deaths of those over age 15, experts believe it was likely due to “the difficulty in managing the disease in a population with a high frequency of comorbidities,” including “sickle cell anemia, autoimmune diseases, asthma, hypertension, uremia, and diabetes mellitus.”
  • In Asia and the Americas (including Brazil), some experts believe that gender is also considered a high risk factor, as “women are more likely to have the disease and are at greater risk of developing more severe forms than men.” Notably, other studies do not prove any major variations in the differences in the distribution by gender.
  • The journal Nature recently published a study that found “that maternal death is three times more likely for women with dengue than for those without the disease,” and that the risk increases by 450% for women who contract the hemorrhagic variant.
  • During 2015 and 2016, Brazil saw an increase in cases and deaths of Dengue, though in 2017, the country experienced a significant reduction in the total number of cases and deaths. Though various studies have attempted to determine the factors attributing to this change, like “herd immunity, cross-reactions between Dengue virus (DENV) and ZIKV, mosquito ecology, vector control measures, and environmental factors,” but none explain the drastic change. About 80% of all cases of Dengue fever in Latin America occur in Brazil, so studying the factors occurring in this region is recommended by experts.

Research Strategy

To identify the driving factors related to the increasing spread of Dengue fever in high-risk (and other) areas, we pulled research on historical and current factors studies on the spread and proliferation of the disease. From this research, we identified several factors responsible for this longitudinal increase in high-risk areas, as well as in those areas which have never seen at outbreak before recently.

Part
10
of ten
Part
10

Dengue Fever Treatments

Home remedies for the treatment of Dengue Fever include a wide selection of food-related remedies. Most of these foods are nutrient-rich, have antimicrobial, antibacterial, and antioxidant properties, many are fever reducers, and most of them help increase platelet counts or stem bleeding, two of the worst symptoms of the disease.

Food-Related Remedies

  • A wide variety of food-related remedies are recommended to help fight the symptoms of Dengue Fever.

Giloy Juice

  • Giloy juice, which builds immunity and improves metabolism, provides those who consume it with strong immunity to fight the fever and symptoms of Dengue. The juice improves platelet counts within the blood. To prepare the juice, boil two Giloy plant stems in water and drink it warm, being careful not to consume too much (as it could be toxic).
  • This Ayurvedic herb “helps in maintaining the metabolic rate, strengthening the immune system,” and protects the body against infections. Additionally, some people add Tulsi leaves to the juice.

Tulsi (Basil) Leaves & Black Pepper

  • This Indian drink is made by boiling Tulsi leaves then adding a couple grams of black pepper. It boosts immunity and “acts as an antibacterial agent.”
  • Tulsi leaves are also called “basil” and are a natural antioxidant that improve immunity, protect against free radicals, and has antimicrobial properties, which can “help eliminate the Dengue virus.”
  • Chewing basil leaves will give the same benefit as drinking basil tea.

Papaya Leaf Juice

  • Papaya Leaf juice also improves platelet counts and overall immunity. To prepare the juice, crush papaya leaves and extra the juice. Only small quantities need to be consumes twice each day. The leaves themselves can also be chewed for the same benefit.
  • Papaya is great for reducing fever symptoms, like “body ache, chills, feeling low, getting tired easily, and nausea.” The juice of the plant helps flush toxins out of the body.
  • The Times of India claims this is “one of the best home remedies for fighting Dengue fever.”

Fresh Guava Juice

  • Freshly-squeezed Guava juice is rich with vitamins, like vitamin C to boost immunity. One cup of juice twice each day is enough to provide benefits. Eating fresh guava also provides the same benefits.
  • Guavas “are a rich source of tannins, vitamins, and minerals,” and help boost the immune system naturally, as well as help with increasing platelet loss.

Fenugreek Seeds & Leaves

  • Fenugreek seeds are highly nutrient-rich, with vitamins like C and K; they also are high in fiber and provide benefits like immunity boosting and fever reduction. To prepare the seeds, soak them in hot water. Once the water cools, drink it! This should be done twice a day.
  • Fenugreek leaves act as fever reducers and also as “a sedative to ease pain and promote more restful sleep” for those suffering from the effects of Dengue. To prepare the leaves, soak them in water and drink the water. Or, it comes in Methi powder form, which can be mixed with water to drink.

Goldenseal

  • The dried roots of Goldenseal plants have medicinal properties, including helping to “clear up the symptoms of Dengue fever very quickly and eliminate the virus from the body.” The leaves of Goldenseal can also be chewed or juiced.
  • Goldenseal has strong anti-viral properties and also improves platelet counts.
  • Goldenseal helps treat the headaches and nausea that accompany Dengue fever.

Turmeric

  • Turmeric is a metabolism booster “and helps in making the healing process faster.” Turmeric can be consumed in milk or cooked into foods.
  • The biggest boost from Turmeric comes from the curcumin in it. The “immunomodulatory functions of curcumin help in boosting” immunity, and turmeric has strong anti-viral properties.

Goat’s Milk

  • Drinking a cup of pre-boiled goat’s milk once or twice a day will help treat the symptoms of Dengue. The milk helps replenish the loss of selenium and platelets from those suffering from the disease.
  • The Times of India claims “goat’s milk is a proven way to cure Dengue”.

Jaggery & Onion

  • Crushing a small block of jaggery with 2 – 3 small onions and consuming it twice a day will help reduce the fever, and help increase platelet counts.
  • The Times of India claims this mixture is a “great way to treat Dengue fever.”

Apple & Lemon Juices

  • Drinking 2 – 3 cups of apple juice mixed with a teaspoon of lemon juice helps “increase the number of blood cells,” which increases platelet counts. Apples also are natural anti-oxidants, which help protect the body from the damage caused by free radicals.

Neem Leaves

  • Boiling a few Neem leaves and drinking the cooled mixture with a few drops of honey (for sweetness and antibiotic properties) helps to increase platelet counts, as well as white blood cells, “both of which see a drastic decrease in those affected by Dengue.”

Kiwi Juice

  • Consuming a cup a fresh kiwi juice each day helps people “overcome fatigue and weakness two symptoms of Dengue fever.” The fruits are rich in vitamin C to boost immunity, and they help increase platelet counts.

Barley Grass

  • Adding barley grass powder to hot water with a drop of honey (for flavor and antibiotic properties), and drinking this twice a day is recommended. The solution improves platelet counts, has antiviral properties, and is an antioxidant.
  • The stems of barley plants have the same antiviral and antioxidant properties, and can increase platelet counts.

Crab Soup

  • Consuming a bowl of fresh crab soup each day can help increase platelet counts, and offer a variety of other nutrients.

Other Immunity-Boosting Foods

  • Strong immune systems are key in helping to prevent Dengue, as well as in fighting it and ensuring a quicker recovery. Adding immunity-boosting foods “like citrus foods, garlic, almonds, turmeric, and many more” to the diet is recommended.
  • Since the hemorrhagic fever version of Dengue is typically accompanied by bleeding, adding vitamin K to the diet is one way to help keep the bleeding controlled (or reduced). Foods like “green leafy vegetables, fish, meat, eggs, and cereals” can help with these symptoms.

Methods of Helping to Prevent Dengue

  • Methods used to help prevent Dengue or the spread of the disease include: keeping the home and body clean, dry, and protected, eating a particular type of diet during mosquito season, and using plants and oils as mosquito repellents.

Home & Self: Clean, Dry, & Protected

  • Keeping homes (and the surrounding outside areas) clean and free of standing water is primary. Wearing protective clothing (especially covering the arms and legs) is recommended, especially during August through October.

Diet

  • Avoiding oily foods during mosquito season, and keeping a diet rich in “oranges, lemons, coconut water, vegetables, fruits, and protein-rich foods” is recommended.

Mosquito-Repellant Plants

  • Placing mosquito-repellent plants in and around the house is recommended, including “feverfew, citronella, catnip, and lavender.” Other helpful herbs include “garlic, lemongrass, basil, peppermint, and rosemary.”
  • Placing garlic cloves near windows will help keep mosquitoes out.

Oils As Mosquito Repellents

  • Using mosquito-repellent oils on the skin is recommended, including “Lemon Eucalyptus oil, Lavender oil, Neem oil, and Cinnamon oil.”
  • Placing a few drops of Neem oil on camphor leaves and burning them for about 20 minutes will help clear a room of mosquitoes, and keep it clear for a while. Additionally, soaking cotton balls with Neem oil and leaving them around living spaces will keep mosquitoes away.

Research Strategy

We identified these home remedies by collecting and synthesizing the recommendations found in various articles on treatments for the disease.

Sources
Sources

From Part 01
Quotes
  • "Kejriwal has appealed to Delhi residents to give 10 minutes every Sunday-- from September 1 till November 15-- to ensure that there is no stagnant water in their houses or surroundings."
Quotes
  • "Chief Minister Arvind Kejriwal had launched the mega dengue prevention awareness campaign on September 1 titled — 10 Hafte, 10 Baje, 10 Minute — and during the next seven Sundays the campaign has been continuing across Delhi with people from all walks of life actively participating in it."
Quotes
  • "Citing the ’10 Hafte 10 Baje 10 Minute’ Dengue eradication campaign, which the public supported, Kejriwal stated that the state government expects to bring about a similar change in the case of air pollution that the capital is struggling from inside out."
From Part 07
Quotes
  • "78% of Brazilian students and 67% of Thai students knew about dengue, less than our study participants. A possible reason for the better knowledge score in our students could be the repeated health education campaigns targeting these schools. Study findings show mass media and social media including advertisement boards to be the most important sources of information for after-school health educational campaigns. "