Lt. Gen. Mahmud Ahmed Akhtar Former Surgeon General Pakistan Army
Prevention is better than cure-in fact the only true cost effective cure. Dengue spread has become an annual feature in Pakistan. The government of Pakistan has warned that 10 major cities could face a Dengue outbreak in this month. The cities include Karachi, Lahore, Rawalpindi, Islamabad, Peshawar, Faisalabad, Hyderabad, Sialkot, Larkana and Multan. Such outbreaks occur especially during the post-monsoon season. This has become an annual feature. The consequences of such outbreaks are dire as thousands are affected annually, straining Pakistan’s inadequate already overburdened health-care system.
The rapid urbanization and inadequate waste management system in cities exacerbate the problem. The lack of awareness/ education of the citizens further compounds the problem. Unfortunately the country’s health budget is the lowest, not only in the region but also in the world. Health is the lowest priority in Pakistan and particularly the prevention/primary care, the lowest, rather has no priority. With the population densely concentrated in the urban areas, the risk of transmission multiplies. Education about preventive measures is crucial. Literacy rate being the lowest in Pakistan, 26.5 million children are out of schools. A large chunk of the population does not understand the gravity of the situation.
Communities must be informed about the importance of eliminating standing water, using mosquito nets and applying repellents. Unfortunately due to high inflation/ poverty many people cannot afford these essentials. The government should provide these items to these people. Simple actions such as regularly cleaning gutters and disposing of waste properly can significantly reduce mosquito breeding sites. Residents do not get regular supply of water, resultant they store water providing breeding miles to mosquitoes. People should get regular supply of fresh water.
Government actions play a pivotal role. Sri Lanka is an example of successes in this region having the highest average lifespan of 76.5 years the highest in the region-Has Universal health and education systems with literacy rate of over 99%-Public participation in preventive measures is exemplary.
It is important to fumigate mosquito larvae to curb the proliferation of these mosquitoes. Local authorities need to priorities Dengue surveillance and control measures, including widespread fumigation and public awareness campaigns. School and community centers can serve as a platform for disseminating information about the disease and prevention strategies. Moreover, engaging local and prayer leaders can enhance community participation. Health care professionals must be trained to recognize Dengue symptoms/ signs early to ensure prompt treatment.
The rapid fall of the platelet count and consequently hemorrhages should be taught and its importance stressed strengthening health care infrastructure to manage outbreaks as essential. Timely medical intervention can reduce morbidity and mortality rates associated with severe Dengue. Local authorities must prioritize targeted fumigation efforts in high risk areas. By combining education (Unfortunately the lowest priority in Pakistan) effective mosquito control measures and improved sanitation (half of the religion-but neglected) we can mitigate the impact of the disease. In health education there should be emphasis on preventive medicine, promotion of health, early diagnosis and prevention of disabilities. That should be the cardinal principle of health/ medical education.
