Dengue Outbreak Highlights Poor Waste Management

• by Catherine Wilson (honiara, solomon islands)
• Wednesday, May 15, 2013
• Inter Press Service

This archipelago nation of more than 900 forest-covered islands, lying just east of Papua New Guinea, has since recorded over 4,200 suspected and over 1,000 confirmed cases, with six fatalities. The outbreak has impacted eight of nine provinces in the country of 552,000, with 88 percent of cases located in the capital, Honiara.

According to Dr. Tenneth Dalipanda, under-secretary for health improvement and chairman of the national dengue fever task force, the crisis has not yet peaked and the country is still in "active outbreak mode."

Dengue fever is an infectious tropical virus transmitted to humans by the bite of female mosquitoes, which breed in clean, warm water. In urban and semi-urban areas, gutters, old tyres, plastic containers and refuse – in short, any items that have become water receptacles in close proximity to households – make excellent hatcheries for dengue-carrying mosquito larvae.

In the Solomon Islands dengue is associated predominantly with the Aedes albopictus and Aedes aegypti mosquitoes, which bite during the day. The incubation period of the virus is typically four to 10 days, with symptoms including fever, headaches, nausea, a body rash and joint and muscle pain.

According to the World Health Organisation (WHO), the global incidence of dengue has grown 30-fold during the past 50 years, reaching an estimated 50 million infections every year. Transmission of the disease is particularly rapid in high-density urban areas in tropical and sub-tropical climates, where mosquitoes proliferate during monsoonal seasons or following periods of heavy rainfall.

But according to Dalipanda, a dengue outbreak of this magnitude has never been seen in the Solomon Islands before.

A small outbreak of "type 2" dengue in 2002 resulted only in a very small number of cases, he told IPS.

"The current outbreak is the first in the country that we have a record of and the strain that we now have is a type 3 dengue virus, which is one of the more virulent," he explained, adding there are some 500 cases per 10,000 residents in Honiara.

The capacity of the nation's health services has been under strain and the main National Referral Hospital located in Honiara was closed to routine services until last week, as resources were diverted to cope with the disease emergency.

The government has established a national task force to coordinate a response to the outbreak, with Australia and New Zealand providing teams of specialised medical and public health staff to assist local authorities.

There is no known cure or vaccine for dengue, making prevention critical. So in March the government spearheaded a citywide cleanup campaign in Honiara to try and contain breeding sites.

Through a public awareness programme, households, businesses and residents across the city were advised on how to clear accumulated solid waste such as tin cans, coconut shells, plastic bags and containers, used tyres, buckets and tin drums, and instructed to remove or cover water containers.

Honiara City Council Chief Health Inspector George Titiulu told IPS he had "longstanding" concerns about waste management and public health in the capital, since there is a strong link between the disease and urban refuse.

"The key mosquito breeding sites are (those areas) where the city's waste collection services do not currently reach," Titiulu said, referring to residential areas on the city's periphery.

Population expansion coupled with rapid urbanisation in small Pacific Island nations has created major waste disposal challenges for the region.

Hand in hand with Honiara's expansion has come an increasing volume of solid waste from shops, offices, markets and residential areas, while informal settlements mushrooming on the city's boundary have now exceeded the capacity of service providers.

Thirty-five percent of the city's population of 64,600, which is growing at an average annual rate of 2.7 percent, live in unplanned communities that have inadequate power, sanitation and garbage collection services, as well as a poor water supply.

The waste burden is even greater in the absence of recycling facilities in Honiara, although some agents collect aluminium cans for foreign recycling companies. The majority of organic, recyclable household waste, together with a great deal of plastic, is either burnt, discarded in coastal and land areas, or collected for landfill sites.

Acknowledging that the cleanup campaign likely prevented a steep increase in dengue cases, Dalipanda still feels its impact has not been adequate. "We would like to see the (incidence of cases) coming down."

He confirmed that it was vital to continue vector-control measures such as managing and eliminating waste, covering water storage containers and applying insecticides, but warned that these should not be "one-off activities".

"Different communities, institutions and ministries should become involved, because it is the only way we can break the cycle of the disease," he emphasised.

The challenge has been taken up by the Honiara City Council, which recently submitted a 960,000-dollar proposal to the government to implement a comprehensive, yearlong garbage collection programme.

"This will be an integrated approach to waste management to include the cleaning of drains where rubbish collects, mass spraying and the social mobilisation of communities," Titiulu elaborated.

"We want to work with those communities where services don't reach and engage especially with youth to implement a (full-scale) cleanup of the city."

But he stressed that the council, which currently only has three vehicles, will need funds, equipment and logistical support in order to carry out the plan.  If successful, it could disrupt the breeding momentum of the mosquitoes and reduce the likelihood of outbreaks in the near future.

© Inter Press Service (2013) — All Rights ReservedOriginal source: Inter Press Service

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