Dr. Khin Nan Lon, Program Manager(DHF/Filaria) 7th ... · • To follow the updated National...
Transcript of Dr. Khin Nan Lon, Program Manager(DHF/Filaria) 7th ... · • To follow the updated National...
Dr. Khin Nan Lon, Program
Manager(DHF/Filaria)
7th November,2015
Population(2014)Census
Yangon 7360703
Mandalay 6165723
Ayeyarwaddy 6184829
Sagaing 5325347
Tanintharyi 1408401
Mon 2054393
Rakhine 3188807
Naypyitaw 1160242
Magwe 3917055
Bago 4867373
Kayin 1574079
Shan 5824432
Kachin 1689441
Kayah 286627
Chin 478801
51,486253
total land
area 676,578
square kilometer
Capital Naypyidaw
First level 2nd Level Third
7 Regions
(White)&
7 states
(Red) 1 Union
Territory
6 -self-
administe
red
zones
69
Districts
330
Townshi
ps
82
sub-
townshi
ps
3045
wards
13,267
village
tracts
67,285
Villages
Neighbour
Countries
Thailand, China,
India, Laos
Country Name Myanmar (Burma)
Dengue endemicity of Myanmar in SEA Region is category A.
Sporadic cases of dengue have been reported since 1960
It was notification of disease since 1964
First outbreak was occurred in Yangon in 1970 (1654 /91)
Firstly spread to other States & Regions since 1974 .
The highest number of cases and deaths recorded were 24285
cases in 2009 and 444 deaths in 1994 respectively.
But DF/DHF cases in 2015 is twice more than 2009.
43845 – cases (From 1.1.2015 to 30.11.2015 )
444
204
161
050100150200250300350400450500
05000
100001500020000250003000035000400004500050000
Cases Deaths
1970-2015 (30-11-15) DF/DHF Cases & Death (Absolute Number)
24285
43845
5.5
3.2
4.3
6.4
5.3
3.1
4.4
3.4 3.9
5.9
2.9
1.7
5.0
3.1
5.4
2.9
4.2
2.2
3.8
2.2
1.0
2.0 1.6 1.3 1.1
0.3 0.6
0.4 0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
0
10000
20000
30000
40000
50000
Cases Deaths
1970-2015 (30-11-15) DF/DHF Cases & CFR
61491
43845
1266
938
1406
537
777
332 161
0
200
400
600
800
1000
1200
1400
1600
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
Cases Deaths
11
mo
nth
s
5 y
rs
5 y
rs
5 y
ears
10
yrs
10
yrs
10
yrs
13376
0
2000
4000
6000
8000
10000
12000
14000
16000
Januar
y
Mar
ch
May
July
Sep
tem
ber
Nov
ember
Jan
uar
y
Mar
ch
May
July
Sep
tem
ber
Nov
ember
Januar
y
Mar
ch
May
July
Sep
tem
ber
Nov
ember
Januar
y
Mar
ch
May
July
Sep
tem
ber
Nov
ember
Januar
y
Mar
ch
May
July
Sep
tem
ber
Nov
ember
Januar
y
Mar
ch
May
July
Sep
tem
ber
Nov
ember
2010 2011 2012 2013 2014 2015
0
5
10
15
20
25
30
35
0
1000
2000
3000
4000
5000
6000
7000
Case Death
0
1000
2000
3000
4000
5000
6000
7000
0.0
50.0
100.0
150.0
200.0
250.0
300.0 Cases/100,000 Population
DHF cases in Urban /Rural
(2010-2014)
DHF cases in
Urban /Rural
(2015)
0
5000
10000
15000
20000
25000
Urban Rural
Urban Rural
Age Group wise Dengue cases (2007-2015)
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
2007 2008 2009 2010 2011 2012 2013 2014 2015
<1 1..4 5..9 10..14 15above
DHF Cases in Grading and Sex, 2015 (upto 30.11.15)
Dengue Virus Serotpye (1999-2010)
Year Total DENV 1 DENV 2 DENV 3 DENV 4 Mixed
1999 11 2 5 3 1 0
2000 8 6 1 1 0 0
2001 121 115 1 3 0 2(D1+2)
2002 72 28 24 3 12 4(D1+2)
2003 11 3 6 0 0 2(D1+2)
2004 5 0 1 2 0 2(D3+1)
2005 12 3 1 5 1 2(D1+3)
2006 5 0 1 2 0 2(D1+3)
2007 12 2 0 9 0 1(D1+3)
2008 16 6 3 4 2 1(D1+3)
2009 17 11 1 3 1 1(D1+3)
2010 31 14 5 0 12 1 (D2+4)
Source- DMR
Dengue Laboratory report (PCR)
Year Total Tested
Sero
type
1
Sero
type
2
Sero
type
3
Sero
type
4
2009 100 (Research at NOGH) 16 - 3 -
2010 15 (from Monywa Hospital) 12 - - -
2011 5 (from Ma-U Bin Hospital) - - - -
2012 4 (From NPT 1000bedded
Hospital)
2 - - -
2013
3 (Mawlamyine Hospital) +
5 (Zeyar Thiri Township,
Ywa Thit Kone Village,
NPT)+
44 (Research at Yangon
Children Hospital) =52
12 2 6 8
2014 5 (Mon state) - - 1 -
DHF Control Program In Myanmar
Goal To reduce the burden of dengue
Objectives To reduce dengue mortality by at least 50 %
To reduce morbidity by at least 25% by 2020
(Base Line data of 2010 are 16259 cases/119 deaths)
(25% is 4000 cases /50 % is 60 deaths)
To estimate the true burden of disease by 2016
Strategies Activities
1 To establish effective disease and
vector surveillance systems
based on reliable laboratory &
Health Information System
Public Hospital based disease
surveillance by VBDC staff
(15 % of private hospital report
in 2015)
2 To undertake disease prevention
through selective, stratified and
integrated vector control with
community
Vector Control
Larval Control with
community participation
Adult (Mosquito) control
Strategies Activities
3 To establish emergency
preparedness capacity to
prevent & control
outbreaks with appropriate
contingency plans
Epidemic preparedness and response
Capacity building
Training of Medical Officers and
BHS staffs on
effective disease and vector
surveillance
Epidemic preparedness
Dengue case management
Dengue workshop –(Sept,Nov 2015)
Updating Guidelines(P&C; Rx)
4 To ensure prompt case
management of DF/DHF
including early recognition
of signs and symptoms to
prevent mortality
Strategies Activities
5 To increase awareness of the
community regarding DF/DHF
prevention control and
management, through IEC
Advocacy meetings &
Community awareness session
on DHF prevention & control
6 To improve management and
technical support system and
strengthen the health facilities for
health sector development
Supervision & monitoring
Intra and Inter-sectoral co-
operation
Operational research - KAP
Study
Strength
• Initiating School Based DHF control plan including
Government schools, private schools and monastery
based education school
• Coordination and collaboration with other sectors in
some extent (Local Authorities, Ministry of Health,
Ministry of Education, Minister of Home Affair,
fishery department, NGOs, INGOs and Media. etc.)
• Better reporting data from Public Hospital and some
Private Hospital
Strength
• Improvement in Early Diagnostics, Effective
Treatment care and early referral system, there is
reduction in Mortality even though cases are
increasing.
• Political commitment of the government , have
more technical and material supports (Abate,
Fogging Machine, diagnostic tools, drugs and even
some INGOs support IEC materials, vector control
materials )
Weakness Shortage of Manpower in Vector Borne Disease Control Unit ,into which, DHF/ LF
section is integrated .
Weakness in Surveillance system- passive surveillance system from public hospitals
Weakness in Prevention and control
Weak integrated approach in control measures between different organizations
(VBDC, NGOs, City Development Council, Environmental Ministry)doing
separately
Local authorities & the community take more interest in fogging than larva control
Limited budgets for operational cost
Limited knowledge on prevention and control of Dengue Fever in the community
Existing vector control methods (Abate, fogging) have several limitations in terms
of cost and long term sustainability
Threats
• Climate Change (Global Warming & greenhouse gas )
• Uncontrolled mobile & migrants in peri-urban areas ( Poor sanitation
including solid waste disposal like as non-biodegradable products
(plastic, paper cups, used tyres)i ncrease vector breeding sites)
• Uncontrolled urbanization with under developed infrastructure
(unplanned settlements with inadequate potable water as increased in
improper water storage system, temporary containers without covers)
• High workload burden on Basic Health Staffs
Opportunities
• Political commitment by local authority and support
by Local government, NGO, Social Welfare
• Role of NGOs –
- promote community mobilization for
implementing environmental management
- correct health seeking behavior
• INGOs – more interest in Dengue Control Activities
The Ways Forward
• DF is an notifiable disease and government need to revitalize it‘s
law enforcement
• To follow the updated National Guideline for Prevention, Control
and treatment for DF/DHF .( National DHF control Program and
Malaria consortium is developing it )
• Program need to find out more funding.
• Need to scale up School and Institutional based DHF prevention
and Control activities( Program is plan and find funding)
• .
The Ways Forward
• To do serological surveillance in selected sentinel hospitals in each
and every State and Region by VBDC,NHL&DMR (Need Budget)
(VBDC, NHL, DMR)
• To initiate mobile/web-based reporting system
• To strengthen of E-reporting system(M-health)and to develop
Dengue Webpage and train IT person
• To use WHO IVM training manual for implementation
• Strengthen social network (using viber or facebook for community
awareness as well as supporting surveillance activities.