DENGUE: Problem IdentificationWhen left undetected and

untreated, dengue could lead to a number of complications and even death.

Currently, no applicable/available effective vaccine.

Current climate change, and variable vector behavior.

Burden of DiseaseDOH latest figures show a total of 27,071 dengue

cases recorded from January to June 11 this year. This is 4.12 percent lower compared to the same period last year (28,234).

Ages of cases ranged from less than 1 month to 89 years old, with most (40%) belonging to the 1 to 10 years age group. Majority (53%) of the cases were male. There were 172 deaths reported.

Most of the reported cases were from the following regions: National Capital Region (8,184), Region III or Central Luzon (4,624), Region IV-A (3,935). In the National Capital Region, most of the cases came from Quezon City (2,017), Pasig City (970), and Kalookan City (951).

Implications Social status is a significant factor in terms of who is

affected by the dengue fever. The impact of the outbreak was greater for poor communities in the urban and semi-rural areas, particularly for women who described themselves as housewives and mothers, and their children. In addition, they experienced the greatest loss of time as a consequence of the outbreak.

The main effect of the outbreak on work activities not traditionally remunerated with money, such as housework, was the inability of adult females in the household to perform their routine activities to maintain family life.

Moreover, the monetary costs of health care absorbed a significant percentage of the household weekly income.

The impact on psychological well-being was related to the stress produced by the clinical, social, and economic consequences of the outbreak for women.

DOH Dengue Control Program  One of the major health problems during rainy

season is the incidence of Dengue Hemorrhagic Fever. It occurs in all age groups. This disease (transmitted by Aedes, a day-biting mosquito) is preventable but is prevalent in urban centers where population density is high, water supply is inadequate (resulting to water storage and a good breeding place for the vector), and solid waste collection and storing are also inadequate.

The thrust of the Dengue Control Program is directed towards community-based prevention and control in endemic areas. Major strategy is advocacy and promotion, particularly the Four O’clock Habit which was adopted by most LGUs. This is a nationwide, continuous and concerted effort to eliminate the breeding places of Aedes aegypti. Other initiatives are the dissemination of IEC materials and tri-media coverage.

Four o clock HabitThe Four-o'clock Habit (“4 o’clock habit”) is an

initiative of the Philippine government that requests residents to practice the cleaning of their surroundings and draining water containers to prevent the spread of mosquitoes, in support of the Dengue Control Program and the Malaria Control Program. This is also known as “operation kaya–kulub (upside down).”

JUNE AS DENGUE PREVENTION MONTHSOCIAL With the month of June declared as

Dengue Awareness month, private companies such as SNI Philippines are actively pitching in to help the DOH combat dengue through nationwide info drives.

STRATEGIESDr. Lyndon Lee Suy, DOH program manager

of anti-dengue program, noted different strategies in dengue prevention and control program including the introduction Ovi-Larvi Trap System, a mosquito trap and putting up of insecticide-treated nets in the school premises.

Lee Suy called on the (SOCIAL) public to be partners in cleaning their surroundings particularly on possible breeding areas of mosquitoes — stagnant water in refrigerator containers, dish drainers, flower vases, and gutters -- should be removed.

STRATEGIESECONOMICAL/SOCIAL/POLITICAL the DOH signed a memorandum of agreement with

barangay officials led by Liga ng Mga Barangay who pledged that each member-barangay will implement a dengue prevention and control program coming from their Internal Revenue Allotment (IRA).

Likewise, the DOH has renewed its call to the public to consider their slogan: "Kilos Na! Mag-4S Kontra Dengue!" and it 4S strategies such as Search and destroy, Seek early consultation, Self-protective measures and Say no to indiscriminate fogging.

STRATEGIES: OVITRAPS The OL mosquito trap is a technology developed by

the Department of Science and Technology (DOST) designed to reduce the population of the dengue-carrying Aedes mosquitoes by attracting and killing their eggs in a simple but proven effective system. This technology will be distributed nationwide in cooperation with the Department of Health (DOH).

(Political) The Governor also encouraged his fellow officials and local constituents to be involved and not to wait until they become victims of the disease. He also stated that the local government of Tacloban will allocate funds to buy extra OL mosquito trap kit to distribute to all houses specially the identified high dengue risk areas.

DOST and DOH will distribute 2,800 kits to each of the 16 regions of the country. National Capital Region (NCR) will get a separate allocation of 5,200 OL mosquito trap kits.

OVITRAP LAUNCHINGLocal executives in Region VIII thumb up with DOST

Secretary Mario G. Montejo (third from right) and DOH Secretary Enrique T. Ona (4th from right)  to this new dengue control and prevention program of the DOST and DOH.

STRATEGIES: PROMOTIONSOCIAL health promotion, since

health is a collective social good. The paradigm for promotion is centered on the principle that health is the greatest resource for social, economic, and personal development, as well as an important dimension of the quality of life. It also recognizes that political, economic, social, cultural, environmental, behavioral and biological factors can help a person's health as much they can damage it.

STRATEGIESECONOMICAL and SOCIAL holistic

vision of promotion. When it comes to dengue, nothing is easy, simple, or cheap. It is essential to promote changes—behavioral changes—not only in the community, but also in the structure and organization of prevention and control programs.They have been successful or sustainable over the years because of their very costly vertical structure, based on chemical control (the use of insecticides),

STRATEGIES: COMMUNITY INVOLVEMENTSOCIAL because they utilize

community participation and health education only in epidemics and emergencies.

Community participation is normally centered around mass clean-up campaigns (trash removal), the distribution of printed matter, and mass radio and television campaigns to disseminate information about the vector, its breeding sites and the disease.

STRATEGIES: BEHAVIORSOCIAL Because dengue a problem

linked to the residential environment, the existence of breeding sites is due to specific human behaviors (individual, community, and institutional), since any receptable capable of holdingwater is a potential breeding site for Aedes eggs.

investigate, select, and apply, appropriate to the situation of each individual, family, or other institutions outside the health sector.

STRATEGIES: POLITICALPOLITICAL Understanding the

linkages between global, national and local level policymaking.

PROPER REFERRAL SYSTEM– Impact of such policies on prudent

and equitable use of antibiotics and other drugs.

– Access to basic services by vulnerable populations.

ability to respond to key health issues

SOCIAL CULTURAL POLITICAL

health management—integrated control programs—is considered a synergistic point

KEY POINTS Integrated epidemiological and entomological surveillance. Advocacy and implementation of intersectoral actions among

health, environment, and education, as well as other sectors such as industry and trade in new materials, tourism, and the legislative and judicial branches of government.

Effective community participation. Environmental management and attention to basic services such as

water supply, wastewater disposal, solid waste management, and the proper disposal of used tires.

Patient care inside and outside the health system . Case notification (clinical cases, confirmed, cases of and deaths

from DHF, circulating serotypes). Incorporation of dengue/health into the formal education curriculum. Critical analysis of the function and use of insecticides. Formal training of health professionals and workers (from the

medical and social sectors). Emergency preparedness, setting up new mechanisms and

preparing to deal with outbreaks and epidemics.

SUMMARY OF STRATEGIES Strong leadership in program management. Political and financial support to provide continuity for interventions. Selective vector control based on effective social communication,

community participation, and environmental management aimed at individual and collective behavior .

Environmental management and related activities (water, refuse, and solid waste).

Active integrated surveillance based on an efficient, reliable health information system (epidemiological and entomological).

Medical care to patients inside and outside the health system, which includes recognition of warning signs and appropriate responses .

Evaluation tools that can periodically measure the effectiveness of the action taken.

Knowledge of the economic impact of the various components of the prevention and control programs.

Continuing education for human resources in the social and biomedical sciences at all levels (from local to national)

IS THE PROGRAM SUCCESSFUL?