Activities & Services eng

Activities & Services eng (6)

24
Mar2014

Facilitating the Improvement of DF/DHF Case Management

Major Activities

  • Provision of resources necessary for proper management of DF/DHF cases
  • In service training of curative health care staff on clinical management of DF/DHF (by Epidemiology Unit)
  • Establishment of High Dependency Units(HDU) to manage severe DF/DHF cases

HDU

HDU Map

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Clinical Training

24
Feb2014

Coordination of Emergency Preparedness:

  • Mitigating outbreaks by MOOH
  • Harnessing activities at district & divisional level

Emergency response includes measures to reduce the number of infective mosquitoes rapidly and proper management of patients
Based on notification,

  • Early detection of increasing fever cases at treatment facilities
  • Analyze data by district/ MOH areas/smaller localities
  • Anticipating/predicting outbreaks using surveillance data
  • Use of entomological surveillance data timely to forecast / Identify high risk areas
  • Develop plans for vector control
    • set targets
    • identify strategies/ resources
  • Monitoring & evaluation
24
Feb2014

Enhance community participation for sustainable DF/DHF control and prevention programme

  • Declaration of Mosquito Control Weeks and media seminars
  • Production of Information, Education and Communication(IEC) materials
  • Advertising campaigns through electronic and  print media to create awareness of public on control / prevention strategies & to promote health seeking behaviour


Communication for Behavioural Impact   

The strategies for the prevention and control of dengue include prompt diagnosis of fever cases, management or elimination of larval habitats in and around homes, work settings, schools, etc, and reducing human vector contacts.

A major obstacle to effective implementation of selective/ integrated mosquito control has been the inability to achieve and sustain expected desired behaviour. Despite growing levels of knowledge and awareness about dengue and mosquitoes, adopting and maintaining effective and feasible new behaviour which remains a challenge.

Communication for behavioural impact (COMBI), espoused by WHO, is an innovative approach to fill this gap to mobilize individual and family action, utilizing social mobilization and communication to bring measurable change in behavior. It helps to plan, implement and monitor a variety of communication actions intended to engage individuals for adoption of healthy behaviours.

COMBI objectives include the clear identification of the target audience, a detailed description of the behaviour being promoted and the frequency of the behaviour, the measurable impact that is desired over a specific time period: In other words the objectives should be ‘SMART’ (specific, measurable, appropriate, realistic,time-bound).

•    Specific: who or what is the focus; what change(s) are intended.
•    Measurable: specified quantum (e.g. % change intended).
•    Appropriate: based on target needs and aimed at specific health-related benefits.
•    Realistic: can be reasonably achieved.
•    Time-bound: specific time period to realize the objectives.
COMBI thus entails purposive and tailor-made strategic communication solutions intended to engage a specific target audience into responsive action.  

In developing the preliminary objectives, suitable recommendations for action by different segments should be considered.


•    Whose behaviour should be changed to bring about the desired outcomes? Who is the target audience?
•     What is required to be done? Is it feasible? Is it effective?
•     Why are they not doing it now? What are the barriers and motivators?
•     What activities can address the factors most influential to change behaviour?
•     Are materials/products/services needed to support those activities? If yes, are those easily available? If not, what should be done?

The behavioural objectives, target groups and key messages currently used are stated below:

Behavioural objectives and target groups:
1.To prompt housewives in 80-90% of homes in MOH areas to remove dengue breeding sites in their houses and surroundings at least once a week


2.To prompt principals and teachers in 80-90% of  schools to keep their school premises   free of dengue breeding sites through regular inspections every Monday and Thursday


3.To establish “ Dengue Prevention Committees” in all government institutions to inspect and  remove dengue breeding sites in their premises and surroundings at least once a week


4.To motivate patients with fever for more than 02 days to seek treatment from a qualified doctor                                                                                                                                                                         

Key messages:
1. Every Sunday for 30 minutes, inspect your house and surrounding for dengue breeding sites. Remove or destroy them

2. Every Friday  for 30 minutes, inspect your school premises for dengue breeding sites. Remove or destroy them

3. Seek treatment from a qualified doctor,   if you have fever for more than 02 days

4. Do not take pain killers/ anti-inflammatory drugs, if you have fever

Enforcement of law against offenders 

Enforcement of law against the offenders who are keeping dengue mosquito breeding places in his/her premises which will endanger the lives of others

Mosquito Control in Schools

To be engaged on a weekly basis

Check for and eliminate mosquito breeding in the following places:

  • Discarded receptacles in open areas and under bushes in school premises
  • Open and closed drains
  • Manholes 
  • Cement lined ground ponds
  • Tree holes, bamboo stumps and leaf axil
  • Refuse bins and bin covers, especially when unused
  • Scupper drains in common corridors
  • Flower pots, plant pots and saucers and other ornamental structures
  • Air-conditioner trays
  • Unused equipment and other items for e.g. canvas sheet, dustpan, tyres, broken plastic chairs etc at storage areas
  • Cement rooftops and roof gutters
  • water storage tanks
  • Unused/ broken cisterns and bowls of toilets
  • Any other water-bearing receptacles

School Vacation

Maintain mosquito breeding free environment even in the school vacations, since several activities including examinations are held in the schools

School Hostel or Boarding House

Carry out the above mosquito control measures at the school hostel or boarding house too.

Vacant School buildings and constructions in schools

  • In vacant schools or schools undergoing constructions/demolition, eliminate mosquito breeding sites in discarded items left behind.
  • Seal/ cover up all toilet bowls/ cisterns/ gully traps with suitable mosquito proof material.
  • Check weekly water storage containers and other water collecting/ stagnated containers and receptacles.

Removal/ elimination of mosquito breeding in school premises

Following measures can be taken to eliminate mosquito breeding in the school premises during the inspection

  • Ensure the water storage tanks are properly covered and all drainage outlets are sealed
  • Collect and Burn, bury or dispose the discarded containers properly
  • Use larvivorous fish in ground level water storage tanks
  • Discourage planting water holding plants in its axils
  • Take immediate action to remove unwanted stored (inventory) items
  • Clean blocked roof gutters

Report to the school management committee all the breeding detected and the potential breeding habitats observed so that appropriate interim or permanent measures can be taken to eliminate the potential breeding grounds.

Mosquito Control in Construction Sites

Check for mosquito breeding in the following places:-

  • Discarded receptacles and building wastes in the worksite and site offices.
  • Building materials, canvas sheets, equipment and machinery.
  • Puddles on the concrete floors of all upper levels and basement
  • Water storage drums, tanks and containers.
  • Bulk waste containers
  • Lift wells
  • Safety barriers
  • Rooftops and water tanks
  • Treatment plants
  • Any other water-bearing receptacles

Destruction of mosquito breeding

Destroy/ eliminate all mosquito breeding sites found during the inspection

Report to the construction site supervisor and the head of the institution of the relevant authority all the breeding detected and the potential breeding habitats observed so that appropriate interim or permanent measures can be taken to eliminate the potential breeding grounds.

Fogging

It is not mandatory to conduct fogging at construction sites. Fogging treatment should only be done when there is an impending disease outbreak or epidemic situations in the area.

Frequently Asked Questions

24
Feb2014

The Presidential Task Force was appointed by H.E. the President to strengthen mulitisectoral collaboration and implementation of strategies at the National/Provincial/District levels. The first meeting was convened on 25. 05.2010 chaired by H.E. the President

Members of the Task Force

  • Ministry of Health
  • Ministry of Public Administration
  • Ministry of Education
  • Ministry of Environment
  • Ministry of Local Government
  • Ministry of Media
  • Ministry of Disaster Management
  • Ministry of Defense 
  • Ministry of Law & Order

 

Roles & Responsibilities of each Ministry

Ministry of Health
• Proper treatment of DF/DHF patients
• Prevent spread of epidemics
• Coordinate with other relevant government & non government sectors to carry out dengue control /prevention activities


Ministry of Public Administration
• Maintain all government & private institutions free of mosquito breeding
• Active involvement of dengue control/prevention activities, mobilizing district, divisional and village level officers comes under the ministry

Ministry of Education
• Maintain all government, private schools, piriven, training colleges, vidya peeta, free of mosquito breeding
• Inculcate a behavioural change in school children to keep the environment free of mosquito breeding
• Collaborate with respective Medical Officer of Health and staff to maintain schools, surrounding premises free of mosquito breeding
• Provide necessary guidance through school children to keep their home environment free of mosquito breeding

Ministry of Environment
• Formulation and implementation of policies for proper disposal of solid waste
• Active involvement in dengue control/ prevention activities

Ministry of Local Government & Provincial Councils
• Proper disposal of solid waste including non biodegradable items
• Cleaning of drainage systems and maintaining them properly to prevent water collections
• Maintain public places without mosquito breeding
• Active involvement in dengue control/ prevention activities
• Strengthen legal activities


Ministry of Defense & Ministry of Law & Order
• Maintain all institutions comes under the ministry free of mosquito breeding
• Active involvement in dengue control/ prevention activities

Ministry of Mass Media & Information
• Telecast, broadcast advertisement free of charge in relation to dengue illness including clinical features, treatments and prevention under the technical guidance of the Ministry of Health

Ministry of Disaster Management
• Provide support to control and mitigate dengue outbreaks

Aims of the Presidential Task Force on Prevention and Control of Dengue Fever

  • To prepare strategic plans, programmes to implement effective integrated vector management.
  • To strengthen technical and managerial capacity for the situation analysis, dengue vector control needs assessment, planning, implementation, monitoring and evaluation of impacts at Provincial and District levels.
  • To promote collaboration among national health agencies and major stakeholders to implement dengue programmes.
  • To address programmatic issues and gaps.
  • To adopt an enabling policy environment in implementing regulatory legislation for effective dengue prevention and control.
  • To develop coordinated actions for sustained dengue vector management within and outside of health sector.
  • To increase visibility and sustainability by providing greater opportunities to decision-making on vector control with participation of local communities.
  • Setting up of a core task force at Provincial, District and Divisional levels with multidisciplinary expertise.


Inter Ministerial Participation

  • A Cabinet Sub Committee appointed under the chairman ship of the Secretary, Ministry of Health comprising of secretaries or Additional Secretaries of relevant Ministries.
  • Aims of the subcommittee are
    • To actively participate in dengue control activities
    • Review the activities
    • Submit a report to Cabinet of Ministers quarterly.

 

 

24
Feb2014

Vector management consists of two components
•    Vector Surveillance    
•    Vector Control   

  1. Environmental management
  2. Biological methods   
  3. Chemical methods            
  4. Integrated vector management         
  5. Intersectoral coordination and social mobilization         

Vector Surveillance

Vector surveillance is systematic monitoring of the seasonality and abundance of vector population.


The main purpose of dengue vector surveillance (larva, pupae and adult) is to obtain information regarding dengue vector density, which can be used to predict outbreaks and control dengue transmission.
Vector surveillance is important…
(1). To monitor vector densities over time enabling early warning and forecasting potential outbreaks/ epidemics. This facilitates initiation of early measures to prevent / control  outbreaks


(2).To study the ecology, biology and bionomics of dengue vectors, in order to collect information on vector breeding sites, biting and resting habits, role played by individual vector species in disease transmission. This information is important for the implementation of an effective dengue control programme in the country.


Vector surveillance is carried out by the NDCU in cooperation with Anti Malaria Campaign (AMC), Anti Filariasis Campaign (AFC) and Medical Research Institute (MRI). In addition to central level offices, these institutions have their district level offices headed by Regional Malaria/ Medical officers (RMOO), Medical officers of AFC or Entomologist who are responsible for planning, implementation, monitoring and evaluation of entomological surveillance at the district level. Currently, 107 entomological teams are deployed for entomological surveillance at the central and district level offices of the AMC, AFC and MRI.

Vector Control

Vector Control activities are managed and conducted by the Medical Officer of Health (MOH) offices in the country with the collaboration of respective Regional Malaria/ Medical officers (RMO) Medical officer AFC and entomologists.


Major Activities

  • Facilitating district and divisional level vector management staff to perform optimally for the elimination/control dengue vectors by providing technical guidance, training, equipment, logistics, insecticides, and other resources including funding
  • Development and distribution of training manuals & guidelines on vector surveillance and control
  • Monitoring and Evaluation of district level activities
  • Conduct of monthly review meetings
  • Insecticide resistance monitoring review weekly entomology returns and send alerts to relevant MOH, RDHS and PDHS whenever entomology indices are high     

 

Nuwara Eliya District is covered by RMO/AMC Kandy

Integrated Vector Management Traning

Dengue Vector Control

In Sri Lanka, Aedes aegypti and Ae. albopictus are responsible for transmission of dengue and Dengue Haemorrahgic fever. These mosquitoes use a wide range of confined larval habitats, both man-made and natural. Some man-made container habitats produce large numbers of adult mosquitoes, whereas others are less productive.
Current vector control measures used in Sri Lanka,

  • Environmental Management (Environmental modification, Environmental manipulation and changes to human habitation or behaviour)
  • Biological methods (Larval control)
  • Chemical methods (Larval control and Adult control)
  • Integrated vector management
  • Intersectoral coordination and social mobilization and
  • Enforcement of law against offenders 


Environmental Management
Environmental management is to change the environment to prevent or minimize vector breeding and/or man vector mosquito contact by destroying, altering, removing or recycling containers that produce larval habitats. Environmental management is the most efficient approach of dengue vector control and it is comprised of three components; i.e.  Environmental modification, Environmental manipulation and changes to human habitation or behavior.

Environmental Modification
Permanent or long lasting physical transformation of vector breeding sites in order to eliminate/ reduce vector larval habitats.
e.g. Provision of reliable water supply to the community in order to prevent water storage
Install a reliable water supply to the community and households would prevent or minimize water storage in cement tanks, barrels and other containers, thus, installation of a regular water supply would help a great deal to reduce dengue vector breeding in water storage containers and thereby reduce dengue transmission. 

Environmental Manipulation
Temporary changes to vector breeding habitats to prevent/ minimize vector breeding
e.g.
•    Frequent emptying and cleaning by scrubbing of water storage tanks, barrels and other containers, flower vases, refrigerator trays
    
•    Installation of mosquito proofing nets or tight lids to water storage tanks, barrels and other containers
Water storage containers can be fitted with tight lids or tightly fitted mosquito proof mesh to prevent entering of mosquitoes to lay eggs (oviposition) in these containers. Studies have shown that such measures prevent mosquito breeding in water storage tanks and barrels in Sri Lanka  

•    Cleaning of blocked roof gutters
Clogged roof gutters are important breeding site of Ae. aegypti. The owners of the premises are required to clean or install them with a suitable angle in order to prevent water collection.  If the owners are unable to maintain them satisfactorily, those gutters should be removed.
 
•    Sheltering stored tyres in order to prevent collection of rain water in tyres
•    Proper disposal or recycling of discarded containers including tyres
Non biodegradable items of household, community and industries should be collected and disposed regularly, preferably, once in 3 days.

Discourage growing plants that collect water in the leaf axils

Changes to human habitations or behaviour
Installing mosquito proof screens on windows, doors and other entry points
Use of mosquito nets while sleeping during day time

Biological Control
Biological control is based on the introduction of organisms that prey upon, parasitise, competes with or otherwise reduce vector species.


Organisms.
• The introduction of organisms that, parasitize, compete with or reduce populations of Aedes  mosquitoes
• Predators – can be deleted
Currently using biological agents for dengue vector control
Lavivarous fish:  Larvivorous fish can be applied for water storage tanks, barrels, cement lined wells and industrial tanks. Most efficient larvivorous fish for mosquito control are

  • Poecilia reticulata - Guppy
  • Aplochcheilus dayi – Nala handaya
  • Oryeochromis mossambicus / Oryeochromis niloticus- Thilapia spp
  • Rasbora daniconius - Dandi


• Microorganisms

  • Bacillus thurengiensis isralensis - Bti

Chemical methods for dengue vector control: Larvicides
Chemical larviciding should be considered as complementary to environmental management. Except in emergencies, chemical larviciding should be restricted to containers that cannot otherwise be eliminated or managed. Currently, temephos 1% sand granules at the rate of 1g/ 10 liter of water is used for larval control in water storage containers such as tanks and barrels.

Chemical methods for dengue vector control: adulticides
In Sri Lanka, space spraying (fogging) is widely used for dengue vector control. However, space spraying is recommended for vector control only in emergency situations to suppress ongoing epidemics or to prevent an incipient one. The objective of space spraying is the massive, rapid distruction of adult vector populations, both indoors and outdoors. In space spraying, a suitable insecticide is mixed with kerosene oil and released to the environment in the form of very tiny droplets. Once these droplets get contacted with the vector mosquitoes, the mosquitoes get knocked down and die. In order for the fog to reach the interior of the premises, the doors and windows should be kept open while fogging, however, food and water should be kept covered to prevent contamination with the insecticide.

Intersectoral collaboration and social mobilization
Aedes aegypti and A. albopictus breed in and around human habitations.In addition to the house holds, these mosquitoes are frequently find in schools, offices, private institutions, religious places, bus depots, tyre shops etc. Thus, involvement of other sectors such as education, security forces, religious leaders, water board, road authority etc are of utmost importance for dengue prevention and control. Involving the other sectors for dengue vector control facilitate a more coordinated approach than the individual and independent efforts of different sectors. This also provides a platform for partners to resolve cross agency issues and to share best practices while reducing duplication of efforts.

 

20
Feb2014

The NDCU in cooperation with the Epidemiology unit, Regional Epidemiologists and Medical Officers of Health(MOOH) is carrying out dengue fever surveillance activities in the country

Major Activities

  • Establishment of web based system to enhance disease surveillance in collaboration with the Epidemiology unit in 50 sentinel hospitals
  • Training of relevant health staff

Sentinel Hospitals

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Province

District

Hospital

Western Province

             

 

 

 

 

 

 

 

 

 

 

 

 

Colombo District      

 

 

 

 

 

IDH

BH Awissawella

LRH

NHSL

BH Homagama

TH Kalubowila

TH Sri Jayewardenepura

Gampaha District

   

 

 

BH Wathupitiwala

DGH Gampaha

DGH Negombo

TH Ragama

Kalutara District

  

 

BH Horana

DGH Kalutara

BH Panadura

Uva Province

  

 

Badulla Distirct

  

 

PGH Badulla

BH Diyathalawa

BH Mahiyanganaya

Southern Province

      

 

 

 

 

 

Galle District

  

 

BH Balapitiya

BH Elpitiya

TH Karapitiya

Hambantota District

 

DGH Hambantota

GH Tangalle

Matara Distict

 

BH Kamburupitiya

DGH Matara

Sabaragamuwa Province

    

 

 

Kegalle Distirict

  

 

BH Karawanella

DGH Kegalle

BH Mawanella

Rathnapura Disrict

 

BH Embilipitiya

PGH Ratnapura

Northern Province

  

 

Jaffna District

TH Jaffna

Mannar Distict

DGH Mannar

Vauniya Distirct

DGH Vavuniya

North Western Province

       

 

 

 

 

 

Kurunagala District

   

 

 

BH Dambadeniya

BH Kuliyapitiya

PGH Kurunegala

BH Marawila

Puttlum Distict

 

DGH Chilaw

BH Puttalam

Anuradhapura District

TH Anurahadapura

Polonnaruwa District

DGH Polonnaruwa

Eastern Province

      

 

 

 

Ampara District

  

 

DGH Ampara

BH Kalmunai

AMH Kalmunai

Batticoloa District

 

TH Batticaloa

BH Kalawanchikudy

Trincomalee District

 

BH Kantale

DGH Trincomalee

Central Province

     

 

 

 

 

 

 

 

 

 

 

Kandy District

   

 

 

BH Gampola

TH Kandy

DGH Nawalapitiya

TH Peradeniya

Matale Dsitrict

DGH Matale

Nuwara Eliya District

 

DGH Nuwara Eliya

 

Contact Us

  • National Dengue Control Unit,
    Ministry of Health,
    Public Health Complex
    , 555/5, Elvitigala Mawatha, Narahenpita, Colombo 05, Sri Lanka.
  • (0094) 1 2368416, 2368417

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