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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 8  |  Issue : 4  |  Page : 88-92

Dengue and malaria: A spatial–temporal study across the Greater Hyderabad Municipal Corporation limits


1 The Chief Entomologist, GHMC, Hyderabad, India
2 Former Asst. Entomologist, GHMC, Hyderabad, India

Date of Submission01-Oct-2020
Date of Decision25-Nov-2020
Date of Acceptance28-Nov-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Dr. Rambabu Ayyadevara
10 3 146, Flat No. G2, Sai Amrutha Nilayam Apts, Maliagudem, Khammam, Telangana State - 507 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjhs.mjhs_3_20

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  Abstract 


Background: Vector-borne diseases (VBDs) have been a worrying factor among the tropical and subtropical parts of the world which include diseases such as dengue, malaria, chikungunya, and Japanese encephalitis wherein mosquitoes acts as vectors, transmitting the disease-causing pathogen. Dengue which spreads through mosquitoes belonging to the Genus Aedes has been on the rise for the past few years in the Greater Hyderabad Municipal Corporation (GHMC) limits. While the symptoms range from mild-to-escalated complications such as hemorrhagic fever and dengue shock syndrome, there is no antiviral therapy currently in use. Symptomatic and supportive treatment is the key for the treatment of dengue patients.
Objective: This research article attempts to track the malaria and dengue incidence over the years, To track the malaria and dengue incidence over the years, more specifically the last 5 years across the GHMC limits.
Materials and Methods: Data on the dengue and malaria cases over the years are usually gathered and preserved by the Health and Entomology Departments of GHMC Head Office. Data of its incidence for the past 10 years, especially taking note of the previous 5 years, from 2014 to June 2020, were collected from these sources and analyzed, using basic statistical techniques.
Results: Within the GHMC limits, there has been a significant drop in the number of malaria cases, but dengue cases rose to an alarming level (3366 cases in 2019). Based on the disease incidence, dengue hotspot areas have been marked so as to effectively take up vector control interventions by using both workforce as well as latest technology (internet of things (IoT), artificial intelligence (AI)).
Conclusion: Consistent efforts in a structured way should be made to control the mosquito population, coupling it with community compliance and awareness among the masses on keeping the environment clean and hygienic.

Keywords: AI, chikungunya, dengue, Greater Hyderabad Municipal Corporation, IoT, JE, malaria


How to cite this article:
Ayyadevara R, Nikhat U. Dengue and malaria: A spatial–temporal study across the Greater Hyderabad Municipal Corporation limits. MRIMS J Health Sci 2020;8:88-92

How to cite this URL:
Ayyadevara R, Nikhat U. Dengue and malaria: A spatial–temporal study across the Greater Hyderabad Municipal Corporation limits. MRIMS J Health Sci [serial online] 2020 [cited 2021 Apr 14];8:88-92. Available from: http://www.mrimsjournal.com/text.asp?2020/8/4/88/304933




  Introduction Top


The Greater Hyderabad Municipal Corporation (GHMC), formed in April 2007, is a civic body which looks after the city's administration and infrastructure. It has 100 wards of the erstwhile Municipal Corporation of Hyderabad, in addition to the newly inducted 12 municipalities and 8 gram panchayats of the neighboring districts. GHMC covers nearly one crore population, including the districts of Hyderabad, Medchal, Vikarabad, and Sangareddy, spanning about 650 km2 of area. Currently, GHMC covers 150 divisions within 30 circles of all the six zones.

Rapid urbanization and increasing job opportunities in the city has ever been triggering exodus of people, who come in search of their livelihood. This burgeoning population is blatantly adding on to the civic woes. One such peril lies in the rise of pollution levels across the city, affecting both the atmosphere and the water bodies in the region. The industrial effluents and domestic sewage released unchecked into the water bodies in and around the city, have led to severe water pollution. Subsequent eutrophication of lakes and water bodies has triggered the wanted growth of water hyacinth. This results in a serious disturbance in the aquatic ecosystem and also an increase in the mosquito population – the vectors of many infectious diseases such as dengue, malaria, and chikungunya.

The perilous effects of the swarming mosquito population throughout the GHMC limits have been a worrying factor among the state government and GHMC–Urban Malaria Scheme (UMS) officials, who swung into action to prevent the spread of vector-borne diseases (VBDs). To curtail the breeding mosquito population, strategies have been updated and implemented from time to time, especially focusing on the hotspots where disease incidence is on the rise. Standard operation procedure (SOP) is implemented whenever the VBDs are notified to the authorities. As per the SOP, entomology team inspects the positive house and 80–100 houses surrounding it and performs the spraying operation and prioritize ssource reduction strategies which include checking for breeding points of mosquitoes and performing antilarval operations (ALOs). Sanitation team inspects for good hygiene and enforces the same among the residents. Medical team conducts medical check-ups of all the members of the household. Urban Community Development (UCD) team upon receiving data, carry out an analysis. Thus the team work by all the four teams (entomology team, sanitation team, medical team and UCD team) is done to mitigate the problem.

Among the VBDs, the most threatening is dengue which is spreading its tentacles at alarming levels across the GHMC areas.

Dengue virus, a Flavivirus, belonging to Flaviviridae, spreads through Aedes mosquitoes, which are quite prevalent in tropical regions. Significant geographic expansion has been coupled with a rapid increase in incident cases, epidemics, and hyperendemicity, leading to the more severe forms of dengue.[1]

Dengue is characterized by relatively mild to sometimes deleterious and life-threatening complications of hemorrhagic shock and fever. Dengue fever is characterized by the presence of high fever, joint pain, skin rashes, and hemorrhagic shock syndrome. It is a self-limiting infection which requires adequate bed rest, fluid replacement therapy, and adequate hydration coupled with analgesics.[2]

Given its widespread casualties, the World Health Organization (WHO) recognizes dengue fever as a major global public health challenge in tropical and subtropical regions. Early diagnosis and treatment are the keys to control this infection.

The WHO guidelines summarize the following principles of fluid therapy:[2]

  • Oral fluid supplementation must be as plentiful as possible. However, intravenous fluid administration is mandatory in cases of shock, severe vomiting, and prostration (cases where the patient is unable to take fluids orally)
  • Crystalloids form the first-line choice of intravenous fluid (0.9% saline)
  • Hypotensive states that are unresponsive to boluses of intravenous crystalloids and colloids (e.g., dextran) form the second-line measures
  • If the patient remains in the critical phase with low platelet counts, there should be a serious concern for bleeding. Suspected cases of bleeding are best managed by transfusion of fresh whole blood
  • Since an effective vaccine for dengue has not been developed, the mainstay to curb the disease spread would be better surveillance measures and vector control strategies. For dengue vectors, this involves using a combination of approaches incorporating key elements of social mobilization, integration of chemical and nonchemical control methods targeting areas of high human-vector contact, evidence-based decision-making guiding research and policy, as well as capacity building.[3]


Having gone through the basics, this research article now puts an effort to focus on the dengue and malaria cases across GHMC limits, the action plan and its nuances, in the backdrop of GHMC's efforts to prioritize and coordinate all its resources in order to curtail its spread.

The present study was carried out to study the comparative analysis of the trends of dengue and malaria cases of about a decade, i.e., from 2014 to early 2020; to investigate the causes for the sharp increase in dengue cases in the preceding year; to disseminate the strategies laid and being implemented by the authorities at the grassroot level; and to reflect upon the containment strategies so as to mitigate the VBD incidence.


  Materials and Methods Top


Data on the dengue and malaria cases over the years are usually gathered and preserved by the Health and Entomology Departments of GHMC Head Office. Data of its incidence for the past 10 years, especially taking note of the previous 5 years, from 2014 to June 2020, were collected from these sources and analyzed, using basic statistical techniques. In due course, various health-care providers and the residents were intercepted on the health and disease status, taking into account the ever-increasing population and the socioeconomics across GHMC limits. The data regarding the same was duly recorded to further the mitigation strategies.


  Results and Discussion Top


The recorded statistics since the year 2014 till the month of April 2020 shows fluctuating disease incidence trends. The rising cases of malaria were effectively curtailed which is evident from the declining numbers recorded until recently, i.e., as of April 2020. Vector control strategies in terms of proper planning, mapping, and communications with various personnel on and off the field to coordinate and supervise the operations seem to be better implemented and the cases were tracked and dealt effectively.

The cumulative cases reported between 2010 and 14 show lot a greater number of cases than those of the next 5 years. After a decline in 2016, a steady rise is seen in the next 2 years (2017 and 2018). This is followed by a sharp decline in 2019 which seems to be continuing. There seems to be a 42% fall in the malaria incidence over the 5 years which is a good sign. The authorities should go with the ongoing vector control programs with more vigor to completely weed out malaria. Of much concern is the spike in dengue cases across GHMC limits. A steady rise in the number of dengue cases is seen in 2016 which seems to lower in 2017. Cases rose in 2018 and reached alarming levels in 2019. This despite takes preventive measures by the state government [Table 1].
Table 1: Incidence of malaria and dengue across Greater Hyderabad Municipal Corporation limits*

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The dengue trends are alarming as the cases spiked steadily in the year 2019. Although all the zones show increasing trends, Charminar and Secunderabad have been recording higher number of cases among the six zones of GHMC [Table 2].
Table 2: Comparative analysis of the dengue and malaria cases of 2018, 2019, and mid-2020 across the six zones of Greater Hyderabad Municipal Corporation

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The GHMC–UMS authorities have scaled up mitigation strategies to stop the growing trend. The dengue hotspot areas across the Greater Hyderabad Region are traced to strengthen the containment measures.

Based on the dengue Cases of the current year 2020, the high-risk areas belonging to different zones and divisions were identified to strengthen up mitigation strategies. Accordingly, divisions 54 – Jahanuma, 46 – Falaknuma, 58 – Shastripuram, 63 – Mangalhat, 77 – Jambagh, Bholakpur, 88 – Himayath Nagar, 101 – Erragadda, 133 – Machabollaram, 134 – Alwal, 135 – Venkatapuram, 138 – Moula Ali, 141 – Gautham Nagar, 143 – Tarnaka, and 147 – Bansilalpet have higher incidence of dengue cases among all the marked hotspot areas.

Vector control interventions of Greater Hyderabad Municipal Corporation Urban Malaria Scheme in brief[4] [Table 3]
Table 3: Monthly report of dengue cases starting from January 1, 2020, to July 18, 2020

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GHMC is taking up all precautions for effective surveillance and control of mosquito breeding and spread of VBDs.

With a total of 2412 workforce, including the chief entomologist (1), 6 senior entomologists for six zones, and 30 assistant entomologists deployed in 30 circles of GHMC, ALOs are being looked after by teams comprising 1919 members, fogging operations being taken up by 342 members, and other special operations being conducted by 114 members across the GHMC limits.

Fogging operations

Fogging operations are actively being taken up daily with 302 portable fogging machines, deploying two such machines in each division, covering at least 2 km/day. Out of the 63 vehicle mounted fogging machines, two machines each have been allotted to each circle, covering at least 18 km a day with a target to cover each locality at least once a week, especially focusing on the slums where mosquito breeding sites have steeply reported.

Antilarval operations

With a well-defined PinPoint program with a proper schedule to cover each and every household, 642 teams cover approximately one lakh household every day, spraying temephos, creating awareness about the hazards of stagnant water left unused, in each household. Pyrethrum spraying will be done in the neighboring 30–40 houses where positive cases (malaria, dengue and chikungunya) are reported. Dropping oil balls in dirty stagnated water and releasing Gambusia fish in all baby ponds and other fresh stagnated water areas have been prioritized. With a special focus on Musi River stretch, three special units are deployed with 54 men for ALOs there.

Drones

Employing drones in the selected zones to spray Pyrosene oil in the lakes had been carried out from December 2019 to March 2020 and further extended till July 2020, especially focusing on reducing larval densities in the region. Further increasing the number of drones to include all the lakes for efficient spraying is being worked out.

Clearing lakes of water hyacinth

Growing mosquito population may also be attributed to the uncontrolled proliferation of water hyacinth in the lakes. To check the vector population, it is imperative to clean up the lakes of water hyacinth which is being worked out by the state government and GHMC officials.

Moskeet machines installation[5]

Moskeet machines are revolutionary devices in terms of mosquito and larval detection and control. They have been employed at different locations in all the six zones, to trap and gather information about mosquitoes and the location of larval sites in the specific region.

Musi action plan

With regard to the Musi River, a special Musi Action Plan is being chalked out to contain the mosquito menace.

Indoor residual spray

Indoor residual spray to be done in all the 2375 schools falling under GHMC limits has been planned out and will be implemented as soon as the schools reopen after the unprecedented lockdown due to COVID-19.

Information, education, and communication activities

Further, information, education, and communication activities are being taken up at the grass root level in the positive case households, vulnerable and hotspot areas. 10 o'clock 10 min program for 10 Sundays was organized, prioritizing ALOs and larval source reduction strategies and creating mass awareness on the same.

SOP[6] is implemented whenever the VBDs are notified to the authorities. As per the SOP, the entomology team inspects the positive house and 80–100 houses surrounding it and performs the spraying operation and prioritizes source reduction strategies which include checking for breeding points of mosquitoes and performing ALOs. Sanitation team inspects for good hygiene and enforces the same among the residents. Medical team conducts medical checkup of all the members of the household. UCD team. Upon receiving data, an analysis by all the four teams is done to mitigate the problem.

Details on the action taken report (ATR) are briefed in [Table 3][7] (Source: GHMC-UMS Head Office, Entomology Wing). The state government officials retrieve the ATR to detect, trace, and further mitigate the spread of VBDs.

Observations

  1. Malaria and other VBDs such as chikungunya have been lowering in occurrence, which is a positive trend
  2. Dengue high-risk areas have been located to control the growing incidence
  3. Introduction of revolutionary technology like geographical information system mapping and spraying insecticides and larvicides using drones for effective ALOs in the lakes, which would otherwise be tedious
  4. Employing Moskeet machines to detect the type and the density of mosquitoes at the specific location and also to detect the larval densities in that area
  5. Clearing the lakes of water hyacinth for the beautification and larval source reduction
  6. Lack of public awareness about mosquitoes and their breeding grounds, especially in the slums
  7. Booming urban population demands increased and effective surveillance strategies to combat the growing menace of dengue.



  Conclusion Top


Mosquito larval and adult control measures have been beefed up, especially in the dengue hotspot areas. Common man should be educated about the importance of extensive fluid therapy and not panic in case of dengue infection. Community confidence and compliance is the key to drive out the mosquito breeding grounds in every locality. Scaling back all the mitigation strategies, in view of the prevailing COVID-19 pandemic, could only compound the difficulties. The hospitals and the surroundings should be kept clean to reduce the chances of nosocomial infections. Moreover, all the mitigation strategies should be carried out in a structured and daily way and made free from window dressing which is abominable in the long run. The need of the hour is to adapt plasticity to respond quickly to the changing environment and brilliance be matched by organizational competence to tackle the mosquito menace.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murray NE, Quam MB, Wilder-Smith A. Epidemiology of dengue: Past, present and future prospects. Clin Epidemiol 2013;5:299-309.  Back to cited text no. 1
    
2.
Hasan S, Jamdar SF, Alalowi M, Al Ageel Al Beaiji SM. Dengue virus: A global human threat: Review of literature. J Int Soc Prev Community Dent 2016;6:1-6.  Back to cited text no. 2
    
3.
Chang MS, Christophel EM, Gopinath D, Abdur RM. Challenges and future perspective for dengue vector control in the Western Pacific Region. Western Pac Surveil Response J 2011;2:9-16.  Back to cited text no. 3
    
4.
Greater Hyderabad Municipal Corporation. Entomology Note. Greater Hyderabad Municipal Corporation – Urban Malaria Scheme; 2020.  Back to cited text no. 4
    
5.
Greater Hyderabad Municipal Corporation. Revised Agenda. Greater Hyderabad Municipal Corporation – Urban Malaria Scheme; 2020.  Back to cited text no. 5
    
6.
Greater Hyderabad Municipal Corporation. Standard Operation Procedure. Standard Operation Procedure – Urban Malaria Scheme; 2020.  Back to cited text no. 6
    
7.
Greater Hyderabad Municipal Corporation. Line List of Dengue Cases of 2020. Greater Hyderabad Municipal Corporation; 2020.  Back to cited text no. 7
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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