1
HEALTH SERVICES DELIVERY
1.4
DISEASE CONTROL PROGRAMME
1.4.2.c.3
Communicable Diseases Control: Vector-Borne Disease
prevention & control (as of March 2008) by Dengue control Unit
DF/DHF
A Focal Point
Dengue control Unit
B Implementing Agencies
Dengue control unit
Epidemiological Unit
Provincial Directors of Health services /Regional
directors of Health Services /Directors of Hospitals
Medical Officers of Health
C Target Areas & Beneficiaries
Hospital Medical staff /Medical Officers of
Health/Primary health Care Staff /Community groups
Project Summary:
Dengue fever and Dengue haemorragic fever (DF/DHF) continues to be a major Public Health
problem in Sri Lanka.
Since the 1st serologically confirmed outbreak in 1965, a wide geographical area has been
affected by both the vector and the disease leading to a hyper-endemicity in most urban areas
in the country. Therefore it is of paramount importance to strengthen the existing national
programme on prevention & control of DF/DHF further with following components;
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Strengthening epidemiological surveillance
Reducing the disease burden through continued in-service education
Promoting behavioral change through continued COMBI (Communication for behavioral
impact) approach
Improve case management
Revision of legislature & strengthening law enforcement
Advocacy on solid waste disposal and environmental management
Enhance inter sectoral collaboration
1. Justification
Epidemic dengue fever has been reported from the Indian Sub-Continent for over 200 years.
The first documented dengue fever epidemic in Sri Lanka occurred in 1965-1966 during
which a few sporadic cases of haemorrhagic disease were reported. Though most of the towns
throughout the country were affected during these outbreaks, western coastal belt was affected
most. Colombo district recorded the highest number of cases and the first two cases of DHF
occurred during this period. Studies at the Medical Research Institute (MRI) documented
continued dengue transmission in the 1970s and 1980s with periodic epidemics, but without
significant numbers of documented dengue haemorrhagic fever and dengue shock syndrome
(DHF/DSS) cases.
In 1989-1990 Sri Lanka experienced its first epidemic of dengue haemorrhagic fever with 203
clinically diagnosed cases and 20 deaths accounting to a case fatality rate of 9.8%.
In 1990, the number of cases rose sharply to 1350 with 365 serologically confirmed cases and
a significant number of DHF cases were reported outside Colombo district. Several hundred
cases a year were reported annually from 1991 to 1996 with a case fatality rate ranging from
0.9% to 6.2% (with an epidemic in North-western province in 1996).
From year 2000 there was a dramatic increase in the number of cases.The total number of
reported cases increased sharply from 1688 cases during the year 1999 to 5203 cases in year
2000 with 37 deaths. The highest number of cases were reported from Colombo (1552 cases)
and most other districts were also affected.
From 1991 to 1996, 60% of dengue cases were reported in less than 15 year age group.
However during the epidemic in year 2000, 63% of the total (3343 cases) occurred in the 15
years and over age group, although 54% of the 37 deaths occurred in the under 15 year age
group
In year 2002 a larger outbreak of DF/DHF occurred, with 8931 cases and 67 deaths. In 2003,
the number of suspected cases dropped to 4,672 with 33 deaths. The highest number of cases
was reported in year 2004, with 15,463 suspected cases and 88 deaths. This is by far the
largest epidemic on record. In 2005 however the case load dropped to 5856 cases with 27
deaths.
Cases are reported from almost all the districts. The highest DF/DHF incidence is reported
from Colombo, Gampaha, Kalutara, Kandy and Ratnapura districts.
DF/DHF has a seasonal transmission in Sri Lanka, with two peaks occurring in June - July
and October – December following the monsoonal rains. The majority of cases occur during
the summer monsoon.
During the year 2006 there were 11,979 cases with 47 deaths and the cases were reported
throughout the year showing a high endemicity.
Year 2007 recorded 7314 DF/DHF cases with 25 deaths giving a Case Fatality Rate of 0.34%
DF/DHF out breaks has become a major public health problem in Sri Lanka.Following the
2004 outbreak the WHO Experts conducted an external In-depth review of DF/DHF control
programme in December 2004. Number of recommendations was made to the Ministry of
health for improvement of the Dengue control activities in the country.
As DF/DHF was becoming a major Public health problem in Sri Lanka the Ministry of health
established The Dengue control unit in April 2005 and a Co-ordinator was appointed to
coordinate Dengue control programme in the country.
The Ministry of health developed a 5 year national plan of action for prevention and control
of DF/DHF in Sri Lanka.
Objectives of the National plan of action
1. To reduce Morbidity and Mortality due to DF/DHF
2. To forecast and prevent Dengue epidemics
3. To strengthen liaison with civil society groups, NGOO, Media and other relevant
stakeholders for social mobilization in Dengue control.
4. To identify and mobilise resources to carry out research on Dengue.
5. To develop and sustain an effective Dengue prevention and control programme in Sri
Lanka.
2. Important Assumptions/Risks/Conditions:
N.I.L
3. Project Objective:
Objective
Prevention and Control of
DF/DHF in Sri Lanka
Indicators
� Morbidity of DF/DHF
Means of Verification
�
Routine
disease
surveillance
data review
� Mortality
� Routine
of DHF/DSS
hospital mortality
data review
4. Project Output/Product:
Outputs
DF/DHF surveillance &
outbreak
prevention
control
strengthened
Indicators
� Hospital admission
& rate
� MOH notification
� Case fatality rate
Means of Verification
�
Data
reviews
Epidemiology
Unit
Medical
statistics Unit
Laboratory surveillance
system strengthened
�
No. of samples tested in
national level reference
Lab.
� No. of samples tested
in regional/district level
laboratories
� Laboratory
Strengthened vector
surveillance
system
control
� No.
� Entomological
of entomological
& surveys done
� Vector control
measures implemented
Mortality prevented by early
� Case
fatality rate
�
of
&
based surveys
indicators
Review data at Medical
recognition & effective case
management of DHF/DSS
� No.
of days in
hospital
Statistics Unit
Effective solid waste
management system in place
� Availability
� Community
Response mechanism made
effective through social
mobilization for DF/DHF
control and prevention.
� Laval/pupa
of
continuous garbage
disposal plan
� No. of offenders
taken to courts
based surveys
data at MOH/local
government level
� Review
indices
� Community based KABP
� No. of community owned
study
programmes
�
No. of programmes
conducted by
stakeholders
5. Related Projects:
Project No.
Project Title
Strengthening epidemiological surveillance for planning purpose and early
response
Standard clinical diagnosis and Disease management plan
Changing behavior and building partnership
Formulation of guidelines and accelerating revision of legislature
6. Relevant Agencies to be Coordinated:
� Ministry of Environment and Natural Resources
� Ministry of Local Government and Public Administration
� Ministry of Education
� All Provincial Councils
� Non Governmental Organizations
7. Monitoring & Evaluation:
1. Who? Director General of Health Services, Dengue control unit, Epidemiology Unit,
Director/Medical Research Institute
2. When? Annual at national level
Bi annual, Quarterly & Monthly at district and other levels
3. What actions to be taken based on results of monitoring & evaluation?
Re planning at national/district /local level
Periodic reviews with stakeholders
8. Activities:
Activities
Expected Results
Process Indicators
1.
Improve
disease Reduction in disease
surveillance and control transmission, morbidity &
activities at MOOH level.
mortality
Regular National, Provincial
and district reviews.
2. Implement special dengue Reduction in disease
control programmes in high transmission, morbidity &
risk MOOH areas.
mortality
Regular monitoring
& evaluation of special
projects implemented.
3.
Strengthen Prevent DF/DHF outbreaks.
Provincial/district level
emergency action committees
Regular monthly
meetings
4. Establish sentinel sites for Reduction in vector density Entomological
Vector Surveillance.
through
more
targeted
vector control activities
indicators
5. Provide regular training Reduction in vector density Entomological
for PHC staff involved in through
more
targeted
Vector Surveillance
vector control activities
indicators
6. Revise legislature on New acts drawn
control and prevention of Existing legislation
DF/DHF
revised
No. of offenders
taken to courts
7. Provide training for Reduction in
Provincial / Regional hospital mortality /morbidity
medical officers
No of MOO trained on
proper clinical diagnosis and
case management in hospitals
8.
Provide
necessary Reduction in
equipment to hospitals for mortality /morbidity
proper clinical diagnosis and
case management.
No of hospitals equipped for
proper clinical diagnosis and
case management.
9. Provide refresher training Enhance Dengue
for provincial, regional PHC activities.
staff on Dengue prevention
and control.
10.
Implement
Strategy
control PHC staff trained.
COMBI Community ownership
control programme.
11.
Involvement
of Enhanced
stakeholders
for
control participation
activity.
of Implementation
of
community programmes.
IEC material produced.
inter-sectoral Activities conducted
by
stakeholders.