Bangladesh struggles to record dengue deaths as disease pattern changes | Health News

Dhaka, Bangladesh – Every time Msmmat Maina enters the dengue ward at Mugda Hospital in the Bangladeshi capital, sadness and fear take over her mind.

The 23-year-old has been working as a cleaner at the hospital for about a month, and the only reason she got the job is because her sister Maria Ratna died of dengue last month while on duty as a cleaner at the hospital. Same wing.

“My sister worked tirelessly for several months during the dengue outbreak this year, and eventually fell ill. After her death, the hospital administration offered me her job,” Maina told Al Jazeera.

“Ratna’s death devastated our family, but since I was unemployed, I accepted the offer even though I was very afraid.”

Bangladesh is witnessing the worst outbreak of dengue fever in history, with hospitals filled to capacity and the death toll rising. Last Wednesday, the country recorded 24 deaths – the highest number in one day – due to the mosquito-borne disease.

Although the disease does not spread from person to person, a mosquito that bites an infected patient becomes a vector and can transmit dengue to others it bites. This makes places with high concentrations of dengue patients — like the hospital where Maina works — more dangerous for those who have not yet been infected.

Health experts are concerned because dengue fever usually subsides in the South Asian region when the annual monsoon rains stop by the end of September.

As of Monday, at least 1,549 people — including 156 children, from newborns to those as young as 15 years old — had died from the disease in Bangladesh, which has recorded a total of 301,255 dengue cases this year, according to the Directorate General of Health Services. To the government. (DGHS).

The record death toll is nearly five times last year’s 281 deaths – the highest in a single year in Bangladesh’s history – until this year’s outbreak. The previous highest number of cases in a single year – 1,01,354 – was reported in 2019.

“I have never seen a dengue outbreak of this proportion,” Dr. Mohamed Nitouzman, director of Mugda Hospital, told Al Jazeera, adding that patients were streaming in from all over the densely populated country. “It is unusual to see so many dengue patients in November.”

An outbreak of “epidemic” proportion.

Earlier dengue outbreaks were largely confined to densely populated urban centers such as the capital, Dhaka, which is home to more than 23 million people. Experts say that this year the disease has reached every region, including rural areas.

DGHS data shows that 65 percent of cases reported this year were from outside Dhaka – the first time the number of cases in the capital has been lower than the rest of the country.

Sohaila Begum came to Mugdha Hospital from the southern Patuakhali district with her 11-year-old daughter, who has been suffering from high fever for more than a week. With no beds available, they stay in the hospital corridors.

“When her fever worsened, the doctors at the district hospital asked us to immediately take her to any good hospital in the cities,” she told Al Jazeera, adding that her daughter’s condition had improved.

“We came to Dhaka but we are running out of money now. Everything is very expensive here. We will be in trouble if we stay longer.

Public health expert and former DGHS director Dr ANM Nuruzzaman told Al Jazeera that this year’s outbreak is nothing short of an epidemic.

“The problem is that the seriousness of dengue fever has fallen off the radar of the public and the media, as the country is going through political turmoil ahead of the upcoming elections,” he said.

Bangladesh is expected to hold general elections on January 7 amid political uncertainty and violence sweeping the country, with the main opposition Bangladesh Nationalist Party (BNP) demanding the dismissal of the ruling Awami League government and the formation of a transitional administration to ensure freedom of expression. And fair elections

“Dengue is a serious crisis as the pattern and severity of the disease have changed and become worse. The government should have declared a public emergency long ago,” said Nooruzzaman.

Government officials claim that they did everything they could to stop the spread of dengue and that declaring it a public emergency or epidemic would not have made much difference.

“All government hospitals across the country have been directed to open special dengue wards at the beginning of August. The Ministry of Health has also allocated an emergency budget to combat the outbreak,” Dr Mohamed Rubid Amin, Director of Non-Communicable Diseases at DGHS, told Al Jazeera.

He said: “The problem is that the healthcare system in our country suffers from serious limitations because we constitute a large population, and it is almost impossible to guarantee healthcare and treatment for everyone.”

Amin pointed out that cases of infection and deaths this year are “abnormally high” for several reasons. He said: “The first and most important reason is the massive spread of the Dengue strain 2 among patients.”

Dengue is divided into four types: Den-1, Den-2, Den-3, and Den-4. A person becomes immune to one type of dengue after infection, but not to the other types.

“For the past two years, Bangladesh has mostly had Den-3 strains and people have developed immunity to them. But this year, more than 75% of patients were diagnosed with Den-2, and almost all the patients who died were affected by this strain.” Especially,” Amin said, adding that multiple studies have found that Den-2 outbreaks are worse when they are monitored. According to the years of deployment of Den-3.

He added that the other reason behind the high number of deaths is the outbreak of the disease in rural areas.

“This year, the disease has spread across the country, and in rural areas, health facilities are extremely scarce. Moreover, most people do not realize how serious the disease is. If you do not get treatment in time, it can become fatal. This has happened In many fields.”

What caused the record deaths

Meanwhile, entomologists say they may have found the possible cause behind this year’s record outbreak.

Kibirul Bashar, a professor of medical entomology at Jahangirnagar University in Bangladesh, told Al Jazeera that the pattern of dengue decline by September had changed from last year when the disease reached its peak in October and caused 86 deaths. A year before that, in 2021, that number was 22.

“We sounded the alarm last year, saying that the pattern of the disease itself had changed. Dengue is no longer a monsoon-related disease, but a disease that lasts for a year,” said Bashar, who is also the only scientific expert on the country’s National Dengue Control Committee. “.

The scientist said that climate change is changing patterns of temperatures, rainfall and other natural phenomena.

“Now, we see continuous, almost monsoon-like rains throughout October and early November. It changes the reproduction and life cycle of the Aedes mosquito population,” she said, referring to the type of mosquito that carries dengue fever.

Dengue spreads mostly in South and Southeast Asia between June and September, where stagnant water provides the ideal habitat for the Aedes mosquito, which usually breeds in clean water and feeds during the day.

But in a groundbreaking discovery, Bashar, who has been studying mosquitoes for more than two decades, discovered that mosquitoes now breed even in dirty sewers and in salty seawater.

“So, on the one hand, you have unusually consistent rains during the off-season providing an ideal breeding ground, and on the other hand, you have mosquitoes expanding their breeding horizon. It’s a double whammy,” he told Al Jazeera.

Entomologists also discovered that the two most commonly used insecticides, malathion and temephos, were rendered “useless” against Aedes mosquitoes in Bangladesh.

“These two insecticides have turned into sub-insecticides, and have lost their effectiveness against mosquitoes because they have developed resistance,” said Dr. Gulam Scharwer, a professor at the National Institute of Preventive and Social Medicine.

“Unfortunately, most of our city businesses across the country are still using these two insecticides, which do little to control mosquito populations.”

Bashar said the government needs to develop a complete five-year plan to control the spread of dengue fever and ultimately eliminate the Aedes mosquito.

“The disease will only worsen in the coming years if such a plan is not activated immediately,” he said.

Back at Dhaka’s Mugda Hospital, Maina, ravaged by an unusually long dengue epidemic, begins to regret her decision to work as a cleaner.

“I thought dengue would subside with the end of the rainy season, but patients keep coming every day. Forget the ward beds, there is no space even in the hospital corridors,” she told Al Jazeera.

“I’m afraid I’ll end up like my sister too.”