MARCH-APRIL , 2023 | THE HEALTH

THE MALAYSIAN Medical Association ( MMA ) observed that even as Malaysia has been underspending on health , the Ministry of Health ( MoH ) with its limited funds and resources has been doing a good job of increasing awareness among the public on the prevention of dengue .

Its President Dr Muruga Raj , said : “ But it ’ s time the Local Government Development Ministry & the municipal councils work together with MoH and assist in enforcement to ensure Aedesfree environments . The Local Government Development Ministry should set Key Performance Indicators ( KPIs ) for relevant departments under them to tackle the dengue issue .”

Intersectoral collaboration is essential to maintain our environment ’ s cleanliness and shield the community from dengue threat , agrees Deputy Director of Health ( Public

Health ) Datuk Dr Norhayati Rusli .

“ At the Ministry level , a National Dengue Task Force Committee has been established since 2014 to coordinate dengue prevention and control activities from various ministries and agencies under their jurisdiction .” The result :

• The Ministry of Local Government Development and local authorities can play a role in maintaining the cleanliness of public amenities and drainage systems and providing adequate facilities for proper solid waste management in the district .

• The Ministry of Works can conduct routine inspections on all construction sites to ensure no risk of mosquito breeding within the compound .

• The Ministry of Communications and Digital can utilise mainstream media to reach the public with messages focused

Dr Muruga Raj on the importance of environmental cleanliness , individual role in keeping own premises free of mosquito breeding , and getting early treatment if symptomatic . The Ministry of Education and the Ministry of Higher Education can integrate dengue preventive measures with the cocurriculum program to inculcate the values of preserving environmental cleanliness among the students .

• The Ministry of Human Resources can engage with employers and employees from the private sector to maintain a mosquito-free working environment in addition to enforcement activities against workplaces found with mosquito breeding .

• At the State level , the Dengue Special Task Force , with a similar function , is responsible for carrying out intervention activities and meetings with local agencies for the dengue and prevention control program .

Lack of cooperation from certain households for indoor mosquito control activities will limit the effectiveness of interrupting dengue transmission in the local community .”

Additionally , advocating for the community to become volunteers of MyCHAMPION , previously known as the Communication for Behavioural Impact ( COMBI ) group , is essential to ensure community ownership of dengue prevention and control activities .

“ The main purpose of MyCHAMPION is to act as an agent of behaviour change in the local community and to mobilise the communities to do ‘ search and destroy ’ of Aedes breeding sites in their neighbourhood weekly . Behavioural change of Malaysian towards maintaining a clean environment will enhance the sustainability of dengue prevention in the community .”

She added : “ National cleaning campaigns activities ( Gotong Royong Mega Perangi Aedes Peringkat Kebangsaan ) have been implemented at the National , State , and District levels to mobilise residents along with relevant agencies to get rid of Aedes breeding sites .

“ In 2022 , the MoH has organised two national campaigns , 30 state campaigns and 54 district campaigns at various locations to engage with the local community . The National level Gotong Royong Mega Perangi Aedes was held in Melaka in June 2022 and Pahang in October 2022 , respectively .” – The Health

STATE Health Departments are responsible for coordinating , monitoring and analysing dengue prevention and control activities in the states .

“ Whenever a dengue case is registered in a particular locality , a vector control team from the nearest district health office will conduct a house-to-house inspection of mosquito breeding places , source reduction , larviciding and adulticiding activities , if necessary , both inside and outside the premise ,” shared Deputy Director of Health ( Public Health ) Datuk Dr Norhayati Rusli .

These activities consist of the destruction of breeding sites , larviciding and fogging . In addition , these activities are repeated for local outbreaks until the outbreak has ended .

According to Selangor State Health Department ’ s Public Health Specialist ( Vector Borne Disease Control Unit ), Dr Sukhvinder Singh Sandhu , the primary focus for dengue prevention and control is through source reduction to remove possible breeding sites for Aedes mosquitoes .

“ Fogging is a very effective method to kill infected adult mosquitoes . It is routinely used in outbreaks management to prevent infected mosquitoes from biting humans and spreading the dengue infection .

“ Nonetheless , it only provides short relief as fogging does not eliminate the source of the mosquitoes as it does not affect larvae and breeding sites . As fogging has been used for many years for dengue control purposes , its widespread usage has led Aedes mosquitoes to show signs of resistance to adulticides used for fogging .”

He said the MoH does regular resistance studies to monitor insecticide resistance in Malaysia . “ Mosquito resistance is reported

Dr Sukhvinder Singh Sandhu

to occur in localities sprayed ( fog ) with similar groups of adulticide repeatedly for a prolonged duration . In addition , the inadequate dosage of adulticide used with the improper spraying technique will also lead to resistance development .

“ As such , trained personnel should use fogging activities judiciously and not as a frequent preventive method .”

The Wolbachia Mosquito Operation ( WMO ), shared by Dr Norhayati , launched by then Deputy Prime Minister Datuk Seri Dr Wan Azizah in 2019 , is a novel tool for vector control under National Dengue Control and Prevention Program .

“ Since July 2019 , 28 high dengue burden localities from seven states in Malaysia , namely Selangor ( 10 ), Federal Territory of Kuala Lumpur & Putrajaya ( 7 ), Penang ( 4 ), Kelantan ( 2 ), Johor ( 2 ), Pahang ( 2 ) and Malacca ( 1 ) have been selected to implement Wolbachia Mosquito Operation ( WMO ) in a staggered manner .

“ Initial analysis shows dengue case reduction between 33 per cent and 100 per cent among localities that have implemented WMO for at least two years . Nevertheless , ongoing evaluation is required to assess the effectiveness of WMO in reducing dengue cases and its impact to avert dengue morbidity and mortality in the long term .”