How FOREWARN's prediction on dengue fever enabled Start Fund Bangladesh members to act early
by Farzana Ahmed Julie
Start Network's national forecasting network in Bangladesh recently predicted an outbreak of Dengue fever, which led to the Start Fund Bangladesh enabling members to act early to mitigate the effects of the Dengue virus on local people. Here we look at what happened.
On 28th March 2020, Start Fund Bangladesh, the national fund for the Start Network, activated its first alert in response to predictions made by the national Forecast-based Warning, Analysis and Response Network (FOREWARN).
Established in November 2019, FOREWARN Bangladesh is hosted by the International Centre for Climate Change and Development (ICCCAD). Its main aim is to create a national community of forecasting information providers, analysts and humanitarians, who will draw on all the available resources, relationships and expertise of Start Network’s global FOREWARN to build the structure and tools and generate anticipatory analysis to support forecast-based early action in Bangladesh.
The recent anticipatory alert is related to a Dengue outbreak, a mosquito-borne tropical disease caused by the Dengue virus. It is spread by a day-time biting mosquito which is typically a problem in urban areas. Symptoms include a high fever, headache, vomiting, muscle and joint pains, and a characteristic skin rash. When treated, severe Dengue has a mortality rate of 2%-5%, but, when left untreated, the mortality rate is as high as 20%.
In February 2020, FOREWARN Bangladesh undertook a study “Dengue risk analysis in Bangladesh 2020: dynamics, prevalence & management options”.* The study sought to better understand the timing of a possible outbreak, the vulnerable pockets and populations, the potential early actions to control the outbreak, and the best time to take those early actions. It also analysed the potential actors and institutions to sensitise.
According to the FOREWARN’s report, Bangladesh experienced its severest 101,354 dengue cases in 2019, where Dhaka experienced up to 51,810 cases alone. Nationally, it caused 156 deaths and a total economic loss of £410 million, while overwhelming the country’s medical services. The study identified high population density and monsoon rains as key variables correlated with Dengue spread. The rainwater collected in containers, humidity and high temperatures are ideal breeding conditions for mosquitoes. It will make the urban areas especially vulnerable during the upcoming monsoon season.
FOREWARN’s coordinator, Ashraful Haque, system analyst and disaster resilience expert, said that Dengue cases are predicted to peak during the forthcoming monsoon rains season (starting between July and August); and in the backdrop of COVID-19 where existing health facilities are already strained, there is a risk of Dengue cases being side-lined. On 5th March, FOREWARN Bangladesh shared the study report with a group of health experts, researchers and ex-government officials who work closely on Dengue to verify the findings, and utilise their feedback to develop an early action plan.
Based on FOREWARN’s report, an anticipatory alert was raised on 26th April and a project was selected on 29th April. Social and Economic Enhancement Programme (SEEP) was awarded GBP 50,000. Its project includes the following activities:
- Mass awareness of the risks of dengue across the country through various media channels such as TV shows, ambassadors, campaigns, leaflet and poster distribution.
- Policy level advocacy with local administration through roundtables.
- Building capacity of health-services specifically targeting nurses and doctors at hospitals in Dhaka.
- Developing an epidemiological model surveillance system, and model isolation ward with a case study hospital.
The project is also engaging key stakeholder groups including Director General of Health Services, Dhaka North City Corporation, and Local Government Division. SEEP’s initiative to develop an epidemiological model surveillance system, whose objective is to monitor and map the Dengue outbreak geographically based on various indicators was recognised as a possible long-term and sustainable solution to Dengue prevention.
In the light of sustainability, Md. Yeakub Hossain, Climate Action and Humanitarian Response focal from SEEP outlined “We had been exploring for a such sustainable, long going project component which will emphatically be a good one for scaling up in coming days”. According to the National Daily, the number of dengue patients (298) this year have already surpassed the previous number (98) last year.
“We expect an early action on dengue prevention will ease not only mosquito menace of the targeted area but also leave a glowing example for other stakeholders to follow”, he added.
In the backdrop of COVID-19 pandemic, other infectious diseases continue to pose health threats across the world. It is important they do not become neglected in the shadow of COVID-19. We need to focus on novel ways to address these in light of the necessary implementation constraints now in place because of the coronavirus outbreak.
* The study was conducted by the FOREWARN health group composed of Dr Md Showkat Ali (Ex-Chief Health Officer, Dhaka City Corporation), Atik Ahsan (Consultant, ICDDR,B), Dr. Kazi Mohammad Hassan Ameen (WHO/Health Cluster), Ruksana H. Rimi, (Associate Professor, MBSTU, Bangladesh) and Najmul Haide (Post-doc Researcher, Royal Veterinary College, Population and Pathogen Biology Sciences, UK). Under the guidance of Ashraful Haque as coordinator and Marwa Tasnim as partnership officer.