Dhaka, Bangladesh – Every time Mosammat Mayna enters the dengue ward of Mugda Hospital in Bangladesh’s capital, grief and fear flood her mind.
The 23-year-old has been working as a cleaner at the hospital for barely a month, and the only reason she got the job is because her sister, Maria Ratna, died of dengue fever last month while She was doing her duty as a cleaner at the hospital. the same room.
“My sister worked tirelessly for months during this year’s dengue outbreak and eventually caught the disease. After his death, the hospital authorities offered me his job,” Mayna told Al Jazeera.
“Our family was devastated by Ratna’s death, but as I was unemployed, I accepted the offer despite my fear. »
Bangladesh is experiencing the worst dengue outbreak in its history, with hospitals bursting at the seams and a rising death toll. Last Wednesday, the country recorded 24 deaths – the highest number in a day – from the mosquito-borne disease.
Although the disease does not spread from person to person, a mosquito that bites an infected patient then becomes a carrier and can transmit dengue fever to other people it bites. This makes places with high concentrations of dengue patients – like the hospital where Mayna works – more dangerous for those who are not yet infected.
Health experts are alarmed because dengue fever usually subsides in the South Asian region when the annual monsoon rains stop at the end of September.
As of Monday, at least 1,549 people – including 156 children, from newborns to 15 years old – died of the disease in Bangladesh, which has recorded a total of 301,255 dengue cases this year, according to the Government Health Services Branch. (DGHS).
The record number of deaths is about five times higher than last year’s total of 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 year – 1,01,354 – was reported in 2019.
“I have never witnessed a dengue outbreak of this magnitude,” Mugda hospital director Dr Mohammed Niatuzzaman told Al Jazeera, adding that patients were pouring in from all over the densely populated country. people. “It is very unusual to see such a large number of dengue patients in November.”
Outbreak of “epidemic” proportion
Previously, 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 the disease has reached all districts this year, including rural areas.
DGHS data indicates that 65% of cases reported this year came from outside Dhaka – the first time the capital had fewer cases than the rest of the country.
Sohaila Begum arrived at Mugda Hospital from South Patuakhali district with her 11-year-old daughter, who has been running a high fever for over a week now. Due to a lack of available beds, they remain in the corridors of the hospital.
“When his fever got worse, the doctors at the district hospital told us to take him to any good hospital in the city immediately,” she told Al Jazeera, adding that the her daughter’s situation had improved.
“We came to Dhaka but now we are short of money. Everything is so expensive here. We’ll be in trouble if we stay any longer.
Public health expert and former DGHS director Dr ANM Nuruzzaman told Al Jazeera that this year’s outbreak was nothing short of an epidemic.
“The problem is that the severity of dengue has sort of disappeared from the public and media radar as the country goes through political turmoil in the run-up to the next elections,” he said.
Bangladesh is expected to hold general elections on January 7 amid political uncertainty and violence in the country, as the main opposition party, the Bangladesh Nationalist Party (BNP), demands the dismissal of the Bangladesh government. the Awami League in power and the installation of an interim administration to guarantee freedom. and fair polls.
“Dengue is a serious crisis because the appearance and severity of the disease has changed and worsened. The government should have declared a state of public emergency long ago,” Nuruzzaman said.
Government officials say they did everything they could to stem the spread of dengue and that declaring a state of emergency or epidemic would not have made much difference.
“All public hospitals in the country have been instructed to open special dengue wards in early August. The Ministry of Health has also allocated an emergency budget to combat the outbreak,” Dr Mohammad Robed Amin, director of non-communicable diseases at DGHS, told Al Jazeera.
“The problem is that our country’s health system has serious limitations, because we are a large population and it is almost impossible to provide health care and treatment for all,” he said.
Amin noted that cases and deaths this year are “abnormally high” for several reasons. “The first and foremost reason is the overwhelming prevalence of dengue strain type Den-2 among patients,” he said.
Dengue has 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 other types.
“In the last two years, Bangladesh had mainly Den-3 type strains and people had developed immunity against this strain. But this year, more than 75 percent of patients were diagnosed with Den-2 and almost all patients who died were affected by this particular strain,” Amin said, adding that several studies have shown that the Den outbreak -2 is worse when followed. by years of Den-3 prevalence.
Another reason for the high number of deaths is the epidemic in rural areas, he said.
“This year the disease has spread across the country and in rural areas health facilities are very scarce. Additionally, most people are unaware of the seriousness of the disease. If you don’t get treatment in time, it can be fatal. And this has happened in many areas.
What caused the record number of deaths
Meanwhile, entomologists say they may have found the possible reason for this year’s record outbreak.
Kabirul Bashar, professor of medical entomology at Bangladesh’s Jahangirnagar University, told Al Jazeera that the downward trend of dengue in September changed last year when the disease peaked in October and caused 86 death. A year ago, in 2021, that number was 22.
“We sounded the alarm last year that the very pattern of the disease had changed. Now dengue is no longer a monsoon-associated disease, it lasts for a year,” said Bashar, who is also the only scientific expert in the country’s National Dengue Control Committee.
The scientist said climate change is altering patterns of temperature, precipitation and other natural phenomena.
“Now we see constant almost monsoon-like rains throughout October and early November. This changes the reproduction and life cycle of Aedes mosquito populations,” he said, referring to the type of mosquito that carries dengue.
Dengue fever occurs mainly in South and Southeast Asia between June and September, when stagnant water provides the ideal habitat for the Aedes mosquito, which typically 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 salty seawater.
“So, on the one hand, you have unusually constant rains during the off-season which provide an ideal breeding ground for them and, on the other hand, you have the mosquitoes which are expanding their breeding horizon. It’s a double whammy,” he told Al Jazeera.
Entomologists also discovered that the two most widely used insecticides, malathion and temephos, had become “useless” against Aedes mosquitoes in Bangladesh.
“These two insecticides have become sub-insecticides, losing their effectiveness against mosquitoes as they have developed resistance,” said Md Golam Sharower, professor at the National Institute of Preventive and Social Medicine.
“Unfortunately, most of our municipalities across the country still use these two insecticides, which contribute very little to controlling the mosquito population.”
Bashar said the government must adopt a comprehensive five-year plan to control the spread of dengue and ultimately eradicate the Aedes mosquito population.
“The disease will only get worse in the years to come if such a plan is not activated immediately,” he said.
Back at Dhaka’s Mugda Hospital, Mayna, overwhelmed by an unusually long dengue outbreak, begins to regret her decision to work as a cleaner.
“I thought dengue fever would subside with the end of the rainy season, but patients continue to arrive every day. Forget the beds in the rooms, there is no room even in the hospital corridors,” she told Al Jazeera.
“I’m afraid I’ll end up like my sister.”
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