By Dr. Muhammad Najeeb Durrani, Epidemiologist, Islamabad
Attention of Health Authorities is needed to make interventions for basic health needs/ threats for the participants of the two protest rallies. Their stay is prolonged for an indefinite period hence they can be declared Internally Displaced Persons (IDPs) of war and strife.
The participants include women and children and old people, being out there since two weeks under the open in the make shift tents under precarious health conditions; are exposed to various health hazards and need management on proper footing.
Of the many public health hazards most amongst these are water born diseases due to the lack of sufficient portable water supply poor hygiene and sanitary conditions (keeping in view the fact that they are coming from the endemic areas).
Although Health Department ICT is providing round the clock ambulatory service through its team of doctors to give prompt treatment/advice or shift the serious ones to the hospitals requiring specialized care; still the unhygienic conditions arising due to the much extended stay continue making it almost impossible for the health planners to institute any comprehensive strategy or a planned outreach program to provide health care to the participants at the site of protest.
Rapid detection of cases of epidemic-prone diseases was essential to ensure rapid control. A surveillance/early warning system was to be established to detect outbreaks and monitor priority endemic diseases.
The risk of outbreaks following sudden overcrowding extending for an uncertain period is closely related to the size, health status and living conditions of the displaced population. The risk of transmission of endemic communicable diseases, such as ARI and diarrhoeal diseases, is always increased many fold in the displaced populations due to associated crowding, inadequate water and sanitation, unsafe food handling, poor access to health care and poor nutritional status of children.
Diarrhoeal disease outbreaks can occur following contamination of drinking-water, and Are always reported in the displaced people. The risk of diarrhoeal disease outbreaks is always higher in developing than in developed countries.
Hepatitis A and E infections are also transmitted by the faecal–oral route, in association with lack of access to safe water and sanitation. Hepatitis A is endemic in the country, and children are exposed and develop immunity at an early age. As a result, the risk of large outbreaks is usually low in these settings. In endemic areas, hepatitis E outbreaks frequently follow heavy rains; it is generally a mild, self-limited illness, but according to WHO in pregnant women case-fatality rates can be up to 25%.
Since the immunization status of the children in present in the protest area is not known and mothers have brought infants and children less than 5 years of age, while children up-to 15 years are amongst the protestors, they are all exposed to vaccine preventable diseases like Measles, Polio and Diphtheria besides Chest Infection and Pneumonia.
The risk of vaccine preventable diseases transmission in the affected population is dependent on baseline vaccination coverage rates among the affected population, crowded living conditions, as is common among displaced people that facilitate transmission and necessitate even higher immunization coverage levels to prevent outbreaks. Risk of Polio and Diphtheria is also there requiring proper immunization. Meningitis caused by Neisseria meningitidis is transmitted from person to person, particularly in situations of crowding.
Mass measles immunization together with vitamin A supplementation is immediate health priorities in areas with habited by internally displaced persons (IDPs) with inadequate coverage levels. In particular the measles vaccine is required among children aged up to <15 years. Where baseline coverage rates among those aged <15 years are below 90%, mass measles immunization should be implemented as soon as possible. The priority age groups are 6 months to 5 years and up to 15 years if resources allow.
Acute respiratory infections (ARI) are a major cause of morbidity and mortality among displaced populations, particularly in children aged <5 years. Lack of access to health services and to immediate availability of antibiotics for treatment further increases the risk of death from ARI.
Amongst displaced persons the place inhabited by them can affect vector breeding sites and vector-borne disease transmission, while standing-water after heavy rainfall can create new mosquito breeding sites, this can result (with typically some weeks delay) an increase of the vector population and potential for disease transmission, depending on the local mosquito vector species and its preferred habitat. Since malaria and dengue mosquitoes are endemic in the area the risk of contracting the disease is always there in the present high transmission season. The crowding of infected and susceptible hosts, i.e., the increasing number of people coming from the endemic areas like Sawat and Punjab where there were major dengue outbreaks in the recent past to the non endemic areas can cause increased transmission.
The dengue transmission risk can be exacerbated by increased availability of vector breeding sites – mostly artificial containers – caused by disruption of basic water supply and poor solid waste disposal services. The risk of vector-borne disease outbreaks can be influenced by other complicating
factors, such as changes in human behaviour (increased exposure to mosquitoes while
sleeping outside, overcrowding), or changes in the habitat which promote mosquito breeding.
For dengue, the main preventive efforts should be directed towards vector control.
Social mobilization and health education of the community should emphasize elimination of vector breeding sites as much as possible, specifically by:
- Continuous covering of all stored water containers;
- Insecticide-treated nets to be used for coveing the body during sleeping outside preferably the long-lasting insecticidal nets (LLIN) from the Malaria Program.
- Removal or destruction of solid debris where water can collect (disposable cups, bottles, plastic containers, tins, etc.).
- Distribution of health education messages, including:
? encouraging good hygienic practices;
? promoting safe food preparation;
? encourage safe food handling;
? ensuring use of boiled or chlorinated water;
? encouraging early treatment seeking behavior in case of fever;
? encouraging use of insecticide-treated mosquito nets
It is believed that the protest would end soon and the protestors would go back to their homes safely otherwise a comprehensive strategy is to be worked out by all the stake holders i.e., Ministry of National Health and Regulations, Ministry of Capital Administration & Development Division, CDA and ICT and the NGOs particularly the WHO to develop an early response mechanism of basic health care, safe water, hygienically prepared food besides providing proper sanitation and swift solid waste disposal. All these mentioned points are critical to prevention, early diagnosis and treatment of a wide range of diseases, as well as providing specialized secondary and tertiary clinical care.