Health Ministry-Sri Lanka

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Website URL: http://maadyadigital.com

Facilitating the Improvement of DF/DHF Case Management

Major Activities

  • Provision of resources necessary for proper management of DF/DHF cases
  • In services training of curative health care staff on clinical management of DF/DHF (by Epidemiology Unit)
  • Establishment of High Dependency Units to manage severe DF/DHF cases

HDU

HDU Map

Clinical Training

Vector management consist of two components
•    Vector Surveillance    
•    Vector Control   

  1. Environmental management
  2. Biological methods   
  3. Chemical methods            
  4. Integrated vector management         
  5. Intersectoral coordination and social mobilization         

Vector Surveillance

Vector surveillance is systematic monitoring of the seasonality and abundance of vector population.


•    The main purpose of dengue vector surveillance (larva, pupae and adult) is to obtain information regarding dengue vector density, which can be used to predict outbreaks and control dengue transmission.
Vector surveillance is important …


(1). To monitor vector densities over time enabling early warning and forecasting potential outbreaks/ epidemics. This facilitates initiation of early measures to prevent / control  outbreaks


(2).To study the ecology, biology and bionomics of dengue vectors, in order to collect information on vector breeding sites, biting and resting habits, role played by individual vector species in disease transmission. This information is important for the implementation of an effective dengue control programme in the country.


Vector surveillance is carried out by the NDCU in cooperation with Anti Malaria Campaign (AMC), Anti Filariasis Campaign (AFC) and Medical Research Institute (MRI). In addition to central level offices, these institutions have their district level offices headed by Regional Malaria/ Medical officers (RMOO), Medical officers of AFC or entomologists who are responsible for planning, implementation, monitoring and evaluation of entomological surveillance at the district level. Currently, 107 entomological teams are deployed for entomological surveillance at the central and district level offices of the AMC, AFC and MRI.

Vector Control

Vector Control activities are managed and conducted by the Medical Officer of Health (MOH) offices in the country with the collaboration of respective Regional Malaria/ Medical officers (RMO) Medical officer AFC and entomologists.


Major Activities

  • Facilitating district and divisional level vector management staff to perform optimally for the elimination/control dengue vectors by providing technical guidance, training, equipments, logistics, insecticides, and other resources including funding
  • Development and distribution of training manuals & guidelines on vector surveillance and control
  • Monitoring & Evaluation of district level activities
  • Conduction of monthly Review meetings
  • Insecticide resistance monitoring Review weekly entomology returns and send alerts to relevant MOH, RDHS and PDHS whenever entomology indices are high     

 

Nuwara Eliya District is covered by RMO/AMC Kandy

Integrated Vector Management Traning

Dengue Vector Control

In Sri Lanka, Aedes aegypti and Ae. albopictus are responsible for transmission of dengue and Dengue Haemorrahgic fever. These mosquitoes use a wide range of confined larval habitats, both man-made and natural. Some man-made container habitats produce large numbers of adult mosquitoes, whereas others are less productive.
Current vector control measures used in Sri Lanka,

  • Environmental Management - Environmental modification, Environmental manipulation and changes to human habitation or behaviour
  • Biological methods (Larval control)
  • Chemical methods (Larval control and Adult control)
  • Integrated vector management
  • Intersectoral coordination and social mobilization and
  • Enforcement of law against offenders 


Environmental Management
Environmental management is to change the environment to prevent or minimize vector breeding and/or man vector mosquito contact by destroying, altering, removing or recycling containers that produce larval habitats. Environmental management is the most efficient approach of dengue vector control and it comprised of components; ie.  Environmental modification, Environmental manipulation and changes to human habitation or behavior.

Environmental Modification
Permanent or long lasting physical transformation of vector breeding sites in order to eliminate/ reduce vector larval habitats.
Eg. Provision of reliable water supply to the community in order to prevent water storage
Installing a reliable water supply to the community and households would prevent or minimize water storage in cement tanks, barrels and other containers, thus, installation of a regular water supply would help a great deal to reduce dengue vector breeding in water storage containers and thereby reduce the dengue transmission. 

Environmental Manipulation
Temporary changes to vector breeding habitats to prevent/ minimize vector breeding
Eg.
•    Frequent emptying and cleaning by scrubbing of water storage tanks, barrels and other containers, flower vases, refrigerator trays
    
•    Installation of mosquito proofing nets or tight lids to water storage tanks, barrels and other containers
Water storage containers can be fitted with tight lids or tightly fitted mosquito proof mesh to prevent mosquitoes for oviposition in these containers. Studies have shown that such measures prevent mosquito breeding in water storage tanks and barrels in Sri Lanka  

•    Cleaning of blocked roof gutters
Clogged roof gutters is an important breeding site of Ae. aegypti. The owners of the premises are required to clean or install them with a suitable angle in order to prevent water collections.  If the owners are unable to maintain them satisfactorily, those gutters should be removed.
 
•    Sheltering stored tyres in order to prevent collection of rain water in tyres
•    Proper disposal or recycling of discarded containers including tyres
Non biodegradable items of household, community and industrial waste should be collected and disposed regularly, preferably, once in 3 days.

Discourage planting plants that collect water in the leaf axiles

Changes to human habitations or behavior
Installing mosquito proof screens on windows, doors and other entry points
Use of mosquito nets while sleeping in the day time

Biological Control
Biological control is based on the introduction of organisms that prey upon, parasitise, compete with or otherwise reduce vector species.


Organisms.
• The introduction of organisms that, parasitize, compete with or reduce populations of Aedes  mosquitoes
• Predators – can be deleted
Currently using biological agents for dengue vector control
Lavivarous fish:  Larvivorous fish can be applied for water storage tanks, barrels, cement lined wells, (concrete irrigation ditches – can be deleted) and industrial tanks. Most efficient larvivorous fish for dengue vector control are
Poecilia reticulata -guppy
• Aplochcheilus  dayi – Uda handaya
• Oryeochromis mossambicus - Thilapia spp

  • Oryeochromis niloticus - Thilapia spp
  • Rasbora daniconius - Dandi

• Microorganisms

  • Bacillus thurengiensis isralensis - Bti


Chemical methods for dengue vector control: Larvicides
Chemical larviciding should be considered as complementary to environmental management. Except in emergencies, chemical larviciding should be restricted to containers that can not otherwise be eliminated or managed. Currently, temephos 1% sand granules at the rate of 1g/ 10 liter of water is used for larval control in water storage containers such as tanks and barrels.

Chemical methods for dengue vector control: adulticides
In Sri Lanka, space spraying (fogging) is widely used for dengue vector control. However, space spraying is recommended for vector control only in emergency situations to suppress ongoing epidemics or to prevent an incipient one. The objective of space spraying is the massive, rapid distruction of adult vector populations, both indoors and outdoors. In space spraying, a suitable insecticide is mixed with kerosene oil and release to the environment in the form of very tiny droplets. Once these droplets get contacted with the vector mosquitoes, the mosquitoes are knocked down and die. In order to reach the fog to the interior of the premise, the doors and windows should kept open while fogging, however the food and water should be kept covered to prevent contamination with the insecticide.

Intersectoral collaboration and social mobilization
Aedes aegypti and Ae. albopictus breed in and around human habitations. These mosquitoes are frequently find in schools, offices, private institutions, religious places, bus depots, tyre shops ect in addition to the house holds. Thus, involvement of other sectors such as education, security forces, religious leaders, water board, road authority etc are of utmost importance for dengue prevention and control. Involving the other sectors for dengue vector control facilitate a more coordinated approach than the individual and independent efforts of diffenet sectors. This also provides a platform for partners to resolve cross agency issues and to share best practices while reducing duplication of efforts.

 

The NDCU in cooperation with Epidemiology unit, Regional Epidemiologists and MOOH are carrying out dengue fever surveillance activities in the country

Major Activities

  • Establishment of web based system to enhance disease surveillance in collaboration with Epidemiology unit in 50 sentinel hospitals
  • Training of relevant health staff (Gallery)
  • Sentinel Hospitals

Province

District

Hospital

Western Province

             

 

 

 

 

 

 

 

 

 

 

 

 

Colombo District      

 

 

 

 

 

IDH

BH Awissawella

LRH

NHSL

BH Homagama

TH Kalubowila

TH Sri Jayawardanapura

Gampaha District

   

 

 

BH Wathupitiwala

DGH Gampaha

DGH Negombo

TH Ragama

Kalutara District

  

 

BH Horana

DGH Kalutara

BH Panadura

Uva Province

  

 

Badulla Distirct

  

 

PGH Badulla

BH Diyathalawa

BH Mahiyanganaya

Southern Province

      

 

 

 

 

 

Galle District

  

 

BH Balapitiya

BH Elpitiya

TH Karapitiya

Hambantota District

 

DGH Hambantota

GH Tangalle

Matara Distict

 

BH Kamburupitiya

DGH Matara

Sabaragamuwa Province

    

 

 

Kegalle Distirict

  

 

BH Karawanalla

DGH Kegalle

BH Mawanalla

Rathnapura Disrict

 

BH Embilipitiya

PGH Rathnapura

Northern Province

  

 

Jaffna District

TH Jaffna

Mannar Distict

DGH Mannar

Vauniya Distirct

DGH Vavuniya

North Western Province

       

 

 

 

 

 

Kurunagala District

   

 

 

BH Dambadeniya

BH Kuliyapitiya

PGH Kurunagala

BH Marawila

Puttlum Distict

 

DGH Chilaw

BH Puttlum

Anuradhapura District

TH Anurhadapura

Polonnaruwa District

DGH Polonnaruwa

Eastern Province

      

 

 

 

Ampara District

  

 

DGH Ampara

BH Kalmunai

AMH Kalmunai

Batticoloa District

 

TH Batticoloa

BH Kalawanchkudy

Trincomalee District

 

BH Kanthalae

DGH Trincomalee

Central Province

     

 

 

 

 

 

 

 

 

 

 

Kandy District

   

 

 

BH Gampola

TH Kandy

DGH Nawalapitiya

TH Peradeniya

Matale Dsitrict

DGH Matale

Nuwara Eliya District

 

DGH Nuwara Eliya

 

National Dengue Control Unit (NDCU) was established in 2005 as a decision taken by the Ministry of Health following a major DF/DHF outbreak occurred in 2004. It is responsible for the coordination of control and preventive activities related to dengue at central level between different stakeholders

Former National coordinators/Directors

Dr.Lakshmi De Silva 2005 - 2008
Dr.Lakmini Magodarathna(Actg) 2008 – 2009
Dr.N. Pannila Hetti  2009 – 2011
Dr.R.Batuwantudawe 2011 -  2013
Dr.N. Pannila Hetti(Actg) 2013
Dr.U.Ranasignhe (Actg) 2013
Dr.Hasitha Tissera 2013 to date

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