Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal

Abstract

Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks.

Knowledge, Attitude and Practice Regarding Dengue Fever among the Healthy Population of Highland and Lowland Communities in Central Nepal

“…Participants living in lowland areas were five times more likely to possess good knowledge compared to those living in highland areas. The higher knowledge level among study participants in the lowlands may be due to relatively frequent DF outbreaks in the lowlands of Nepal in recent years [9], [26], [27], [55] and occasional awareness programmes at the time of outbreaks [42]. The higher attitude level among older female participants may be attributed to the major role of women in domestic works, collecting and storing water for domestic use, caring of ill members of the family and cleaning the breeding places of mosquitoes and to the fact that DENV vectors are primarily domestic and peri-domestic breeders [56], [57].…”

Detecting and Responding to a Dengue Outbreak: Evaluation of Existing Strategies in Country Outbreak Response Planning

“…Yet, the overworking and consequent demotivation of public health staff may be a barrier in a dengue outbreak response, and plans may fail to take into consideration the difficulties facing redistribution of relevant trained professionals in practice [12]. The benefit of staff training for an outbreak in the interepidemic period has been established in the literature and in this plan analysis, and experience has led to a recognition of the additional use of hands-on training during a dengue outbreak [3, 13, 14]. Thus, investment in human resources must come prior to the outbreak.…”

Delivering More with Less: Subnational Service Provision in Low Capacity States

“…Other measures of welfare, such as stunting and food insecurity, follow a similar pattern (Haslett et al 2014). Evidence of low levels of state capacity and poor projection of the state into remote areas is especially pronounced in the wake of largescale disasters, such as the 2015 earthquake (Jones et al 2014) or the 2010 Dengue fever outbreak (Griffiths et al 2013).…”