The healthcare around the globe is developing tremendously and Malaysia is one of the countries which are undergoing a health transition that can promote the wellbeing of the people by reducing morbidity and mortality. Although, Malaysia enjoys tropical climate with warm and humid weather all year round, yet warm and humid climate can create several diseases (Shekhar 1992). Warm and humid climate has induced vector borne disease and water reservoirs serve as breeding ground for vector mosquito such as Malaria. As comparison, Malaria can be spread from the bite of the malaria- infected mosquito and the saliva of the infected malaria-mosquito contracted into the person's blood, Sekhar &Ong (1992).
Particularly, known mosquito which is dangerous and can lead to mortality is Aedes aegypti; a domestic, day- biting mosquito that feeds on human which leads to dengue fever. In similarity, Dengue is caused by the dengue virus that is transmitted through the bite of an infected female Aedes aegypti that introduces saliva containing 'dengue viruses' into the bite which would spread to the possible target tissue such as liver, lymph nodes, spleen or bone marrow. There are two peaks of biting activity, early morning for 2 to 3 h after daybreak and in the afternoon for several hours before dark, World Health Organization [WHO] (1997). However, these mosquitoes will feed all day indoors and on overcast days. As explained by Reiter (1997) the female mosquitoes are very 'nervous feeders', disrupting the feeding process at the slightest movement, only to return to the same or a different person to continue feeding moments later. Because of this behavior, Aedes aegypti females will often feed on several persons during a single blood meal and, if infective, may transmit dengue virus to multiple persons in a short time, even if they only probe without taking blood. An infected Aedes mosquito takes an average of 4 to 7days to become infective and remains infective for life up to a week. An infected person harbours virus in the blood stream for up to 5 days of fever. For instance, Gubler (1998) analyzed that the dengue transmission may spread to the places where people congregate during the day and dengue may also spread in setting involving large numbers of people, such as in hospitals where visitors, patients, and staffs may be bitten by the infected female Aedes Aegypti. In adding up, the spread of the transmission may introduced by the air travel of infected passengers over long distance has carried the disease to town or rural places.
According to WHO (2006), the patterns of increased transmission have been coinciding interrelated to the rainy season and these are due to the interaction between the temperature and rainfall affecting patterns of the mosquito feeding and reproduction hence raised the density of vector mosquito. However the occurrence may relate to vector control efficacy and a culture dependent on disposable crockery, which caused the increase of breeding sites when improperly predisposed was done, Vellayan (2008). In addition, prevention is important to combat dengue especially by relying on the new methods of diagnosis to detect infection and control the spread of dengue causing increased of mortality rate due to the Dengue Hemorrhagic Fever (DHF). In the real world, we are constantly challenged by different presentations and manifestations and in order to improve the knowledge and reduce the rate of the Dengue transmission in the society therefore, I have chosen dengue outbreak as one of the contemporary issue.
Dengue Hemorrhagic has imposes the society burden that is difficult to measure because of the disease non specific symptom. As supported by The National Health and Morbidity Survey (2001), the average number of dengue in Malaysia was 925,896 that is almost double figure comparing in 1990-1999 with 479,848 cases. In Malaysia, dengue was made a notifiable disease in April 1973, WHO (2006). In addition to, it proves that Dengue Hemorrhagic outbreak has become a public health problem in such of communicable disease. As it was described by George (1974), the clinical feature was seen as an endemic in the country following the period of the major epidemic that occurs every 4 years and it was reported that majority of the cases occurred in young adults. The endemic outbreak has proved that the half of the country population lives in areas is at risk of dengue infection. As supported by Halstead (1980), dengue fever is endemic over large areas especially in Southeast Asia which increases the fatality rate that is caused by 'Dengue Hemorrhagic'. The first major outbreak of dengue hemorrhagic case in Malaysia was reported in Penang year 1962, George (1974).
One of the main reason dengue has become a 'notifiable' disease is because the society in the country failed to demonstrate the prevention and control of dengue transmission and it was due to the effective mosquito control programme where the surveillance is poor and the response has always been 'too late' or 'too little' to impact on the dengue transmission. Thus, it causes the society is not sensitive of the dengue effects or outcome if no proper management is taken and causing the transmission to continue to spread unabated. In order to look up on this matter, the government should have emphasized on the importance of the prevention and control of dengue transmission.
Lam & Devi (2000) emphasized that the growth of the mosquito's preferred breeding areas of stagnant water such as flower vases, uncovered barrels, buckets and discarded tires, but the most dangerous areas are wet shower floors and toilet tanks, as they allow the mosquitoes to breed in the residence. Still, as argued by Osmali (2007), contaminated water containers that consist of chemical and bacteria help to stimulate the female mosquitoes to lay eggs. As a result, it suggests that less widespread control efforts may be sufficient to control the mosquito population by be more 'focused' around the site of origin that could be the preferred breeding area. Although the current dengue management plan used by Ministry of Health [MOH] is based on an active case detection by using serological and clinical methods however, the surveillance with the aim of detecting changes in adult or immature Aedes aegypti populations is a crucial factor of active dengue surveillance because the disease can be life threatening. For example, recently 6 cases were reported death due to Dengue Hemorrhagic and it brings total of 31 deaths in year 2010 that compare a higher number for the same period as last year, The Sun, March 5th 2010.
There are different types of dengue and dengue is like an acute febrile viral disease which frequently presenting with headaches, bone or joint muscular pain, rash and leucopenia and thrombocytopenia symptoms. As explained by Rebecca (1992), the clinical feature of Dengue Fever (DF) is depending on the age of the patient infants and young children will develop the febrile illnesses with maculopapular rash. However, young children or adults may develop abrupt onset of high fever, severe headache, and pain behind the eyes, muscles pains, joint pain, and rash.
Unlike, Dengue Hemorrhagic fever (DHF) is characterized by high fever, hemorrhagic phenomena such that the bleeding tendencies was commonly observed as a significant finding in the form of petechiae, malena or ecchymoses and it may cause circulatory failure. In such patient, it may cause hypovolaemic shock due to plasma leakage or loss with the symptoms of tachycardia out of proportion to body temperature, decreased tissue perfusion as evidenced by cool extremities, increased capillary refill time, narrowing of pulse pressure, weak distal pulses, oliguria and altered conscious level, systolic pressure within the normal range thus; it is called the Dengue Shock Syndrome (DSS) as it increases the fatality rate, World Health Organization [WHO] (1997). The pathophysiology that is seen in the dengue DHF cases often shows an acute increase in vascular permeability that leads to leakage of plasma into the extravascular component, resulting hemoconcentration and decresed blood pressure, Bhamarapravati (1997).
According to Shamala (2008), the dengue detection could be identified through the serological test. The basic methods of establishing a laboratory diagnosis of Dengue infection are from the detection of the virus such as the culture or detection of anti-dengue antibodies through the serology test. Active laboratory- based surveillance should be the component of disease prevention programme. In order to approach and identify the diagnosis, dengue based on the antibody identification of the laboratory test has emerged as the most practical approach, Kalayanarooj (1997). The virus could be detectable in the blood for the duration of febrile period. For example, the serological test depending on the presence of IgM antibody (dominant immunoglobulin isotype) or a rise in IgG or IgA antibody where mostly 90% of the patient resulting positive by the fourth day of infirmity however, the IgM antibody may last resulting an infection up to 3 months or earlier. Another test that is common in diagnosing dengue is the dengue NS1 antigen test. Dengue is confirmed according to the results of the NS1 test. For instance serum sample are usually collected between day 0 and day 4 after fever onset. Positive result of NS1 test has proved the strong evidence of dengue, Chandra (1993).
As argued by WHO (1997) there is no specific treatment for dengue but careful clinical management such as assessing the needs of intravenous fluids, medications, blood products, intensive care equipment, and equipment for transporting patients frequently saves the lives. As reported by the WHO (1997) early detection and anticipation of dengue is crucial due to absence of vaccines. Gubler (2002) acknowledged that the progress of the vaccines funding has been running for over the past 10 years unfortunately, there is not 'magic- bullet' that can be used to prevent it. Even though vaccine viruses have been developed and have been evaluated however; current progress on the live dengue vaccine is undergoing a review phase.
Shamala (2008) analyzed that the dengue is an endemic in more than 110 countries worldwide with two-fifths of the world's population are at risk and this critically proved that dengue attacked is an outbreak in various part of the world and is the most important arthropod-borne viral disease of humans which estimated 100 million cases of dengue were reported in the country. Unfortunately, Malaysia Ministry of Health [MOH] (2008) reported more dengue outbreaks in various part of the Peninsular Malaysia with the number of 44189 that is noted with positive Dengue Hemorrhagic cases. As comparison, the incidence rate of the clinical diagnosis of dengue and dengue hemorrhagic that were reported is showing upward trend from 8.5cases/100,000 populations in 1988 to 88.6/100,000 populations in 2003, Clinical Practice and Guideline (2003). The outbreak significantly proved that the rises of Dengue Hemorrhagic have become pockets of epidemic and mortality in the country and the statistics will worsen unless urgent and needs were addressed promptly with effective surveillance, prevention and control programs.
The Ministry of Health (MOH) has identified environmental factors to be the major contributors to the health problems of Malaysian society. MOH analyzed that the degradation of the environment especially in both chronic and infectious disease in nature causes the country in a great concern that will undermine the sustainability of social and economic development and health. The outbreak of the mosquito Aedes aegypti involved several important factors that have been identified. Lee (2005) identified that ineffectiveness of mosquito control virtually nonexistent in most dengue-endemic countries such as in increased of the population rate and uncontrolled or rapid urbanization housing area that plays a vital role to facilitate the transmission of the mosquito Aedes aegypti which causes a disturbance in human ecology. And so, it has proved that Malaysia as a developed third world country has affected with the matter above as it caused and facilitate the transmission of the mosquito Aedes aegypti that caused increase of Dengue Hemorrhagic.
Health awareness such as dengue campaign at the housing area has been promoted by the Malaysia government in order to encourage the society to get involved and maintain a proper waste management system where most cases occurred in urban areas, MOH (2009). Conversely, one of the main factors is caused by a seasonal pattern with cases escalating due to the raining season and the mosquito can be breed in water-filled flower pots, plastic bags, and cans year round. Due to that, the prevention of Dengue requires control and eradication of the mosquitoes that is from governmental and society initiative in order to help to keep the disease in checked. And so, the societies are urged to empty the stagnant water from old tires, trash cans, and flower pots so that chances of the mosquito breeding will be decreased.
Lee (2005) discussed that a public information campaign should be instituted by stressing on the basic epidemiological characteristic of DF or DHF and the measures of individual's knowledge could reduce the risk of infection for example; personal protective measures, and the use of households insecticides. For personal protection, the use of mosquito repellent sprays when visiting endemic places is encouraged. The objective of this measure is to eliminate infected mosquitoes and to break the transmission cycle by reducing mosquito populations and to lower level of bitten by the mosquito Aedes Aegypti during the time of necessary. In my point of view, community participation requires extensive social marketing of dengue prevention with health education and community outreach. However, the dengue surveillance programme should be implemented as it helps to act as the early detection and control measures.
Leontsini (1993) supported that the government involvement in the form of leaving out of mosquito production sites on the larger scale and some through limited use of larvicides and adultcides are essential. However, in many Asia countries come across that the spraying of insecticides has proved to be ineffective where it represents a great expenditure for many governments. Reiter (1997) stressed that the ineffectiveness was due to the vector breeding sites are often found in residential premises but the residents did not place the burden for action thus the effectiveness of spraying the insecticides were wasted. In Malaysia society, the MOH applied the use of the spraying or fogging of insecticides as one of the main concern to reduce the vector breeding. Like this situation, frequent spraying and fogging of insecticides by the MOH to control the vector breeding, has helped in generating the general notion that the government is the only entity capable of conducting vector control activities; therefore, dengue prevention is the government's responsibility.
Kuberski (1997) analyzed that active laboratory based surveillance that can provide an early warning for the epidemic activity is crucial. As argued by Ibrahim (2005), the effort should be supplemented with the clinical training for physicians, nurses and laboratory staff on the management of dengue patients. Medical or health care practitioners such as nurses, doctors and paramedics involvement and participation that is able to sustain the prevention of DF is from the education on the clinical diagnosis and management where it helps to understand the changes to occur hence, fatality rate will be reduced. Besides that, the health care practitioners could help by implementing the community- based education program by involving the social worker and private sector in developing educational materials and prevention projects. These efforts are to build the awareness and sense of responsibility among the community. However, in my point of view further steps are needed to increase community participation within the neighborhoods, government sector, private and public sectors allies in cooperating of planning, implementing, and evaluate the activities.
As part of a comprehensive program, community participation by doing routine dengue prevention practices is one of the most important environmental and health concern where it involves the general cleanliness for example in house, yards and the community areas. One of the main issues that caused the spread of the vector breeding is related to the lack of appropriate waste disposal by the community. As it is emphasized by Abu (1992) in order to improve the environmental problem, government should provide an appropriate refuse and garbage collector so that the community would not continue to throw rubbish into the streets, rivers and ravines. Nevertheless, the MOH emphasized the environmental sanitation through community cleanup campaigns, education and house visits as well as fumigation when dengue cases are reported is necessary to let the community to be cautious of it.
The participants of the mass media campaign are to be considered as the best strategies to distribute the prevention message to the community. As argued by Winch (2002) an aggressive message from the media could be an effective whereas it has to be specific, show worst-case scenarios, be real, present with testimonials and repeated regularly. As Malaysia broadcasting is tremendously outstanding and catches attention, distribution of prevention through media such as television, followed by newspaper and short printed handouts with concise and clear information could make a huge impact to catch the community attention. Conversely, at the same time the mass media should make a strong impression and be broadcast with the sensitive words and images that appeal to the viewers' feelings where it should be focused on the family and stress that dengue could be prevented, thus it helps to reduce and avoid illness in the family.
Dengue Hemorrhagic Fever has been the important emerging tropical disease in the country. The resurgence of the disease have been closely tied with population growth, urbanization and traveling. Despite repeated warnings, public health education and government and non government support groups have taken part, yet it is still one of the most important public health problems. Thus, if the country could have had the resources and implemented integrated community based prevention and control programs in the society, the emergence and outbreak of Dengue Hemorrhagic could be reduced. Therefore, effective method and dengue prevention is essential in order to reduce more mortality rate in the country that is interrelated to Dengue Hemorrhagic.
