Background and Objective: Amongst all the states and union territories in India, New Delhi shares the highest burden of the disease. Dengue infection is influenced by several socioeconomic factors, which involve roles, and responsibilities of various stakeholders of the society. In this study, we attempt to explore the awareness, knowledge and perception about dengue amongst relevant stakeholders.Methodology: A sample of 30 stakeholders having different roles in management of dengue was taken all over from Delhi. In-depth, face-to-face, qualitative interviews were taken using an interview tool customized as per roles and responsibilities of the stakeholders.Result: The study identified four key themes in management of dengue in Delhi. These themes were studied in depth and various challenges in dengue management were explored

Dhariwal, A C

Hossain, Shah

Narayanan, Prakash

Rajvanshi, Harsh

English

Advanced Research Publications: Medical Journals

© ADR Journals 2017. All Rights Reserved.Research ArticleDengue Scourge in Delhi – What the Stakeholders Think, a Search for PerspectiveHarsh Rajvanshi1, Prakash Narayanan2, Shah Hossain3, AC Dhariwal4AbstractBackground and Objective: Amongst all the states and union territories in India, New Delhi shares the highest burden of the disease. Dengue infection is influenced by several socioeconomic factors, which involve roles, and responsibilities of various stakeholders of the society. In this study, we attempt to explore the awareness, knowledge and perception about dengue amongst relevant stakeholders.Methodology: A sample of 30 stakeholders having different roles in management of dengue was taken all over from Delhi. In-depth, face-to-face, qualitative interviews were taken using an interview tool customized as per roles and responsibilities of the stakeholders. Result: The study identified four key themes in management of dengue in Delhi. These themes were studied in depth and various challenges in dengue management were explored. Keywords: Dengue, Delhi, Stakeholders, Qualitative interviews, Public factors, Private health centers, Government factors, MediaIntroductionIndia reported 111,880 cases in the year 2016.1 Amongst all the states and union territories in India, New Delhi shares the highest burden of the disease with a total of 15,867 (15.8%) out of 99,913 cases in 2015.2 Major epidemics were reported in the National Capital in the years 1967, 1970, 1982, 1996, 2003 and 2006. 3-8 The 2006 outbreak also showed concurrent infection by all four serotypes making Delhi a hyper-endemic for the disease.8 There is endemicity of dengue in Delhi. Year after year, the disease burden continues to increase, putting more pressure on the health system and has led to loss of lives. Dengue infection is influenced by several socioeconomic factors, which involve roles, and responsibilities of various stakeholders of the society. In this study, we attempt to explore the awareness, knowledge and perception about dengue amongst relevant stakeholders.MethodologyThe study adopted a descriptive cross-sectional study design with qualitative in-depth face-to-face interviews of the stakeholders involved/knowledgeable of the 2016 dengue outbreak in Delhi. Ethical clearance for the study was obtained from the Institutional Ethics Committee, Kasturba Medical College and Kasturba Hospital, Manipal University (IEC 757/2016). Stakeholders involved were academicians/public health professionals, legislators, healthcare providers, vector control authority, opinion leaders from general public involved, media and non-government organizations (NGOs)1Post Graduate Scholar (MPH), 2,3Associate Professor, Department of Public Health, Manipal University, Manipal, Karnataka – 576104.4Director, National Centre for Disease Control (NCDC), Directorate General of Health Services, Ministry of Health and Family Welfare, Delhi. Correspondence: Dr. Prakash Narayanan, Department of Public Health, Manipal University, Manipal, Karnataka – 576104.E-mail Id: prakash.nvp@manipal.eduOrcid Id: http://orcid.org/0000-0001-9361-3989How to cite this article: Rajvanshi H, Narayanan P, Hossain S et al. Dengue Scourge in Delhi – What the Stakeholders Think, a Search for Perspective. J Commun Dis 2017; 49(4): 19-22.Digital Object Identifier (DOI): https://doi.org/10.24321/0019.5138.201730ISSN: 0019-5138J. Commun. Dis. 2017; 49(4)20ISSN: 0019-5138Rajvanshi H et al.working for management of communicable diseases. Total 30 interviews were done using a customized interview tool as per roles and responsibilities of the stakeholders. A few stakeholders for interviews were selected from areas where vector density and cases were the highest.9 Manual thematic analysis was done by identifying codes, categories and themes in MS Excel. Results“People build their ramps over the drains, blocking them off. Shopkeepers stack their goods by encroaching the roads, water stagnation takes place there. People are only worried about their personal agendas and not at all concerned about the society. So, this is a social problem.” (RWA President of a society in West Delhi)“Somehow, in this, I would say, the private sector both the doctors, labs and the hospitals are not reading the rule (reporting and management of dengue) very well. Either they are not fully aware of it and require CMEs or there are motives which may not be in the best interest of the population.” (Dean of a prominent public health institute)“Writing of slogans, pasting flyers outside hospitals, advertisement in newspapers – these things do not help a lot. There should be a massive campaign. Door-to-door visits are necessary explaining to people about prevention from dengue. Only advertising will not help. For this, these things are very important. The people-contact (Jan-sampark) movement is necessary. We need to take it at war level, like Sri Lanka did.” (Sr. Health Beat Correspondent from a prominent media house in Delhi)“I have heard recordings in the radio by the mayor that they are doing a great work in cleaning the areas, They also say that this is a ‘Swachh Bharat Abhiyan’, but I think this is a big failure. I did not like it at all. There is filth everywhere; there is rain and water accumulation everywhere. This is so much water that you can swim there. From the environmental sanitation point of view – I would rate it zero. Even in negative.” – (Nurse at a PHC in South Delhi)The authors identified four key clusters contributing towards various challenges in the management of dengue in Delhi, namely – public factors, institutional factors, for-profit health centers and media. Public factors consist of lack of awareness, lack of community participation, panic during outbreaks and ignorance amongst the general population. Government factors consist of poor sanitation, infrastructure, manpower, logistics, support from Municipal Corporation of Delhi (MCD) and disease surveillance. Private health centers are attributed with a non-existent disease reporting system. Media is involved in spread of panic during outbreaks and has difficulty in verifying actual data. The dotted lines indicate the inter-relationship between two or more factors. (Fig. 1) DiscussionThis study identified four key clusters, suggested by stakeholders, highlighting various challenges in the management of dengue in Delhi, namely – public factors, institutional factors, for-profit health centers and media. Public factors consist of lack of awareness, lack of community participation, panic during outbreaks and ignorance amongst the general population. No recent study was found that looked into drivers to control dengue as perceived by stakeholders. As such, there are certain community studies that have thrown light on the parts of those areas in bits and pieces. A study done in New Delhi at a tertiary care center by Chinnakali et al.12 showed that almost everyone knew about dengue (96.3%); however much lesser proportion of respondents actually translated that awareness into practice.10-12 In a study done in Malaysia, similar findings were reported by Ayyamani et al.13 Singh reported concerns over poor institutional facilities in the 2006 outbreak of dengue in Delhi.14 Rao et al. commented on the acute shortage of healthcare workforce and poor infrastructure in India.15 In a study done by Hay et al.,16 the authors estimated the actual malaria burden using the verbal autopsy method. It was up to 13 times the reported cases. Similarly, like in the case of Malaria, Kakkar identified gross underreporting of dengue cases in India.17 Talyan et al. commented that only 9% of total waste generated in Delhi is treated by correct methods and the rest is disposed of in uncontrolled open landfills at the outskirts of the city.18 Authors believe that if the media is briefed and trusted, the same media can be used to disseminate and communicate correct information.ConclusionThis study identified four key themes in management of dengue in Delhi – public factors, institutional factors, for-profit health centers and media. These areas should be further explored for more challenges in management of the disease so that appropriate interventions can be advised. J. Commun. Dis. 2017; 49(4)21 ISSN: 0019-5138Rajvanshi H et al.Conflict of Interest: NoneReferences1. Dengue cases and deaths in the country since 2010: Dte. of National Vector Borne Disease Control Programme, MoHFW, GOI; 2016 [cited 2017 Mar 20]. Available from: http://nvbdcp.gov.in/den-cd.html.2. NVBDCP. Dengue cases and deaths in the country since 2010. In: Services DGoH, editor. New Delhi: Ministry of Health and Family Welfare 2016.3. Balaya S, Paul S, D’lima L et al. Investigations on an outbreak of dengue in Delhi in 1967. Indian Journal of Medical Research 1969; 57(4): 767-74.4. Diesh P, Pattanayak S, Singha P et al. An outbreak of dengue fever in Delhi – 1970. J Commun Dis. 1972; 4(13): 8.5. Rao C, Bagchi S, Pinto B et al. The 1982 epidemic of dengue fever in Delhi. The Indian Journal of Medical Research 1985; 82: 271.6. Kabra S, Jain Y, Pandey R et al. Dengue haemorrhagic fever in children in the 1996 Delhi epidemic. Transactions of the Royal Society of Tropical Medicine and Hygiene 1999; 93(3): 294-98.7. MoHFW. Annual Report 2004-05. New Delhi. 2005.8. Bharaj P, Chahar HS, Pandey A et al. Concurrent infections by all four dengue virus serotypes during an outbreak of dengue in 2006 in Delhi, India. Virology Journal 2008; 5(1): 1.9. Rajvanshi HNP, Hossain S, Dhariwal A et al. Trend-analysis of dengue cases and its relation to vector density in selected areas of Delhi state. Journal of Vector Borne Diseases (Submitted). 2017.10. Chellaiyan VG, Manoharan A, Ramachandran M. Knowledge and awareness towards dengue infection and its prevention: a cross sectional study from rural area of Tamil Nadu, India. International Journal of Community Medicine and Public Health 2017; 4(2): 494-99.11. Acharya A, Goswami K, Srinath S et al. Awareness about dengue syndrome and related preventive practices amongst residents of an urban resettlement colony of south Delhi. Journal of Vector Borne Diseases 2005; 42(3): 122.12. Chinnakali P, Gurnani N, Upadhyay RP et al. High level of awareness but poor practices regarding dengue fever control: a cross-sectional study from North India. North American Journal of Medical Sciences 2012; 4(6): 278.13. Ayyamani UD, Ying GC, San OG. A knowledge attitude and practice (KAP) study on dengue/dengue haemorrhagic fever and the Aedes mosquitoes. Medical Journal of Malaysia 1986; 41(2): 108-15.14. Singh B. Dengue outbreak in 2006: Failure of public health system? Indian Journal of Community Medicine Figure 1.Framework for Challenges and Suggestions in Dengue ManagementJ. Commun. Dis. 2017; 49(4)22ISSN: 0019-5138Rajvanshi H et al.2007; 32(2): 99.15. Rao M, Rao KD, Kumar AS et al. Human resources for health in India. The Lancet 2011; 377(9765): 587-98.16. Hay SI, Gething PW, Snow RW. India’s invisible malaria burden. Lancet 2010; 376(9754): 1716.17. Kakkar M. Dengue fever is massively under-reported in India, hampering our response. BMJ 2012; 345: e8574.18. Talyan V, Dahiya R, Sreekrishnan T. State of municipal solid waste management in Delhi, the capital of India. Waste Management 2008; 28(7): 1276-87.Date of Submission: 2017-08-26 Date of Acceptance: 2017-10-11 

Dengue Scourge in Delhi – What the Stakeholders Think, a Search for Perspective

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Dengue Scourge in Delhi – What the Stakeholders Think, a Search for Perspective

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