Dateline: Thakhet District, Khammouance Province, 15-19 July. Reported by Vanly Lorkuangming and Ben Duncan, WHO Country Office, Lao PDR
“People with severe dengue sometimes come to the hospital late, due to lack of awareness. This can be fatal. Providing timely and accurate information about Dengue to the affected communities is critical, particularly during a big outbreak like the one we are experiencing this year.” – said Miss Manophap, a Health Education Staff member at the Lao Ministry of Health’s Center of Information and Education for Health (CIEH).
It was just after 9:00 am in the morning and we were at the temple in a village a few kilometres outside Thakhek District in Khammouane Province, in south-central Laos. Manophap was there with a small team from the Ministry of Health and Khammouane Province’s Health Department to run a health education meeting on Dengue awareness. The Head of the Village was already there, along with some of the Heads of Village Unit who look after individual neighbourhoods in the village. Each person at the meeting is representing a household.
A loudspeaker in the temple was playing a selection of radio spots on dengue produced by CIEH. These were interspersed with announcements that the health education on dengue was about to begin. Pretty soon the temple filled up and the meeting began.
Figure 1: Villagers attend health education at the Temple in Yangkome Village, Thakhek District, Khammouane Province. Photo: © WHO/Vanly Lorkuangming
“Who has someone in their household who has been sick with dengue?” – asked Manophap. A dozen or so arms go up. In every village we go to there have been at least 10 or 15 dengue cases. One village has had 40 or more cases. People know Dengue is a public health threat and they want to talk about it.
In one village, a teenage girl who recently had Dengue tells the meeting of her experience. This is a serious illness and needs to be taken seriously. It can kill you. Villagers are urged to seek medical attention if they have a Dengue like-fever and told to go straight to hospital if they have symptoms of severe dengue. These are:
- Abdominal pain or tenderness
- Persistent vomiting
- Bleeding from nose, gum or eyes
- Being very tired
- Anxiety
People with a higher than usual risk of getting severe Dengue include: pregnant women, infants under 1 year old, the elderly, obese people and people with chronic diseases such as diabetes, kidney failure or heart disease.
The health education has two aims. The first aim is to make sure all of the participants can recognize the warning signs of severe dengue – and know that if someone in their household has those symptoms they must go straight to hospital. The second aim is to engage leaders, and other influential people in the villages, to step up dengue prevention activities. This means targeting the breeding sites of the Aedes mosquitos that spread dengue.
Villagers are presented with simple actions that can eradicate mosquito breeding sites around their homes such as: covering or sealing water containers; emptying and cleaning water containers at least once a week; either placing Guppy fish in water containers to eat the mosquito larvae or adding larvicide powder to eliminate them; and keeping the houses and surrounding environment clean. Aedes mosquito eggs, and the larvae that grow from them, are able to live and thrive in very small amounts of water – as little as a bottle cap full. A small pile of rubbish can shelter numerous little puddles where Aedes larvae are able to live, and develop into adult mosquitoes. People need to collect and dispose of any rubbish lying around their homes or common areas of the village.
Figure 2: Manophap explains simple actions people can prevent mosquitos from breeding around their homes. Photo: © WHO/Vanly Lorkuangming
Once we have discussed the theory, the health team and the village leaders walked round a selection of households putting the 5 bullet points into practice. Water containers are inspected for mosquito larvae (immature mosquitoes).
Figure 3: The team walks around households to search for – and eliminate – mosquito breeding sites. Photo: © WHO/Benjamin Duncan
When larvae are discovered the water in the container needs to be emptied onto dry ground to kill them. The health team also has a new weapon in the battle against the Aedes mosquito: a chemical that can be put into drains and water tanks that keeps them free of larvae for up to 3 months.
Figure 4: The health staff applies BTI larvicide powder. This larvicide has been pre-qualified by WHO for use in vector-control campaigns and lasts up to three months. Photo: © WHO/Vanly Lorkuangming
There are dengue cases across South-East Asia every rainy season. However, this year Lao PDR and its neighbours have experienced an unusually large dengue outbreak. As of July, over 15,000 cases and over 30 deaths from dengue had been reported in the country– and the outbreak is not yet over. The four most affected Provinces so far are: Vientiane Capital, Khammouane Province, Savannakhet Province, and Champasak Province.
Figure 5: A villager cleans his water jar after the health team found larvae in it. Photo: © WHO/Vanly Lorkuangming
Manophap has been providing health education to the communities for many years. Being able to connect with people, and perhaps even make them laugh, is key to running a successful health education. However, so too is having clear and understandable health messages. Manophap stresses “we must think about how to make our key messages understandable by using more pictures to illustrate.”
For more information see:
Lao Ministry of Health (EN pages)
Centre for Information and Education on Health Facebook page (CIEH)
WHO is supporting the Lao Ministry of Health in all aspects of its response to the Dengue outbreak, including in the area of risk communication. Vanly Lorkuangming and Ben Duncan, Communication team of WHO Country Office, Lao PDR, accompanied the Ministry of Health team sent to Khammouane Province 15-19 July 2019 to assess needs and offer technical advice.