From the Ground Up: Community-Led Efforts Keeping Dengue at Bay in Lao PDR

Dengue fever, a mosquito-borne disease, remains a significant public health concern in Lao PDR, with outbreaks during the rainy season from May to October. In 2024, dengue cases surged beyond previous years, approaching 2013’s tragic 44 171 cases and 95 fatalities nationwide.

Dengue is transmitted to humans by mosquitos, which pass the virus when it bites. Dengue cases, especially severe dengue, impact the health and financial well-being of families, and puts a significant burden on the health system and communities.

Dengue cases are reported every year in Lao PDR, and it is important to take action before large outbreaks occur. This trend may continue or even worsen given the potential impact of climate change, such as more intense or unexpected heavy rains occurring outside the usual season.

Preventing bites is one of the best ways to protect yourself from dengue. One way to do so is destroying mosquito breeding sites to reduce the number of mosquitos, and can be done by individuals and communities at home. But, it requires joint efforts by families, communities and local authorities.

Recently, the Ministry of Health and the World Health Organization identified ‘Best Practice Villages’, where dengue is being effectively controlled, with dedicated efforts by many making a life-saving difference. Here, we amplify the voices and lessons learnt from villages that have demonstrated sustained success in addressing dengue.

Engagement of provincial and district governors essential to dengue control

Dengue is not just an issue for the health sector; rather, it is a responsibility of everyone, from the government to the private sector, and from the leadership level to the community level.

At home, dengue prevention remains a challenge for many, often due to the time and effort involved in cleanup. Participation of key stakeholders, such as district and provincial governors, has shown to be important in motivating people in the community to work together at the village level.

Chief of Phon Village, Mr Toumany Phetdouangta shared: “When it comes to cleaning up the village, we are not as alert as we should be because most people are farmers, raising livestock, and giving priority to income generation. When it comes to health, they’re not as interested. But, if someone from the leadership level comes to motivate them, it will be effective. Therefore, I want the leadership level to come and follow up often.”

Use of online platform to facilitate effective communication between village authority

With access to fast and efficient communication technology, dengue coordination and response efforts have become more effective. WhatsApp is widely used to coordinate and exchange information between the district health office and village authorities in many locations.

"When I receive a notice in the WhatsApp group, I immediately read it and notify the head of each unit in my village to tell their unit members according to the notice received – I don't have to send the notice by hand,” said Mr Xayphone, Tha Pan village chief from Luang Prabang Province.

“I can also get various communication materials from the WhatsApp group to announce via the village loudspeaker, it is convenient to save time.”

“During the dengue season, we also surveyed larvae and encouraged each household to clean up and eliminate mosquito breeding sites,” said Ms Phoukeo Souvanhdee, a village health volunteer from Chomchaeng Village, Vientiane Capital.

“We reported the district health office via WhatsApp weekly by taking photos of the mosquito larvae monitoring form and sending them to the WhatsApp group. If the number of larvae exceeds the standard, they will come to help monitor further. We also exchanged lessons with other volunteers in neighbouring villages in the WhatsApp group.”

Using WhatsApp significantly improved surveillance efforts and streamlined coordination between the district health office and villages. This enabled the district office to share crucial information directly with village heads and volunteers, while simultaneously receiving updates from villages.

The use of WhatsApp as a communication channel, and engagement of leadership levels, have proven to be key ingredients to effective dengue control, along with village health volunteers’ ongoing support and timely hospital treatment

Dengue control can be challenging and time consuming – however, it is very much possible, as these community champions are proving.

“Successful dengue response is about everyone working together and staying proactive to keep our homes and families safe,” said Mr Visith Khamlusa, Director of Centre for Health Statistics and Information person. “The lessons learned from these model villages will be instrumental in strengthening the national response and building resilient communities capable of preventing dengue.”

Crucial to dengue control is strengthened village health volunteers’ capacity

Village health volunteers (VHVs) play an important role in safeguarding health at community level, from regular house visits and health education sessions to monitoring and responding to outbreaks. Their efforts have significantly boosted community knowledge regarding dengue prevention and control.

Ms Phoukeo Souvanhdee, a VHV from Chomchaeng Village, Vientiane Capital shared with us: "We visit each house to monitor mosquito larvae, every week. When we find mosquito larvae, we educate the household about the dangers of dengue fever and advise them to clean up and eliminate mosquito breeding sites. Then the team will come back to check again."

Volunteers are recruited from within the community and receive short-term training on dengue surveillance monitoring and reporting, as well as other topics.

Supporting village volunteers to prevent and control dengue is a successful model of community health initiatives. By harnessing local knowledge and promoting community participation, village volunteers have helped to effectively address the threat of dengue. In the future, training should be expanded, and sustainability should be enhanced through continued community participation.

Doctors play an important role in encouraging timely hospital treatment

One significant challenge in combating dengue stems from a lack of understanding regarding dengue symptoms, particularly severe dengue. This knowledge gap leads to delayed hospital treatment, which has resulted in complications and, in some tragic instances, fatalities.

Ongoing efforts have been made to raise awareness on dengue symptoms and ensure people act promptly. Beyond regular house visits and community meetings, healthcare workers and VHVs play a significant role in encouraging patients and their families to seek medical treatment when experiencing symptoms.

“I remember when I had dengue, my body temperature was high, and I had a very bad, throbbing headache,” said Mrs Ta Xayavong from Phon Village, Xekong Province. “I remember saying to myself, ‘I won’t take medicines yet, I will go to the hospital first.’”

Mr Visith Khamlusa, Director of Centre for Health Statistics and Information said: “There have been many cases of severe dengue in the past, and often times, patients are reluctant to visit the hospital. With this in mind, we’ve emphasized the importance of timely hospital treatment and ensured healthcare workers and village health volunteers educate the public when they do house visits.”

In Lao PDR, the Ministry of Health advises to remain vigilant, particularly during the rainy season, and practice five simple measures to prevent dengue:

• Closing and sealing all unused containers;
• Flushing out and cleaning all water vessels;
• Cleaning areas around homes, especially eliminating stagnated water;
• Putting small guppy fish in water jars as they eat mosquito larvae;
• Remembering to do these four tasks each week and seeking medical attention when experiencing symptoms.