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Communication for Behavioural Impact ) Program in the Prevention and Control of Dengue – the Hulu Langat Experience

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Communication for Behavioural Impact ) Program in the Prevention and Control of Dengue – the Hulu Langat Experience View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by UKM Journal Article Repository ORIGINAL ARTICLE THE COMBI (COMMUNICATION FOR BEHAVIOURAL IMPACT ) PROGRAM IN THE PREVENTION AND CONTROL OF DENGUE – THE HULU LANGAT EXPERIENCE S Rozhan 1 , M Jamsiah 1 , A. Rahimah 2 and K.T. Ang 2 1 Department of Community Health, Faculty of Medicine, Universiti and 2 Department of Health State Selangor ABSTRACT Background: The COMBI concept is a novel approach by the WHO to control communicable diseases which are influenced by community behaviour. The Ministry of Health is currently evaluating its use against dengue in selected areas throughout Malaysia. COMBI doctrine differs from previous dengue campaigns. It acknowledges that the factors contributing to dengue proliferation may differ between areas. Factors for a given area are analysed, then a single precise behavioural goal to overcome those problems is formulated. To inculcate this behavioural change, the target community is subjected to an intensive campaign using Integrated Marketing Communication techniques adapted from the advertising industry, particularly involving volunteers from the community itself . Methodology : In Selangor the pilot project was implemented in Section 3 and Section 4 of Bandar Baru Bangi, in the district of Hulu Langat. Here, Aedes breeding was found to occur mainly in water containers of semi permanent nature (eg. ‘kolah’, aquatic plant jars, flower pot bases etc). A total of 172 volunteers were recruited to disperse the message of “Suluh – Suluh, Basuh - Basuh” whilst distributing leaflets and flashlights to 2666 homes. Residents were instructed to illuminate such water containers twice weekly and scrub any containers found to contain larvae. The program commenced on 23/5/2004 and lasted 16 weeks. Results : During this period, the initial Aedes Index of 5 was reduced to 0.96 while combined cases of Dengue Fever / Dengue Haemorraghic Fever in Sections 3 and 4 reported to the Hulu Langat District Health Office also dropped to 1 (unconfirmed). Conclusion : The COMBI approach in Hulu Langat successfully demonstrated that correct problem identification synergized with community engagement can potentially reduce Aedes proliferation and dengue morbidity. Keywords : COMBI, Community, Behavioural Approach, Dengue Fever, Aedes Index INTRODUCTION In 1992 there were 5,473 reported cases (incidence rate of 29.38/100,000 population) Dengue fever (DF) was first recorded in while in 2001 there were 16, 363 reported cases Malaysia in 1902 while the first case of Dengue (incidence rate of 68.78/100,000 population) 1. Haemorrhagic Fever (DHF) was first described In Malaysia, dengue is predominantly a in 1962 during an epidemic in Pulau Pinang. disease of urban and rapidly developing areas, Since then, dengue has remained an endemic whose vector, the Aedes mosquito species, is disease with sporadic outbreaks and fatalities, found in two subtypes, A. Albopictus and A. whose control remains a major public health Aegypti. Pending the commercial availability of a concern to the Ministry of Health (MOH), as suitable dengue virus vaccine, all disease control well as the Ministry of Housing and Local efforts necessarily focus on eradication of Government. breeding habitats of these mosquitoes. Studies conducted by the Institute of Medical Research Correspondence to: M Jamsiah, Department of (IMR) have long shown that both these subtypes Community Health, Faculty of Medicine, Universiti favour breeding in shaded containers or water Kebangsaan Malaysia retaining structures of almost any type where Tel: 03-91702540, Fax: 03-91737825 rain or any other clear water can stagnate 2. (e-mail: [email protected]) The propagation of Aedes mosquitoes control, and enforcement activities as well as owes as much to the practices and behaviours of health promotion and education programs 2 . convenience of the affected communities as it The anti dengue and public awareness does to the existing architectural and campaigns conducted by the RKPBV nationwide infrastructural conditions. Urban buildings and via posters, banners and media ads all dwellings, slum and squatter areas, construction homogenously implore a decades-old, generic sites, refuse sites, storage yards and domestic and unchanging theme ie. appropriate refuse households have all been implicated with flower disposal, burying potential breeding containers, pot bases, bathroom water troughs, discarded putting abate etc. The aim as ever, is to inculcate refuse, blocked gutters and unused tyres 3, as in the general public some basic knowledge and well as domestic, commercial and industrial a sense of responsibility in reducing the breeding junk, static machinery, landed and strata property of mosquitoes. While this is rightly so, the water storage tanks 4 are frequently incriminated. relevance (and thus appeal) of such traditional Any attempt to resolve the problem of Aedes exhortations in today’s diverse modern living cum dengue proliferation by addressing certain deserves timely scrutiny. The ministry has taken issues in isolation is unlikely to attain long term cognizance of this fact through the adoption of success. the COMBI concept, which amongst others, While improvements involving demands not just the disease but also the people legislation and personnel, urban renewal and involved be studied beforehand prior to any resettlement, better city structural and landscape campaign 4. designs, improved drainage and council refuse There is also now a shift towards disposal services are actions within the community empowerment as evidenced by the government’s prerogative, there is a recognized trial of community based programs such as need for a fresh approach to action at community COMFOG (Community based Fogging) in level. This recognition and issues related to it Perak, Selangor and Pahang, and again COMBI were discussed at great length by speakers and whose area of scope is progressively being participants at the MOH-organized COMBI expanded in various states 1. training course in Melaka in September 2003, This paper provides an abbreviated and some of the salient comments are reiterated background of COMBI, the observation of the in the following paragraphs. unifying characteristics of Aedes breeding in the Although in general, most states in target community of Section 3 and Section 4 of Malaysia often exhibit common patterns of urban Bandar Baru Bangi, the assessment of communal dengue endemicity, it is only recently that the makeup, traits and routines, the application of more subtle differences in breeding COMBI marketing principles and finally, the circumstances among different communities perceived impact on dengue incidence within the have begun to be explored in the hope of finding said community. It is not intended to be an alternative solutions. It is with such exhaustive treatise of COMBI doctrine per se, considerations in mind that the COMBI concept the details of which can be obtained through the was introduced to Malaysia, with the aim of RKPBV unit at federal level. using its unique methodology to identify social traits in dengue affected communities and tailor COMBI (COMMUNICATION FOR eradication programs accordingly 4. BEHAVIOURAL IMPACT ) In Malaysia, the responsibility for dengue control activities (eg: fogging, Aedes COMBI is a new approach towards surveys) in most major cities and towns is tackling communicable diseases espoused by the increasingly being assumed by the local World Health Organization (WHO). The official authorities. The Ministry of Health maintains its WHO Communicable Diseases Programme role in non – council areas whilst retaining its description of COMBI reads “..the task of advisory capacity in training and assisting the mobilizing all societal and personal influences local councils. Through its Vector Borne on an individual and family to prompt individual Diseases Control Unit (RKPBV) of the and family action.” It incorporates the lessons of Infectious Disease Control Division, the ministry the past 50 years in health education and remains the main government agency responsible communication while drawing substantially from for monitoring dengue disease incidence and the experience of the private sector in consumer breeding indices, evaluation of eradication, communication (advertising) 5. The number of nations incorporating the course was the identification of dengue COMBI into their indigenous communicable problem localities amenable to subsequent disease control programs is growing COMBI amelioration. exponentially. Since 2001, COMBI has been The Hulu Langat District Health Office applied in the elimination of leprosy in was directed by the Selangor State Health Mozambique 5, the control of tuberculosis (TB) Department to spearhead the program. Based on in India and Nepal 6, lymphatic filariasis control its own 2002 data, the Hulu Langat District in Zanzibar 7 and the control and prevention of Health Office Vector Unit selected the Bandar dengue in Lao People’s Democratic Republic Baru Bangi area for the pilot project. The reasons and Johor Bahru, Malaysia 8 . Since 2003, the list for selection were threefold : i) high number of has grown to include Bangladesh, Kenya, Sri dengue cases (30% of total for district) ii) Lanka , Sudan and a host of Latin American increasing number of dengue cases (39% countries 9. increase from the previous year) iii) consistently COMBI integrates health education, high Aedes Index (> 5). Within Bandar Baru information-education-comunication
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