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A Rapporteur's Summary: Health System

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Trop. Med, 35 (4), 335, December, 1993

A Rapporteur's Summary: Health System

Sai Kit LAM

335

Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia

During the session on Health Systems, it was recognized that almost all countries have their own health systems for handling dengue outbreaks. However, the means to do so vary considerably from country to country and Singapore can be considered as a model country with an excellent health system. Despite this, the dengue problem in Singapore has not been controlled and has actually increased in the last few years.

Failure to control dengue has been reported not only in Singapore but with many other countries, including Malaysia. Several problems with the existing health systems for dengue control were identified, including the following :

1. Rapid urbanization

2. Increased industrialization 3. Unusual breeding sites

4. Inadequate manpower for vector control

5. Lack of an early warning system for dengue outbreaks 6. Inappropriate surveillance systems.

A missing component of surveillance systems in most countries is the isolation of dengue viruses. This could be due to lack of technical skills and facilities, as well as the expenses involved. It was felt that more laboratories should be encouraged to isolate viruses so that strain movements and variation can be studied.

The role of Aedes albopictus need to be studied since this mosquito is now quite widespread and present in areas where Aedes aegypti has been reduced drastically.

Present control measures are directed at Aedes aegypti and this approach may need to be modified if Aedes albopictus is found to be an important vector.

Community participation as part of the health system for dengue control is of

paramount importance. However, there are few examples of sustained success and more

needs to be done to train the relevant people to carry out this activity. A stronger

commitment by policy makers in each country and better inter-agency collaboration is

needed to ensure effective vector control through community participation.

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