Chapter 2
Box 2.3 Dengue fever contained by cooperation in Cambodia

Close cooperation between the Cambodian Ministry of Health (MoH), the International Federation and the Cambodian Red Cross (CRC), during a seven-month operation ending in February 1999, helped bring under control a serious epidemic of dengue haemorrhagic fever (DHF). A rare and deadly outcome of dengue fever, DHF is a viral disease spread by the ‘aedes aegypti’ mosquito which mainly affects children under 14 years.

The seasonal DHF outbreak in Cambodia escalated into an epidemic from June to October 1998. Peaking in August, 4,434 patients were admitted to hospital and at least 185 children died. Recorded cases throughout the year reached over 16,000.

The International Federation’s regional health and information delegates arrived on 7 August to assist the CRC. They reviewed health data on population and numbers of new cases, provided by the MoH and WHO, in order to identify high-risk provinces.

Red Cross teams then carried out village-level spot checks with the MoH outreach team, monitoring use of insecticides and the practice of covering water storage jars. The CRC, MoH and WHO carried out a needs assessment during a joint field visit to hospitals in the two worst-affected provinces and the national paediatric hospital in Phnom Penh, where they assessed the situation of hospital wards and drug supplies. What the teams found in the field corresponded closely with centralized data.

The information they collated enabled them to identify urgent medical supply, insecticide and staffing needs and set up a variety of preventive and education campaigns bolstered by CRC youth and volunteer training. There is no known vaccine to help combat DHF, making other preventive measures like reducing the population of mosquitoes and health education the most effective form of control.

Immediate objectives aimed to reduce mortality rates by targeting hospitals, carrying a DHF caseload of more than 150 as of 31 July, with medical supplies and blood transfusion kits. A health education campaign via TV, radio, leaflets and posters urged people to store water in specially cleaned containers, to use lids to cover them and to add larvicide to the water. The education campaign also advised mothers in high-risk areas how to recognize early symptoms so that children could receive prompt medical treatment.

Simultaneously, Red Cross volunteers helped promote early hospitalization and mass environmental clean-ups, while larvicide and insecticide supplies airlifted into the country were distributed via the MoH and WHO.

Monitoring was based on drug consumption and hospital records. Evaluation was carried out after three months using epidemiological data provided by the MoH and WHO, hospital patient records and drug consumption records. Success of preventive measures was determined by monitoring behavioural changes of the population and spot checks helped evaluate participation in clean-up campaigns.

Longer-term, the Red Cross aims to reduce the vulnerability of the urban population to DHF outbreaks with the introduction of a dengue module in their community-based first-aid training, and through regular environmental clean-ups organized by CRC youth groups.