UCA News

Bangladesh’s worst dengue outbreak hits the poor hard

The poor are easy prey as they live where Aedes mosquitoes are born, says an epidemiologist
A nurse tends to a child suffering from dengue fever at a government hospital in Dhaka last year

A nurse tends to a child suffering from dengue fever at a government hospital in Dhaka last year. (Photo: AFP)

Published: September 11, 2023 12:36 PM GMT
Updated: September 11, 2023 01:02 PM GMT

Shakila Nasrin still grieves the loss of her 49-year-old younger brother, a father of two, to dengue fever two years ago.

She considers herself lucky that her son survived the worst-ever dengue outbreak which infected nearly 150,000 people and claimed 730 lives across Bangladesh since July.

Her 22-year-old son recovered in July after five days in Dhaka National Medical College Hospital, a private health facility in the national capital treating 40 percent of its patients free in exchange for a yearly government grant. She herself also recovered from dengue this year.

Nasrin, 55, is a teacher at East Jurain Government Primary School in Dhaka. She said 53 out of a total of 350 students had dengue fever this year, and some of them have not returned to school yet.

The mother of three earns about 40,000 Taka (US$ 360) per month, but she was forced to take a loan of 600,000 Taka to cover the costs of education and health costs of her family over the last few years.

She shuddered as she recounted the ordeal of another mother whose son caught the disease and spent three weeks in the same hospital.

The mother went out every morning to stand in front of a public university in Dhaka begging students to donate blood to her dengue patient son, Nasrin recalled.

“Can you imagine the horror of a mother who needs to find bags of blood for her dying son almost without any help?” she asked.

This was in July, weeks before the dengue outbreak broke national records for deaths and hospitalization.

Dengue has so far resulted in the hospitalization of 148,328 people across Bangladesh and 730 deaths, according to data from the state-run Directorate General of Health Services (DGHS). Dhaka alone recorded 521 deaths.  

The figures showed most of the dead and sick visited public hospitals, where mainly impoverished families go for treatment. Public hospitals account for 75 percent of all deaths in Dhaka.

Most of the deaths and hospitalizations were recorded in Dhaka, a mega city of about 20 million.

Both Nasrin and the mother hail from Jurain in Kadamtali, the third most affected area in Dhaka.

Many poor and low-income people like them flocked and overwhelmed government-run hospitals for treatment because they could not afford expensive private facilities.

Besides frequent blood tests, treatment of critical dengue cases might require platelet transfusion, which costs 700 Taka (US$6.39) a bag in public hospitals, one-third of the cost in private hospitals.

The DGHS data shows Kadamtali area recorded 8.29 percent of all dengue hospitalizations in Dhaka. Local residents claim the actual figure is much higher.

Kadamtali resident and activist Mizanur Rahaman in an independent survey of houses in a radius of 500 feet found ground floors of 270 out of 403 houses either submerged in water or were prone to water logging that can be breeding ground for Aedes mosquito, the vector of dengue virus.

“It feels like living in hell caught in eternal water logging caused by embankments built to protect Dhaka city from flood,” Rahman said.

He alleged that the construction of a flood protection embankment without a proper drainage system is now a major threat to public health in the city.

Jatrabari and Sabujbagh, also prone to water logging, are two top dengue-infected areas in Dhaka with 17 percent and 13 percent of all hospitalizations respectively.

Other major affected areas include Mohammadpur, Khilgaon, and Keraniganj, which accommodate the largest clusters of poor living in slums and slum-like conditions.

“The worst affected areas draw attention to an important fact - the absence of social justice in our country,” said Akter Mahmud, who teaches urban and regional planning at Jahangirnagar University.

Dhaka slums feature some of the world’s worst living conditions with millions cramped without any access to formal services such as piped water and gas supplies, and sanitation, urban planners say.

Many slums are officially city garbage dumping grounds, where almost everything turns into water containers, where aedes can hatch eggs that can survive for eight months unless destroyed.

“City poor live in Aedes production factories where authorities never go with containment program,” said Razzab Ali, who teaches entomology at the Sher-e-Bangla Agricultural University.

Data shows government hospitals accounted for 60 percent of all 67,059 hospitalizations in Dhaka.

‘The poor are easy prey’

Unlike the rich, the poor people have been forced to rush to poor-equipped and overcrowded hospitals for treatment.

A similar scenario has been seen in Chattogram, the port city in the southeast, and in poverty-ridden coastal areas such as Barishal, Patuakhali, Lakshmipur, and Pirojpur.

Epidemiologist A.M. Zakir Hussain says the poor are particularly vulnerable to dengue.

Thousands of poor people live close to places where Aedes mosquitoes are born, he said, while the mosquito needs to fly a long way before it can bite rich people living in high-rise apartments.  

The poor also do not have the comfort of a protected home, covered with nets at doors, over windows, and sprayed with mosquito repellent, he said.

“The poor are also fatalistic, leaving dengue to be handled by heaven and not paying attention to preventive measures such as using mosquito curtains,” Hussain added.

Government figures show that the country recorded five worst outbreaks in the last six years since official records began in 2000.

Epidemiologists blamed poor containment and the effects of climate change for lingering dengue outbreaks, citing mosquitoes’ ability to breed and transmit more with a certain range in temperature and humidity increases.

This year, dengue fever has continued from January, spiking from May with unprecedented ferocity.

A World Bank report released in 2021 said that dengue cases increase when day and night temperatures range between 35C and 25C with a peak at 32C, a condition occurring more frequently in Bangladesh than before.

The WB report noted that the capacity of mosquitoes to transmit dengue fever has increased by 9.5 percent globally since 1950 due to changing climatic conditions.

Media reports say while mosquito control mechanism is improper and fogging is unscientific, but that too are more in privileged parts of cities and towns and less in impoverished areas.

About a quarter of Bangladesh's estimated 165 million people are classified as poor.

Nasrin, the mother of three, said her poor neighbors have been suffering and dying silently.

“Many of my neighbors are silently dying at home. They starve and fall frequently ill but have nowhere to go,” she said.

Limited Christian response

Christians who make up less than half percent in Muslim-majority Bangladesh have done their bit to tackle dengue despite limited funding and resources.

Catholic charity Caritas Bangladesh has made efforts and conducted dengue awareness campaigns across the country, said Executive Director Sebastian Rozario.

Institutional donors are not interested in investing in health programs that are considered government responsibility, Rozario added.

Association of Bangladesh Catholic Doctors president Edward Pallab Rozario said that their doctors and medical students were creating awareness in clinics, NGOs and other places.

Christian Commission for Development in Bangladesh did not have any specific program for dengue victims due to financial constraints, said its communication coordinator Probir Kumar Das.

“We are preparing for it,” he said.

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