%0 Journal Article
%T Public Health Responses to a Dengue Outbreak in a Fragile State: A Case Study of Nepal
%A Karolina Griffiths
%A Megha Raj Banjara
%A T. O'Dempsey
%A B. Munslow
%A Axel Kroeger
%J Journal of Tropical Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/158462
%X Objectives. The number of countries reporting dengue cases is increasing worldwide. Nepal saw its first dengue outbreak in 2010, with 96% of cases reported in three districts. There are numerous policy challenges to providing an effective public health response system in a fragile state. This paper evaluates the dengue case notification, surveillance, laboratory facilities, intersectoral collaboration, and how government and community services responded to the outbreak. Methods. Qualitative data were collected through 20 in-depth interviews, with key stakeholders, and two focus-group discussions, with seven participants. Results. Limitations of case recognition included weak diagnostic facilities and private hospitals not incorporated into the case reporting system. Research on vectors was weak, with no virological surveillance. Limitations of outbreak response included poor coordination and an inadequate budget. There was good community mobilization and emergency response but no routine vector control. Conclusions. A weak state has limited response capabilities. Disease surveillance and response plans need to be country-specific and consider state response capacity and the level of endemicity. Two feasible solutions for Nepal are (1) go upwards to regional collaboration for disease and vector surveillance, laboratory assistance, and staff training; (2) go downwards to expand upon community mobilisation, ensuring that vector control is anticipatory to outbreaks. 1. Introduction Dengue is the most important vector-borne viral infection worldwide with 2.5 billion people at risk, according to the World Health Organisation (WHO) [1]. The number of cases and number of countries affected has doubled from the period 1990¨C1994 to 2000¨C2004 [1¨C3]. Larger epidemics are becoming more common [4], with countries in Asia witnessing an increase in severe dengue and a higher mortality in the earlier stages [5]. Nepal reported its first case of dengue in 2004 and the first indigenous case in 2006 [6]. Only sporadic cases were then seen until the outbreak in 2010, with 917 cases reported nationally (unpublished data), seen almost solely in 3 administrative districts in the Terai region on the Indian border: Chitwan, Nawalparasi, and Rupandehi. The aim of this paper is to describe the public health surveillance and outbreak response to dengue in Nepal in 2010 and to draw lessons from the experience of a fragile state. The WHO World Health Assembly urged member states to improve surveillance, prevention, control, and management of dengue [7]. Guidelines highlight the need
%U http://www.hindawi.com/journals/jtm/2013/158462/