CHAPTER 2: DENGUE FEVER IN MALAYSIA

i. LOCATION OF MALAYSIA & THEIR PEOPLE

ii. WHY DENGUE IS IN ASIA, PARTICULARLY MALAYSIA?

iii. IMPACT OF DENGUE

iv. STATISTICAL DATA

Where is Malaysia?

o Malaysia is situated in Southeast Asia, bordered

by Thailand in the north, Indonesia in the south, and the Philippines in the east.

o The country has an area of 329,758 square kilometers (127,320 square miles).

Who are we?

Malaysia is the ONLY country in the world consist of multiracial people with different culture and religion, living together in the same community.

The population of Malaysia was estimated at

21,793,000 in July 2000. Now app. 30 million.

•The Malay are Malaysia's largest ethnic group, accounting for over half the population and the national language.

•With the oldest indigenous peoples they form a group called bumiputera, which translates as "sons" or "princes of the soil.“

• Almost all Malays are Muslims.

The Chinese traded with Malaysia for centuries, then settled in number during the 19th century

When they first arrived, however, Chinese often worked the most grueling jobs like tin mining and railway construction.

Most Chinese are Tao Buddhist and retain strong ties to their ancestral homeland.

They form about 35 percent of the population.

Indians had been visiting Malaysia for over 2,000 years, but did not settle until the 19th century.

Most came from South India, fleeing a poor economy. Arriving in Malaysia, many worked as rubber tappers, while others built the infrastructure or worked as administrators and small businessmen.

Today ten percent of Malaysia is Indian.

Their culture -- with it's exquisite Hindu temples, cuisine, and colorful garments --is visible throughout the land

The oldest inhabitants of Malaysia are its tribal peoples.

They account for about 5 percent of the total population, and represent a majority in Sarawak and Sabah.

Though Malaysia's tribal people prefer to be categorized by their individual tribes, peninsular Malaysia blankets them under the termOrang Asli, or "Original People."

The transmission of dengue illness is associated with the geographic expansion and distribution of mosquito vectors and viruses

There are many factors that have created the ideal conditions for this expansion, especially in low- and middle-income countries, including Malaysia.

Dengue Risk Areas All over the World

Factors favoring the dengue spread

high rates of population growth,

unorganized urbanization

the proliferation of slums,

crowding, poor water, sewer, and waste management systems,

global warming,

rise in global commerce and tourism,

changes in public health policy,

decreasing resources for vector prevention and control,

and the development of hyperendimicity among other factors

1) Individual & family level People are not capable of

bearing the cost of treatment to disease (most of the involved country, including Malaysia are still developing countries)

Absence from work during the duration of illness (7-10 days), more in case of hemorrhagic dengue fever, and thus decreasing in the total family income.

The illness caused significant stress: a psychological burden shared by patients and families.

2) Impact on health sector & government of

Malaysia

Mortality & morbidity burden: leading number of

incidence rate among vector-borne disease (63.75%)

The health sector could not cope with the expanding

population which worsens the situation; rapid growth of

population & migration to area with infection

Strain on health care services due to sudden, high

demand during epidemic

Treatment of the disease is very costly & most of the

action taken so far are not so effectively control the

disease

Confusion of the control of the disease; public

assuming the disease is well controlled by the

increasing frequency of spray etc.

3) Impact on economy of Malaysia

Medical expenditures for hospitalization of patients & treatment of infected cases, add to the burden.

Control activities themselves are also of course costly.

Loss of productivity of affected work force resulting from those suffering from the illness

Most people with dengue fever do recover but when, at the height of an epidemic, so many of the workforces are sick and unable to work, the cost to the national economy will be high.

It was estimated in 2005 that dengue typically costs Malaysia $13 million in treatment and vector control efforts annually, and that the output of 940,000 days of work is lost to the nation. From this study, it was concluded that: “One hospitalized case of dengue fever costs one-fifth of Malaysia’s per capita gross national product (GNP)”.

A study by the Indian Institute of Management (IIMA) conducted in 2009 on the comparative costs to economies in the region put the financial burden of the virus on Malaysia at $5.30 per person, with total lost more than $153m every year!!!

Considerable expenditures for scale emergency control actions incur and also the loss of national income from tourism as a result of negative publicity

Many areas with a dengue problem are tourist destinations and visitor numbers are likely to decline as media coverage of dengue outbreaks reaches those who might be considering holidaying in the countries concerned.

1902 - The earliest recorded case of dengue fever in Malaysia in Penang

1962 – The first documented major outbreak of dengue fever occurred in Penang in 1962.

1973 – A nationwide outbreak in Kuala Lumpur

Since then dengue has become a major public health problem in the country.

Statistic showing incidence of dengue cases & death from 1998 to 2012 (up to 15 September 2012) in Malaysia:

27381

10146

7103

16386

15493

31545

33895

39654

34386

48846 49355

41486

46171

13743

15606

0

10000

20000

30000

40000

50000

60000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

mb

er

of

rep

ort

ed

ca

ses

Year

Number of reported cases of dengue fever in Malaysia from 1998 to 2012 (up to 15 Sept. 2012)

82

3745

50 54

72

102

107

70

98

112

88

134

22

27

0

20

40

60

80

100

120

140

160

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

mb

er

of

de

ath

Year

Number of death from dengue fever in Malaysia from 1998 to 2012 (up to 15 Sept. 2012)