Misdirected drive

HAMARI Dilli -- swasth Dilli (Our Delhi -- healthy Delhi). Delhi's health department has gone to town with the slogan. As if to live up to the slogan, the commissioner of the Municipal Corporation of Delhi (mcd) recently issued a controversial public notice prescribing "special measures" to control mosquito breeding. Failure to take up these measures and causing mosquito breeding is liable for prosecution under section 188 of the Indian Penal Code, attracting imprisonment up to six months and a fine up to Rs 1,000, or both. What followed were surprise house-to-house checks and imposition of fines.

The drastic move, brought about under section 376 of the Delhi Municipal Corporation Act, 1957, was sought to be justified in the wake of fears of a repeat of the 1996 dengue epidemic which killed some 500 people in the capital. Amidst the Rs 10 crore media blitzkrieg against mosquito breeding, Delhi health minister Harsh Vardhan lamented that people continued to be careless. Union health minister Renuka Chowdhary warned of punitive action against those who let mosquitoes breed. Subsequently, control rooms to monitor a possible dengue outbreak were set up.

By October 5, mcd had prosecuted 3,944 people whose premises were found to breed the dengue vector Aedes aegypti mosquitoes. These prosecutions followed a special mcd inspection drive, mostly in middle and lower middle-class localities.

Even as raids and prosecutions continue, health experts are sharply divided on the issue. V P Sharma, director of Malaria Research Centre says, "The menace of mosquitoes cannot be resolved without community involvement. Despite the government's awareness campaign, people continue to be careless." Many others share his view. P N Sehgal, former director of the National Institute of Communicable Diseases (nicd) and currently a consultant to Voluntary Health Association of India (vhai) says, "Instead of improving public sanitation systems, the authorities seem to have passed the buck on to individual families."

Check and fine is a strategy that has worked in developed countries, such as Singapore, that have better literacy rates and standards of living. "One cannot compare the Indian situation with that of the developed countries," notes Sehgal. "Instead of bringing a legislation, all authorities -- including mcd , New Delhi Municipal Corporation (ndmc), the Cantonment board, and other bodies -- should provide efficient, comprehensive, and integrated services conducive for effective management of mosquito-borne diseases."

Professor Imrana Qadir of the Centre for Community Health and Social Medicine, Jawaharlal Nehru University, implies that the drive is some sort of an eyewash. "The mcd just wanted to show that they are concerned about people's health. They are just trying to do something. The story does not end just by making the law. It should be implemented properly."

Anupam Mishra, environmentalist with the Gandhi Peace Foundation, New Delhi, criticises the programme for its class bias. "People who use desert coolers do not come from the affluent section of the society which uses air-conditioners. There is no guarantee that police or concerned authorities -- who are known for corrupt practices -- will not unduly harass people from the middle class and lower-middle class and demand bribes to thwart penal action," he says, adding that the government authorities might end up exploiting those who are most in need of protection from dengue.

The Aedes mosquito breeds in domestic and peri-domestic collections of clean water such as desert coolers, empty tins, plastic containers, broken jars, old tyres, flower vases, collection of water in kitchen gardens, near taps, and earthen pots. It develops from egg to larva and pupa to adult in water in about eight to 10 days. One-time cleaning of stagnant water from coolers or bathtubs does not put an end to the dengue mosquito breeding. It helps larvae to breed as it gives the eggs some time to dry up.

The female Aedes mosquito lays eggs at more than one place in a household and the eggs remain cemented to the damp area just above the water surface. The eggs of the dengue mosquito can withstand long periods of desiccation. Moreover, all eggs do not hatch at the same time. Some hatch when they come in contact with water at the second or third time. mcd , Delhi Development Authority's leaky pipes, broken drainages, and clogged water outlets can equally contribute to dengue.

Interestingly, the mcd move does not cover public areas. "They do not react or pass any law for unauthorised colonies where water logging is taking place. What about the nullahs flowing outside. Who is responsible for mosquito breeding outside public premises?" asks Qadir. "They are only targeting 'people's mosquitoes' and leaving out 'the government's mosquitoes'," says Mishra in a lighter vein.

P K Das, director of the Vector Control Research Centre, New Delhi, defends the measures taken by the mcd. "This is the right way to control the Aedes mosquito. But penalty should also be on the municipalities if their solid waste disposal practices produce mosqitogenic conditions."

Contrary to what has been made out to be in media advertisements and reports, dengue is not restricted to Delhi. In the last 15 years, there has been a dramatic increase in the global incidence of dengue and its severe manifestations such as the dengue haemorrhagic fever (dhf) and dengue shock syndrome (dss).

Outbreaks in endemic countries are becoming more frequent. At present Dengue/ dhf is the most dangerous viral disease in humans with over two billion people living in tropical areas at risk. What made the problem particularly bad in Delhi is its haphazard and uncontrolled development, migration, and unauthorised colonies with poor hygienic conditions, health experts point out.

"For prevention and long-term control measures in Delhi, the haphazard development activities should be stopped forthwith," says Sehgal.

What has also come under fire is the mcd's lack of coordination with other agencies that work in related fields such as the National Malaria Eradication Programme. "There is no organisation to make an independent assessment of the magnitude of the vector problem, coordinate the work of different implementing agencies, and to cross-check the efficiency of both laboratory and field work," says Seghal. "The anti-mosquito operations should be entrusted to a single authority with complete administrative and technical control for operations," Mishra suggests.

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