Mubashar Rumi | History, Knowledge & Facts

 

Table of Contents

List of Figures. 2

Introduction: Dengue in Pakistan. 3

Critical Discussion of IPC Strategies, Recent Successes, and Remaining Challenges. 6

Social Determinants and Dengue Vulnerability. 8

Vector Control Measures: Progress and Pitfalls. 9

Community Awareness and Behavior Change. 10

Conclusion. 12

References: 13

 

 

List of Figures

Figure 1: Monthwise indication of dengue in Year 2023 (Haqqi et al., 2023) 5

Figure 2: Dengue cases in Pakistan (WHO, 2022) 8

Figure 3: Shows a 3D picture (model) of a protein called Vgsc from the Ae. aegypti mosquito. This model was created using a method that was described by Kasai and colleagues in a study published in 2022. 10

Figure 4: A dengue control notification from GOP Health Department 11

Figure 5: Local news against dengue. 15

Figure 6: Initiative by  punjab to spread awareness againt this virus. 17

Figure 7: Awareness efforts in Pakistan against dengue. 18

 

 

Introduction: Dengue in Pakistan

Dengue has a history traced back to Jin dynasty of China (265-420 CE). As per Chinese medical encyclopaedia, the first record was found in 992, when the shipping industry expanded globally and port cities became large and urbanized in 18^th and 19^th centuries, it created an ideal situation for principal mosquito vector, Aedes aegypti (Gubler, 2006). Since then this fever poses a significant global health threat becayse the viruses and mosquitoes both were spread to different geographical locations. Now over half of the world's population living in areas where there is a risk of infection. According to National Institute of Health, Pakistan, The primary transmuter of this disease is Aedes aegypti mosquitoes but this mosquito-borne viral disease is caused by four different serotypes. Pakistan is also one such regions that is greatly affected by this virus each year and recognized as an endemic region for dengue. Pakistan has experienced recurrent outbreaks that place a considerable burden on its healthcare system and economy. The first case of dengue that is documented in Pakistan was reported in 1994, but from 2005 onwards the outbreak patterns becoming evident, which indicate a recent establishment of the disease within the country (Tabassum et al., 2023). Since then, Pakistan has witnessed increases in dengue cases considerably each year. The peak transmission often occur during the post-monsoon season because such an environment creates an ideal condition for mosquito proliferation. Pakistan has a climate and geographical diversity and since 2005 the increasing trend in DF points towards a complex interaction of factors that facilitate its spread and persistence. This necessitate a thorough investigation to develop effective control strategies against it. The seasonal pattern of outbreaks suggest that there is a link between environmental conditions because these cases increased during rainfall and humidity. This temporal correlation suggests that control efforts should be intensified in a planned way during and immediately after the rainy season so that the life cycle of mosquitos can be disrupted and reduce the risk of infection (Yousaf et al., 2021).

This report explores how public health experts in Pakistan can use social action and community development approaches to control dengue, which is a prevalent disease in Pakistan. This question is particularly relevant to the contemporary public health practice where multidisciplinary and participatory methods are gaining traction. The findings are expected to contribute in the formulation of more equitable and culturally sensitive interventions that can address this issue keeping the specific socioeconomic and environmental contexts of urban Pakistan in front.

Rationale for the Choice of Question

Punjab is the most populous province of Pakistan and also the significantly affected region by dengue outbreaks. Punjab’s epidemiological profile places it at a high-risk category for dengue virus with substantial morbidity and mortality observed during the monsoon seasons. The virus presents flu-like symptoms but with time it can showcase severe conditions that include engue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) that are seriously harmful for health. Hence, it poses a serious challenge to Pakistan’s infection prevention and management systems.

If talking about specific area then within Punjab, the district of Vehari has also reported cases of dengue fever. This indicate its vulnerability to the disease. Recent data from 2024 and 2025 confirm that the dengue is continuously occurring across Punjab, including Vehari, which highlight the persistent challenge posed by this vector-borne disease. For instance, in October 2024, health authorities reported a single new dengue case of dengue in Vehari with a broader increase in cases across the province. Similarly, during November 2024, Vehari continued to report individual cases with an overall rise in dengue infections across Punjab (Salamat, 2024). The consistent reporting of dengue cases in Vehari despite the small numbers in comparison to major urban centers like Lahore and Rawalpindi, highlights the critical need for localized prevention and control strategies that address the district's unique context. As a fluctuation has been observed in reported cases in Vehari across different months and years, hence there is a necessity of continuous surveillance and the application of adaptive control measures rather than a uniform strategy so this transmission can be minimized and finally eradicated. Dengue is endemic in almost all parts of Pakistan however there has been seen significant fluctuations over the years. The notable major outbreaks occurring in 2011, 2017, and 2019. Various factors are believed to be a contributors to the exacerbation of dengue outbreaks including floods and the broader influences of climate change (Tabassum et al., 2023). The devastating floods of 2022 affected Pakistan deeply, for example, it was followed by a significant surge in reported dengue cases across the country (Mushtaq, Abro and Hussain, 2024). This relationship between major floods and dengue surges is another critical factor that raise the importance of integrating vector control measures into disaster preparedness and response efforts control the post-disaster outbreaks.

Figure 1: Monthwise indication of dengue in Year 2023 (Haqqi et al., 2023)

Traditional vector control methods, such as insecticide spraying and larval source management, is not entirely useless and play an important role in dengue prevention, but they may not be sufficient for achieving long-term and sustainable control.

This disease is not a mere biomedical issue but in deeper context it a symptom of socio-environmental dysfunctions as said by Gubler (2011). This dysfunction ranging from inadequate municipal services to climate vulnerability and social inequity.

From the microbiological standpoint Dengue virus belongs to the Flaviviridae family and exists in four distinct serotypes. If a person is infected by one serotype, he builds immunity against it but not other serotype (McFee, 2018; PreventionWeb, 2023). That is the reason of its recurrence and escalation. There is no universally effective vaccine against it or any antiviral therapy which raise the need of having primary prevention strategies.

Epidemiologically, Pakistan’s dengue profile is affected by seasonal peaks as explained earlier and it peaked in monsoon period. The concentration of cases in urban centers such as Lahore and Karachi indicate a strong link of this disease with environment as stagnant water bodies, poor drainage systems, and unregulated construction sites all provide ideal breeding grounds for Aedes mosquitoes. According to WHO (2022), vector control and community awareness is the pivotal yet under-resourced aspects to mitigate dengue.

The Social Determinants of Health (SDH) framework reveals that social and economic conditions greatly mediate the exposure to disease vectors. For instance, people who lives in informal settlements often lack access to basic sanitation, clean water, and municipal waste management, all of these factors increase mosquito breeding and ultimately resulted in dengue transmission. Furthermore, weak health literacy alongside distrust in public health messaging makes adherence to prevention protocols undermined (World Health Organization, 2010).

The Health Belief Model (HBM) and Socio-Ecological Model (SEM) further clarify behavior at the individual and community levels. HBM suggests that perceived severity and susceptibility to dengue impact the likelihood of preventive behavior. SEM calls attention to the link between individual, interpersonal, community, and policy-level influences (Alyafei and Easton-Carr, 2024). This layered perspective is important for a disease like dengue, where collective action and environmental interventions are important.

There are multiple stakeholders involved in making these theoretical models successful. For instance, government bodies must develop and enforce surveillance and vector control systems. Local communities must acknowledge and identifies risk factors and apply behavioral interventions. NGOs and civil society play a bridging role, especially to develop trust and co-production of knowledge. Health professionals and public health workers also need to be equipped with not just clinical training but also community engagement competencies to cater any situation.

The study of dengue control in Pakistan using community development lens thus serves as a pertinent example how IPC strategies can be enhance through social innovations. For instance, programs like the Punjab Anti-Dengue Campaign have shown localized success as explained in the study by Waseem I. (2017), but they lack slack the scalability and adaptability required to serve diverse socioeconomic settings.

Critical Discussion of IPC Strategies, Recent Successes, and Remaining Challenges

The management of dengue fever in Pakistan is multifaceted hence it includes a mixture of vector control, disease surveillance, clinical management, and community awareness campaigns. However, To guarantee the success of these strategies there are some systemic inefficiencies, environmental and sociopolitical complexities, and weak community engagement issues that need to be addressed. This section critically explores the present infection prevention and control (IPC) strategies, evaluates recent progress, and identifies persistent gaps.

Social action and community development approaches are getting hype in recent times as they are recognized as vital for nurturing a sense of ownership among residents. This helps promoting preventive behaviours at the grassroots level. Actively engaging and involving communities in the design and implementation of control strategies helps to address the specific local contexts and behaviours. These local behaviours, when addressed, then they help controlling dengue transmission which can lead to more effective and sustainable outcomes. The growing focus on community participation in dengue control is a proof that the top-down interventions alone have limitations and empowering local populations plays an active role in safeguarding communities. Social action approaches are regarded higher because they can address the underlying behavioral and environmental factors that take part in dengue transmission which gives a enduring impact compared to purely reactive measures. As Bardosh et al. (2017) argue that this transition reflects that vector-borne diseases requires addressing complex socio-ecological systems to control them instead of simply targeting mosquitoes. Their study across multiple endemic settings shows that the community ownership significantly improved intervention sustainability in comparison to the conventional programs. However, Arunachalam et al. (2020) present a more critical perspective. They analysed five community-based dengue interventions in South Asia. They found that there is a substantial variability in outcomes and found that the successful programs characterized by meaningful community participation instead of mere symbolic involvement. Their longitudinal data from Sri Lanka and India showed that interventions having lack of genuine power-sharing can only resulted in temporary behaviour changes and once the external support withdrew the results disappear.

Focusing on community education, mobilization, and empowerment can give significant changes in practices related to water storage, sanitation, and waste management. All of these are fundamental to control vector in an effective manner.  

The transmission cycle of dengue, highlight that to break the chain of chain of infection and reduce the overall disease burden it is necessary to implement interventions that target both populations to effectively break the chain of infection and reduce the overall disease burden.  

Figure 2: Dengue cases in Pakistan (WHO, 2022)

Social Determinants and Dengue Vulnerability

Poverty and adverse socioeconomic conditions are frequently associated with increased risk of vector-borne diseases, including dengue fever. Several studies conducted in Pakistan have indicated that the people having lower socioeconomic status, or living in poverty has a higher likelihood of dengue infection. Specifically, families that has a lower monthly incomes and individuals belonging to less educated groups have been found to be victims of dengue disproportionately. A review by Mulligan et al. (2014) analysed 260 peer-reviewed articles and deduced that this disease is often called, “Disease of impoverished places”, however the limited study sample make the poverty indicators less strong.

Deficient sanitation and inadequate waste management systems are important environment factors that nurture an environment of breeding sites for Aedes mosquitoes. The accumulation of stagnant water in open containers, bad drainage systems, and the improper disposal of waste provide ideal conditions for mosquito larvae to thrive. Hussain et al. (2019) argued that reports from different areas of Punjab indicate the presence of sanitation crises, characterized by issues such as overflowing sewage systems and the ineffective management of solid waste. This claim is also backed by Punjab Intermediate Cities Improvement Investment Programme (PICIIP) as well (Piciip, 2025). Also, the public spaces that are often neglected, such as parks, can also become breeding grounds for mosquitoes due to the accumulation of garbage and standing water.

Substandard housing conditions, such as dwellings constructed with mud walls and earthen floors as a significant proportion of the population residing in slum areas live in kacha (unpaved) houses, are also one of the contributor to dengue vulnerability because of the same reason as they provide breeding sites for mosquitoes. Moreover, in Pakistani households many people live under same roof which leads to overcrowding within households, that also elevate the risk of dengue virus transmission.

Vector Control Measures: Progress and Pitfalls

Vector control is the cornerstone to prevent dengue virus spread. The Aedes aegypti mosquito, the primary vector that thrives in urban environments, especially in places where water accumulates in uncovered containers or clogged drainage systems as evident from literature that has already been discussed by Gubler (2011) and World Health Oragnzizations. Pakistan employs vector control primarily through:

•                Fogging and Fumigation: Especially during outbreaks fogging is conducted to reduce adult mosquito populations with immediate affects. However, this is a short-term solution and it is often criticized because the residual effect are limited and it fail to address larval habitats, and potential ecological consequences (Lee et al., 2023). Reyes-Castro et al. (2017) also call it a false security sense in Mexican people that it can control the dengue virus.

•                Larvicidal Spraying and Source Reduction: Efforts have been made to eliminate stagnant water sources by using larvicides and community-driven cleanups. According to WHO (2022), sustainable control requires routine surveillance and most importantly the community stewardship, not a mere sporadic emergency response. However limited participation of community can limit sustainability. For example, in Balochistan and Khyber Pakhtunkhwa authorities faced logistical challenges due to displaced populations (Nieto et al., 2012). 

•                Insecticide Resistance: One of the most pressing microbiological challenges is the development of resistance among Aedes species due to the widespread and common use of insecticides. A recent entomological study in Karachi found that Aedes mosquitoes had high resistance to pyrethroids which is the primary insecticides used in fumigation campaigns (Uemura et al., 2024). This undermines current chemical-dependent strategies and calls for a better and integrated vector management (IVM) approaches.

Figure 3: Shows a 3D picture (model) of a protein called Vgsc from the Ae. aegypti mosquito. This model was created using a method that was described by Kasai and colleagues in a study published in 2022.

Community Awareness and Behavior Change

Education campaigns on dengue prevention using digital media or through television, radio, social media, and community health workers is of prime importance to IPC strategies. These campaigns focuses on the personal protection (nets, repellents), source reduction, and early symptom recognition.

WHO used Vector Management approach by combining it with chemical, environmental, and biological tools. In Sri Lanka, community-driven programs helps to reduce the dengue hospitalizations by 60%, a model Pakistan could adapt. However the efforts of Pakistan in this regard are fragmented. A dengue expert advisory group has been made in Pakistan to support the community engagement as well but the recently reported cases shows its ineffectiveness. One of its reasons is the limited publicity and not many people are aware of these groups working. Moreover, Punjab has a widespread area it is not possible to monitor and cover whole province.

Figure 4: A dengue control notification from GOP Health Department

The literacy issue that is particular in peri-urban and rural areas, limit the comprehension of health messages. There is also a critical need to tailor message into local languages as per cultural norms, vice versa it reducing message uptake.

The Health Belief Model (HBM) explains some of the behavioral inertia where Wong and AbuBakar (2013) argued that individuals who are not aware or who do not perceive dengue as a serious threat then it reducing the likelihood of engaging in preventive behavior In such contexts, trust-building through community influencers (e.g., imams, teachers) and peer-led education models can give better results..

Conclusion

Dengue fever represents a significant health challenge especially for the Punjab, Pakistan because of its ethnic and ecological diversity. The reports provide a detailed interplay of epidemiological factors, environmental conditions, and underlying social determinants of health that leads to the ongoing risk of dengue transmission within the country. While traditional vector control measures remain important it is also important to develop sustainable and effective dengue control. As evident from literature, in order to materialize this, it is important to have a comprehensive, multi-faceted approach that can actively engage communities and the root causes of vulnerability. Empowering the residents of Punjab through health literacy, developing community centers for ownership of prevention efforts, and implementing a targeted social action strategies are among the important steps towards reducing the burden of dengue. Furthermore, it is equally important to address the social determinants of health, such as poverty, inadequate sanitation, and limited access to clean water. Appraoching this disease from every side will create a more resilient community which will be less susceptible to dengue outbreaks. As dengue virus has developed immunity against the traditional sprays and fumigation strategies hence there is a need to revise the existing resources and programs and take these enhanced interventions to the provincial level. Such a thorough and strong collaboration between the health department, local government, and the community, will help the government to develop and implement a model dengue control program. The long-term success of dengue prevention and control in such diverse ecological land as Punjab needs community-driven strategies to safeguarding public health.

 

References:

•       Aftab, S., Yaqoob, E. and Javed, S. (2024). Dengue epidemic: Pakistan on alert. The Lancet. doi:https://doi.org/10.1016/s0140-6736(24)02284-0.

•       Ahmed, S., Ali, N., Anwar, S., et al. (2023) ‘Year-round dengue fever in Pakistan, highlighting the surge amidst COVID-19 pandemic’, Journal of Infection and Public Health, 16(4), pp. 456–463. doi:10.1016/j.jiph.2022.12.010. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10129218/ (Accessed: 24 April 2025).

•       Ali, L., Gul, Z., Ijaz, A., Khalid, N., Zeb, F., Afzal, S., Ullah, A., Subhan, F. and Ahmed, S. (2022). An overview of dengue viral infection circulating in Pakistan. Journal of Vector Borne Diseases, [online] 59(2), p.109. doi:https://doi.org/10.4103/0972-9062.331412.

•       Khan, J., Khan, I., Amin, I. & Anwar, S. (2016) ‘Community Participation, Dengue Fever Prevention and Control Practices in Swat, Pakistan’, International Quarterly of Community Health Education, 36(2), pp. 91–101. doi:10.1177/0272684X15625533. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC5187638/ (Accessed: 24 April 2025).

•       Khan, U. and Azeem, S. (2022). The rising toll of dengue cases in Pakistan every year: An incipient crisis. Annals of Medicine and Surgery, [online] 76, p.103549. doi:https://doi.org/10.1016/j.amsu.2022.103549.

•       Ministry of National Health Service, Regulation and Cordination (n.d.). @ Govemment of Pakistan Ministry of National Health Services, Regulations and Coordination 3rd Floor, Kohsar Block, New Pak Secretariat Islamabad rr***t*. [online] Available at: https://www.nhsrc.gov.pk/SiteImage/Misc/files/Advisory%20for%20the%20Prevention%20and%20Control%20of%20Oengue%20Fever.pdf [Accessed 17 Mar. 2025].

•       National Institute of Health (NIH) Pakistan (2024) ‘Pakistan reports over 20,000 dengue cases, 10 fatalities in 2024’, ARY News, 20 November. Available at: https://www.aninews.in/news/world/asia/pakistan-reports-over-20000-dengue-cases-10-fatalities-in-202420241120185046/ (Accessed: 24 April 2025).

•       Pan American Health Organization (PAHO) (2024) ‘TAG Recommendations for Dengue’, PAHO Technical Advisory Group (TAG) on Vaccine-preventable Diseases. Available at: https://www.paho.org/sites/default/files/2025-01/1999-2024-tag-recommendations-dengue.pdf (Accessed: 24 April 2025).

•       Raza, S., Hussain, S., Iqbal, S., et al. (2022) ‘Effects of Dengue Incidence on Socio-Economic Status of Patient’s Family: A Comparative Analysis of Multan and Lahore City (Pakistan)’, International Journal of Innovation and Sustainable Development, 16(2), pp. 123–134. Available at: https://www.academia.edu/77054850/Effects_of_Dengue_Incidence_on_Socio_Economic_Status_of_Patient_s_Family_A_Comparative_Analysis_of_Multan_and_Lahore_City_Pakistan_ (Accessed: 24 April 2025).

•       Saleem, M., Sheikh, A., Nawaz, H. & Ara, G. (2023) ‘Strengthening dengue control in Pakistan’, Eastern Mediterranean Health Journal, 29(12), pp. xxx–xxx. Available at: https://www.emro.who.int/images/stories/emhj/documents/in_press/Strengthening_dengue_control_in_Pakistan.pdf (Accessed: 24 April 2025).

•       World Health Organization (13 October 2022). Disease Outbreak News; Dengue - Pakistan. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON414

•       Yasir, M., Iqbal, S., Shabbir, M., et al. (2022) ‘Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study’, International Journal of Environmental Research and Public Health, 19(2), p. 1046. doi:10.3390/ijerph19021046. Available at: https://pubmed.ncbi.nlm.nih.gov/35055914/ (Accessed: 24 April 2025).

Appendix

 

Figure 7: Awareness efforts in Pakistan against dengue

Figure 5: Local news against dengue