Monday, September 30, 2019

Philosophy Epistemology Essay

Epistemology is one of the very important branches of philosophy. It is also known as the knowledge theory. The knowledge theory consists of three questions; â€Å"What is the origin of knowledge? What is the reliability of knowledge? & What is the criteria of knowledge? † Rene Descartes and John Locke really looked into epistemology and both had different theories to approach it. John Locke looked at empiricism and Rene Descartes looked at rationalism. John Locke was an English philosopher and formed his opinion around empiricism. Empiricism is an approach to doing philosophy stressing experience as the in road to all knowledge. The human being is a blank slate to him. Locke was a moderate skeptic, who doubted until valid proof was given to substantiate truth claims of a demonstrative and sensitive nature. The foundations of knowledge functioned in the following manner according to Locke. The human being takes in the external world through sensation (the five senses) and gives form to the experiential data through the processes of reflection. To Locke, intuitive knowledge is the most trustworthy because we automatically recognize the agreement or disagreement of ideas without the intervention of a â€Å"proof†. His criterion of knowledge depended on the force and intensity with which someone perceives either agreement or disagreement between ideas. So for example, we know that 2+3=5. We also know that 2+3 does not equal 7. Locke, unlike Descartes, argues against innate ideas. However, Locke believes that we are all born with the ability to acquire knowledge through the organization of sensate data by the cognitive capacities and capabilities we possess at birth, which are innate to the human. Descartes had a different view of epistemology. He argued for rationalism. Rationalism is an approach to philosophy that employs â€Å"pure reason† to acquire instances of fundamental truth. In Meditations on First Philosophy, Descartes comes up with three fundamental truths by way of pure reason. The first fundamental truth is â€Å"I think, therefore I exist. † This fundamental truth establishes for Descartes the â€Å"essence† of the human being in his philosophy, as the â€Å"thing that thinks. † He is reflecting on himself as the â€Å"object of deception† and reasons that despite being deceived, as long as he can think about it, he exists. Having a clear perception of the fundamental truths can guarantee they can be trusted with absolute certainty and cannot ever be false. The three fundamental truths (self, god, & mathematics) are examples of innate knowledge, or truths that all humans are born with given to by God. Descartes says we can discover these truths through the Meditations, by way of doing philosophy, but we do not pursue these in the same manner we pursue other forms of knowledge such as science. The dream argument is aimed at the external world. It says that â€Å"I often have perceptions very much like the ones I have while I’m dreaming. There are no definite signs to distinguish dream experience from wake experience, so it is possible that I am dreaming right now and all my perceptions are false. † In my opinion, I think that John Locke’s position on empiricism is more philosophically sound to me. Just to re-cap, empiricism is an approach to doing philosophy stressing experience as the in road to all knowledge. The human being as a blank slate really makes sense to me. We automatically know that we can agree or disagree without having to have proof to go along with it. I think that sense experience is always the starting point to knowledge. I think in order to learn something in life you have to experience it first. You can’t just go out and expect the knowledge to be in your brain for no reason. For example, how would you know what the color blue looks like if you were born blind? You would need to use your senses to try and understand what the color is. God couldn’t just put it in your mind because it’s something that you just need to see. Also, you can learn from the experiences you go through. If you do something and it ends up being wrong, then you learn from that experience and how you can go about it differently next time. In my opinion, rationalism has some defects that would make it harder to understand philosophically. A rationalist comes to believe that knowledge is a lot like math. So pretty much, it is knowledge that comes before experience. Something that you already know, but have never experienced before. I think that is a bit problematic because how can you know something that you never experienced? Epistemology plays a big role in philosophy as does John Locke and Rene Descartes. They both have great views on epistemology looking at rationalism and empiricism. When thinking about rationalism, we know that knowledge can be acquired through reason alone and that we don’t need experience. But when thinking about empiricism, we know that we learn through our experiences as a person. Justifying truth as a philosopher, I would agree more with Locke’s view on empiricism. I believe that everything happens for a reason, and that you need experience to learn, and to grow as a person.

Sunday, September 29, 2019

Advantages and Disadvantages of Early Retirement

Constant pursuit of money, making the big time, flux, accomplishing social status but where is the time to enjoy those attainments? When are we to say ‘enough’? Current pace of life disables us to do so. Just work work and again. Is there any key? Maybe worth of consideration would be early retirement ; what are the advantages and disadvantages of previously mentioned action? Firstly, when we are talking about advantages. It is a new start, some kind of a new beginning. People can afford on more what they used to. There is much more time for themselves (when describing a couple) friends or family. On the other hand nimiety of free time makes human being feel redundant. It is the main cause of depression, slough, generalised anxiety disorder, loss of poise and many others. As the old dictum says ‘prevention is better than cure’. Secondly when one retires his post is within range of someone younger. It is a benefit for all the society- because early retirement is a mechanism for reducing unemployment which is widespread among young generation. Sad but true. Despite that fact it is said that ‘the older- the more experienced’ which factor is crucial for the employer. Some features of characteristics cannot be superceded, f. e. conscientiousness, diligence, reasonableness. As previously mentioned, filling someone's shoes it is not obvious as it may seem. As presented above; early retirement has both assets and drawbacks. It cannot be judged that one are more important than others, because it is simply individual point of view including encumbrances, personal assurances and many other aspects. ‘When you are young, you think that your path is longer than old colleague of yours. Is it so? ’ In my modest opinion that quotation is universal and definitely hits the point.

Saturday, September 28, 2019

Psalms 23

Psalms 23 I find in the historical background of the 23rd Psalm that David was the author. David was a shepherd in his youth, preparing him for the shepherding of God’s flock, the nation of Israel. The Lord chose David as his servant, and brought him to shepherd Jacob His people, and Israel His inheritance. There is a possibility that David wrote this psalm as a boy while he was tending his flock, since he spent many lonely hours in the fields. It is hard to understand how a young boy could write of such imagery when young boys knew little of dangers and disappointments in life. There are two imageries, the shepherd and the host. (Deffinbaugh) In ancient Near East time the Israelites were known as shepherds describing leadership of an individual or group, or a king referring to a leader. The shepherd imagery shows the Lord was the leader, the King of all humanity. Jacob spoke of God as â€Å"The God who has been my shepherd all my life†. (Deffinbaugh) David spoke of God as his shepherd, his provider, protector and king. It states â€Å"The Lord is my Shepherd, I shall not want† meaning that he had the Lord and was not in need of anything. The shepherd imagery is that David is describing God’s relationship with him in a loving relationship, in relation to how shepherds tended to their flocks. The author states â€Å"he guides me in the paths of righteousness† the Lord will always be there to guide us in the right direction, yet evil will always be lingering, it is our choice which way we go. In Psalms 23:4, â€Å"Even though I walk through the valley of the shadow of death† could possibly mean that he could have faced some kind of tragedy in his life, or he faced some kind of evil. Therefore, David had possibly used these situations in his life, which could have inspired him to write this psalm. David also wanted to lead a righteous life and follow the way of the Lord. Then we read â€Å"fear no evil†. Evil is always present, yet the Lord will be there to protect us from evil. The author talks about dinning with his enemies. In ancient Near East hospitality to foreigners, strangers, and travelers was a sacred duty. By extending this hospitality the host would take on the responsibility of protecting the traveler as long as he was in his area. As David’s enemies he still took care of them and feed them while they were his guests. He felt that the Lord would reward him for this and he would live in the â€Å"house of the Lord† (referring to the temple) forever. This doesn’t mean he will live in the temple; this attitude will help shape the rest of his life. (Bratcher) Psalms 23 deals with the faith in the Lord, and living a righteous life, which would lead you to a wonderful life on earth and here after. This psalm applies to my live by having faith in God always, even when bad things happen to the people I care about or me. My faith in God is what gets me through the bad things in my life and the good things that he blesses me with. I know that God is there to protect me even when evil shows itself. If it wasn’t for my faith, I would not be where I am today. If we follow David’s example which is the psalm, in the 21st Century we should care for Jesus’ flock in the same way that David cared for his. We should love our enemies and help them find faith in God just like David. This psalm has honesty about life and even in the most faithful people they still know that darkness may come upon them. In the 21st Century there is darkness everywhere, yet we still need to listen to the words of Psalm 23 and reflect on its possibilities of helping us out of the darkness with the help of the Lord, since we know that he walks with us always. Today we look for physical things from the Lord, where in David’s time it was more spiritual. God does provide us with physical needs, yet we can not always be sure when it will occur or what the circumstances might be, but when it happens we know and our faith lives on. Praying this psalm will keep your faith in God.

Friday, September 27, 2019

Employee Engagement Dissertation Example | Topics and Well Written Essays - 1750 words

Employee Engagement - Dissertation Example ss the organization. These issues should be addressed early in order to avoid the deterioration of employees-employer relationship in the specific organization. From another point of view, the identification of the reasons of the low response of employees to the specific survey would help managers to identify the measures required for the increase of employee satisfaction – an increase that could lead to the improvement of their performance. 3. What is its relevance to the â€Å"client† organisation? The subject of this study is directly related to the strategic framework of the chosen organization. In fact, it is in the context of this framework/ policies that the quarterly employee engagement survey is developed. From this point of view, the review and the evaluation of the performance of the above survey could help to identify any potential gaps in the implementation of the firm’s strategies. 4. Research Objectives The research objectives implied from the stud y’s research question could be described as follows: a. Which is the role of employee engagement in modern organizations. b. Which are the most common factors/ elements that can influence employee engagement in firms of different industries? c. Which methods are likely to be used by managers in order to measure the level of employee engagement within their organization? d. Which is the value of quarterly employee engagement survey for measuring the level of employee engagement in modern firms? e. Which strategies would be developed by the firm’s managers in order for the response rate of employees to be increased to 95% - from its current rate of 77% - in the next two quarterly surveys? 5. Texts/journal articles which were used to identify the key themes within the academic and practitioner literature related to the research question and objectives. Axelrod, R. (2010) Terms of Engagement: New Ways of Leading and Changing Organizations. Berrett-Koehler Publishers Erez, M., Kleinbeck, U., Thierry, H. (2001) Work motivation in the context of a globalizing economy. Routledge Federman, b. (2009) Employee Engagement: A Roadmap for Creating Profits, Optimizing Performance, and Increasing Loyalty. John Wiley and Sons

Thursday, September 26, 2019

Artworks in painting from the 16th century Essay

Artworks in painting from the 16th century - Essay Example Until 15th century printed books were elusive or presence of the handwritten materials was left to a few affluent people in the society. The lives of the saints could not learned from books and considering most people in the towns were majorly illiterate people and thus understanding of documents written in Latin became a problem most people. Latin was the main language used in most biblical teaching amidst a wide variety of lingual speaking groups of people. The parish priest applied the paintings in teaching his flock concerning the bible and on saints in general. Such common types of paintings called ‘Biblia Pauperum or in other terms the ‘Poor Man’s and was considered to act as visual aid in helping the congregation in assimilation of the elementary teachings. Some informed people in the villages helped in teachings the crowds on messages contained in the paintings and thus unraveling the main intrinsic relevance of the paintings. The painting had very synonymo us inclusions of exaggerations which were applied in unearthing the data contained in the painting. The paints exhibited traits such as wicked leaders, assassins, executioners, torturers and other quality by the application of the exaggerations in the paintings. The forms of the clothing’s and adornments of the people were also very notable from the paints. The villagers had the skills to identify between the true message delivered and notable exaggeration entailed in the process.

Sex Education in America Article Example | Topics and Well Written Essays - 1000 words

Sex Education in America - Article Example A better option would indeed be to sit them down and explain to them in moral or practical terms what they need to know about sex. Knowing the stages in the 28 days of ovulation did not benefit that 16 year old pregnant girl in the clinic, but perhaps if that girl who had remarked over hoping child-birth did not hurt as much as sex, had been told how to say no or avoid doing something she clearly never enjoyed doing, she wouldn't be in the position that she currently was. Teachers should sit students down and explain to them the social aspects of teenage pregnancies, explain the possible 'solutions' one relies on when such a situation arises, and explain how none of them are ever really a solution. Furthermore, rather than scaring them away from sex using pregnancy as a tool, students should be educated on sex itself, in practical terms rather than scientific ones. Sex is not a tool to keep someone interested in you, nor is it something to increase intimacy. Rather it is something us ed to express intimacy, and until students know how to do that, it would be like speaking French without actually knowing how to. Furthermore, as that girl in the high school told you Ms. Quindlen, most girls will succumb to intercourse under pressure from their peers or their boyfriends. Perhaps girls should also be taught that there is no need to feel the pressure to keep a friend or a boyfriend who will judge them on their willingness to have sex. Yet we find that none of these issues are ever actually discussed in sex ed classes. Nor is student input ever taken, so that their confusions or queries can be cleared out. Indeed it is possible that, as you, the future or aftermath is such a vague distant matter that the students aren't even aware of their confusion in reference to it. If all that matters is the build-up to the act, they would not find themselves focusing on the ifs, buts, whys and hows of the matter. Perhaps this is because parents are not comfortable with the idea o f sex being taught to their children in such an accepting matter, because idealistic or not, many parents do not want to accept that the idea is relevant to their child. Nonetheless, as their teachers and parents, it is our job to protect our children and educate them on the matter and I do feel that sex education needs to be reconsidered in the way that it is being taught. As for the matter brought up by Ms. Austin, I also completely agree with what you had to say. Indeed as you said, after the revolution of the sixties and the current changing trends, many girls today feel that as they are career-oriented women and not the basic definition of a housewife, home economics and learning how to run a home is not relevant to them. Men on the other hand feel that it's the woman's job to handle a house and they too feel it is not relevant to them. This, in my view, is the basic reason for the decreasing popularity of home economics, and perhaps the rising rate of broken or mismanaged hous eholds. Home economics is essential for anyone hoping to have some form of a household or family, whether it is as a full-time housewife or husband, or as a part-time housewife.

Wednesday, September 25, 2019

The relationship between changing of labor force(total labor number ) Research Paper - 2

The relationship between changing of labor force(total labor number ) and Unemployment rate - Research Paper Example The drop was sharp in 2002 heightened by the global financial crisis where most firms were laid off their staff. However, the situation was later on put under control (STOICA, pp.3-7). Additionally, the study that was carried out in the same locality indicated that a decline in the population caused the number of employable persons to fall. It was that the number decreased by more than 13900 people. There were low rates of migration into the locality, low birth rates, high mortality rates and a great number of the aging population. The factors caused the total number of labor to decrease sharply (STOICA, pp.3-7). However, the trend was slightly different in other localities where there was an increase in the labor force due to a population increase. More so, most of the people chose to reside in urban settlements where employment opportunities were more available than rural areas. Additionally, the demographic indicators within the area indicated population increase was as a result of increase birth rates, low mortality rates, increased population due rural to urban migration (STOICA, pp.4-5). Shierholz, (paras.1-3)came up with a report that indicated there was a decrease in labor force participation between 2008 to 2012.The decline was about 2.5% from the previous years where the participation was 66.2%.Due to the decline, the rate of unemployment reduced significantly. A decrease in labor participation was caused by unwillingness by most of the people to seek for employment opportunities because of low wages that were being offered in the job market. However, he indicated that if industries provided lucrative job opportunities, there was a possibility for the market to be by prospect job seekers hence raising the rate of unemployment in an economy. Plumer, (2013) showed that the labor force in the US was sharply weakening. According to his publication, about 66% of Americans had managed to secure a job vacancy or were still in the

Tuesday, September 24, 2019

Is mountain climbing a heroic or selfish act Research Paper

Is mountain climbing a heroic or selfish act - Research Paper Example One of the mountaineers, a sick man, after the avalanche passed away, told his friends, â€Å"I was going to unclip and get it over with,† as they were holding together with just a single ice-screw. Mark Twight, one of the mountaineers of the Rupal Face, like the British mountaineer, Joe Simpson, also shares the same feeling that the sport is for personal and â€Å"super-selfish† glory. Success of mountaineers is celebrated in royal way; they are rewarded and awarded in a magnanimous way (Coffey, 2003, p. 68-69). According to the Oxford English Dictionary, a hero is a person who â€Å"exhibits extra-ordinary bravery, firmness, fortitude, and greatness of soul in any action.† Mountaineering presents such heroic opportunities innumerably. Alex Lowe set an example of sheer bravery, fortitude and greatness of soul in rescuing the Spanish climbers; he carried one collapsed climber on his back on the thirty-five degree slopes of ice and snow for hundred vertical feet to deliver the climber to the Park Service although the climber had collapsed. Such herculean tasks can be accomplished by a true hero only (Coffey, 2003, p. 70). Alex Lowe’s extra-ordinary stamina, drive, and capability as a climber were outstanding. Another name attached to the mountaineering heroism is that of Alison Hargreaves, the only women to climb Mount Everest by her own without oxygen in 1995 (Coffey, 2003). Alison was the second woman to reach Mount Everest without oxygen and on her own; the first legendry woman was Reinhold Messner. Criticism of such heroic personalities is widely attempted by media, as the tragedy pounces upon their lives. The same thing happened to Alison. Successful adventures were glorified beyond limit but as soon as defeat surfaced in the form of loosing the life while performing the adventurous task of mountaineering, the woman was criticized by press for leaving behind two small kids. Questions were put

Monday, September 23, 2019

Social theories in social work Essay Example | Topics and Well Written Essays - 3000 words

Social theories in social work - Essay Example Social work is a discipline that involves the application of social theory and some research methods. The purpose of which is to improve the overall quality of living of society at large. Social work incorporates and uses other social sciences in order to improve the human conditions. Social work is thus a profession committed to attain social justice and an enhanced life style. Social work deals with and resolves almost every major social issue. Social workers are involved in the analyzing the root causes of various social problems and developing ideal solutions studies for the same. They may work with individuals, groups or the society evolved in the early nineteenth century.  Social work as a profession evolved in the early nineteenth century. This was initiated by the problems created in society by the industrial revolution. Social work as a profession. It was triggered by the vivid application of scientific reasoning and theories to various studies. Numerous educational instit utions accepted social work as a discipline and began to offer courses. In the twentieth century, the social work as a profession began to depend heavily upon research and various evidence based practices. This led to an overall improvement in the professionalism of social work. At present social workers are obsessed with myriads of pursuits in solving societal problems. Professional social workers usually hold a professional degree in social work and may even have a license or are professionally.

Sunday, September 22, 2019

Marital Paradigm Essay Example for Free

Marital Paradigm Essay I grew up in a joint family in India, which had 3 married couple and their kids. Marital relationships that I saw in my family were not great but not bad either. All the men used to work in the family business and the women used to take care of the children and the house. Many times my parents used to fight and my dad used to scream at my mom, but my mom never had the guts to say anything to him. I always saw that my mom was scared of him and I used to question myself why doesn’t she reply back. And being a girl myself I used to think that probably girls cant say anything when theirs husband are screaming at them. I used to talk to my mom and tell her why cant she reply back, but I never really got an answer. I always saw my mom as the weaker one in the relationship. On the other hand we had a family friend and both husband wife used to work as college professors. In their house the husband never screamed at the wife, I am sure they had conflicts but you could totally see the respect that he gave to his wife. When I grew a little bit older my mom started telling me how she felt. That was when she told me that she was a housewife and my dad was the one who earned in the family and thus he could talk like that to my mom. My dad always dominated her as he is the man of the family and is the one responsible for all the decisions of the family. And this was not only my parents I 4saw this trend throughout my family with the other two couples as well. Certain assumptions that I saw in the relationships were that even if it was my dad’s fault, my mom always had to be the first one to apologize. Also since my mom is eight years younger than my dad I saw that my dad didn’t really understand her and took her for granted at times. Bring the older one he tried to impose certain things on her. I also saw that if I tried to calm down my dad he didn’t like it as I was a child and I should not be involved in their matters. This training has had a lot of impact on my relationships. As I always saw my mom being dominated by my dad, I didn’t want that to happen with me. When I grew up I had certain things very clear in my mind. I wanted to be educated enough so that I can earn myself and have a good job, so I never dependent on my husband for anything. For that reason I came to USA and decided to study here. In my past relationships, I made it very clear to my artners that my career is more important than anything in my life and I wouldn’t leave it for anyone. I was also very clear about anyone screaming at me. Since I saw my mom always being screamed at and I always hated it. Also I have certain things straight for my future. I want my husband to understand that I will not stop working and be a housewife, so that later I have to dependent on him. I want him to respect my decisions and me. Many times I have seen that the women of the house are not asked to contribute in family matters, and I think that is not right at all. So I want to have a relationship where we both contribute in the family matters and come to a conclusion together. I am not yet married but I think the things I have in mind for my marital relationship are very clear. According to the book women still do two-third of the household work. I think if women can earn like men do, then men should work the same like women. I think my idea of marriage is based on a simple rule, which is to give the amount of resect you get. And I think it is pretty healthy because if two people cannot respect each other for what they are then they cannot be together for long. Moreover I have been taught marriage is not only about two people, but it is about two families that get together. And I expect my husband to respect and get along with my family as being the only child I think my parents are my responsibility and will always be. Thus whoever marries me has to understand the importance of my parents in my life, and on the other hand I want to be comfortable with his family too. I also feel that at times girls tend to be too clingy with their partners, and I think that is one reason why guys get irritated. Therefore I would like to give space to my husband when he needs and expect the same from him. Some people might think that this is being stupid but I know I wouldn’t like if my husband gets over protective about me, and the same way I don’t want to be over protective about him. I know it’s not easy to be with a person like me who is over ambitious. And at times it can be a problem for guys to see the girl so much into her work, and for me my career has always been more important than anything. I think this can be a problem when I get married, because at times it has been a problem for my boyfriends to understand my passion about my work. This is something I want to work on as most of the times guys don’t understand this. Also I like the idea of peer marriage as in a marriage where both people respect each other equally and understand each other’s likes and dislikes it becomes easier to be together. According to the book faithfulness is the number one reason for marital success. And I totally agree with this, even if the physical relationship between two people is not that good, if they both are faithful to each other nothing can separate them. My parents have not only taught me to be faithful but I also have seen this in their relationship. Even though my father was dominating my mother, they are still together. This is because no one of them was unfaithful to the other. Also I think from a few years the fights between my parents reduced I think this happened because they saw that I am a grown up now and all this might affect my thoughts about marriage. Children are a big reason why two people stay together even if they don’t want to. But I think that’s not right. I don’t want my husband to be with me just because of our children, because that’s doing a favor to our relationship. I would like us to be together because we make each other happy not because of a third reason. I am brought up in a culture where non-marital sex is not accepted. And these values are embedded inside me. I know now a days girls have sex when they are 14 years of age, but I am 21 years old and I am still a virgin. Being in USA and telling your boyfriend that you wont have sex with him because of your culture is not easy. Many times people judge my beliefs but that has not affected me at all. I want my husband to respect my beliefs and understand where I am coming from. Because for me a relationship is not only about getting physical, there is a lot more to it, and what I have heard and seen around me is that guys only want to get physical. I know according to the book sex is the second reason why marriages work. But for me it is not. I am not against sex at all, but I don’t want my marriage to be dependent on it. Book talks about homogamous marriage, which is a type of marriage in which spouses share their race, ethnicity, age, or social class. Basically a marriage where the two people have something in common. Obviously my parents want me to get married to a guy from the same caste and I agree with them. Because I think if the guy is familiar with my religion, my caste, and my society there is better change of understanding between both of us. In a nutshell I want a marriage where we both can share our happiness, and problems with each other without any problem. A relationship where I get the same respect that I give to the other person.

Saturday, September 21, 2019

Typical Family

Typical Family As society has evolved, so has the idea of the typical family.  Historically, the idea of family  consisted of one father (the King of the Castle, so to speak), one mother (often the family matriarch) and a child or children, all of whom are biologically related. The image painted around the All American Family  is one that includes a beautiful house with blue window panes and a white picket fence, set right in the middle of middle-class, suburban America. While families that do fit this stereotype continue to exist, many of todays typical American families have the roles of the parental units filled by not just one mother or one father. Parental roles are being filled by grandparents, aunts, uncles, elder siblings, adoptive parents, single parents, co-parents and/or step-parents. The children in these families may or may not be biologically related to the parents or caregivers; if the children are not biologically related they are usually adopted children, foster children, or step-children. Families such as these are often referred to as blended families . The term co-parenting  is sometimes used when two parents of a child are not married to each other. The same term is also used when referring to a family that has two lesbian mothers and/or two gay fathers. Although there is open opposition to gays and/or lesbians being parents or wanting to be parents (whether biologically, foster or adoptive), studies show that people around the world support and acknowledge these types of families. According to Gary Gates at the Urban Institute, as of May 30, 2003, the amount of lesbian mothers has grown to between one (1) and five (5) million; the amount of gay fathers has grown to between one (1) and three (3) million; and there are eight (8) to ten (10) million children who have one or more gay or lesbian parent.1 Mr. Gates further states that, 96% of all U.S. Countries have at least one same-sex couple with children under the age of 18  in their household.2 If one were to compare these numbers to the numbers that would be presented of tr aditional families, these numbers seem quite minimal; however, in the fight for gay and lesbian rights, these numbers are encouraging. Because the numbers continue to increase each day, they are also a testament to the desire of gay and lesbian parents to be seen as equivalent members within their communities, Lesbian, Gay, Bi and Transsexual (LGBT ) community or otherwise. Societys general outlook on gay and lesbian parenting is also changing. According to a poll conducted by the Wall Street Journal (1999), one-third of poll takers endorsed same-sex marriage and unions. These same people would most likely endorse same-sex parenting. Though there is acceptance and welcome for people in the LGBT community to openly parent and raise children, gay and lesbian couples and individuals still face many challenges from others who are not so open minded. Some people have argued that homosexuality is a mental disorder, therefore are of the opinion that members of the LGBT community should not be able to marry or have children. The American Psychiatric Association declared that homosexuality is NOT a mental illness [emphasis added] in 1973.3 The American Psychological Association adopted the same measure in 1975. As psychology was one of the first disciplines to study homosexuality in depth, psychologists have discovered that the fear of being gay (or homophobia ) has played a key role in anti-gay attitudes and behaviors of those who disagree with the gay lifestyle. Though this finding has helped people better understand the reasons certain people are uncomfortable or against the LGBT lifestyle, it has not completely neu tralized the unfounded fears that some people have. There have been some arguments that gay or lesbian parents will molest their children, biological or otherwise. The Child Welfare League of America studied and concluded that, the likelihood of homosexual adopters molesting children placed with them is no greater than it is for the general population. 4 Roland Summit, M.D. concludes that, the vast majority of offenders are heterosexual men. Male offenders who abuse young boys maintain adult heterosexual relationships. The habitual molester of boys is rarely attracted to adult males.5 The premise that ones sexual orientation defines that person as a pedophile has been proven false time and time again. This particular fear has propounded multiple studies, most, if not all, with the same generalized conclusion. The American Psychological Associations policy statement regarding placing prospective adoptive and foster children within gay or lesbian homes reads, in pertinent part: The picture that emerges from research is one of general engagement in social life with peers, parents, family members, and friends. Fears about children of lesbian or gay parents being sexually abused by adults, ostracized by peers, or isolated in single-sex lesbian or gay communities have received no scientific support. Overall, results of research suggest that the development, adjustment, and well-being of children with lesbian and gay parents do not differ markedly from that of children with heterosexual parents.6 This policy has generously helped LGBT parents to fulfill their dream of having a family through the adoption process.

Friday, September 20, 2019

Preventing Dengue Fever in the Mauritius

Preventing Dengue Fever in the Mauritius INTRODUCTION Mauritius is a small tropical island located at latitude 20à ¸ 18 0 S and longitude 57à ¸ 34 60 E. It has a tropical climatic condition. Mauritius has an area of about 2,040 sq km and is located to about 2000 kilometers from east west of Africa and some 800 kilometers from Madagascar. The positioning of Mauritius makes the latter a tropical country with moderately lofty temperature throughout the year. Winter and summer are the seasons that manifest onto the island. The island of Mauritius finds itself as one of the most accessible islands in the Indian Ocean. Situated amid R‚union island and Rodrigues island, the island of Mauritius has gained the reputation, through the course of time of that of the key and star of the Indian Ocean. The Mauritian population estimates for the year 2008 was about 1, 260, 781 with an annual growth rate of 0.7 %. Since the country is undergoing major developmental changes many industries have implanted here and thus the number of expatriates in the country is on the rise. These people may be a carrier of the disease and of course those Mauritians visiting the dengue endemic areas can also become infected and bring the disease in the country. It is an indisputable fact that during the lapsed decades, Mauritius has witnessed a multitude of diseases. The most prominent and recent one being Chikungunya which has infested merely about 12000 Mauritians. Furthermore, the history of diseases in Mauritius is marked with Malaria epidemics since colonial regimes and through the intensive effort of the Public Health sector, the latter has been proclaimed eradicated by the World Health Organization in 1973. Some years ago many of the realms citizens were not aware of what was dengue fever even though it had already occurred in the country but there was not mass infection by the virus. Providentially, the number of cases reported beforehand was only one or two and through the close collaboration between the Ministry Of Health and the infected person the situation was under control and hence no further positive case of dengue were recorded. The Mauritian government is putting forward all steps to prevent an epidemic rather than to rush for controlling it when it has already hit the population. The Ministry of Health is working on a list which highlights all water retaining sites and is identifying the hotspots of such sites that are liable to cause proliferation of mosquitoes; this process is carried out each year. Furthermore, an action plan is being prepared by the ministry which gives a layout of which and what job is to be done by which section of the ministry or other stakeholders (anonymous, 2009). Dengue viruses are transmitted by the Aedes species. Two known species the Aedes aegypti and Aedes albopictus are vectors of the disease. The Aedes albopictus can be found in large quantity all around the island whereas Aedes aegypti is said to be eradicated from the country. Surveillance on the abundance of mosquitoes is carried out by the entomological section throughout the year. All sites where mosquitoes that can be vectors of disease are seen, they are referred to the nearby health office for a larviciding to be carried out at that place and in the vicinity. Aedes albopictus (Skuse) is known as the Asian Tiger mosquito (Robertson and Hu, 1988). Aedes albopictus is native to Southeast Asia, but now occurs throughout the world. The worldwide spread of Aedes albopictus during the precedent 20 years has caused apprehension in the midst of public health officers and scientists over the possibility that the introduction of this species will amplify the risk of epidemic dengue fever and other arboviruses in countries where it has become established (Gubler, 2003). Aim The aim of this study is mainly to evaluate the effectiveness of the control measures taken to prevent dengue fever in Mauritius. Emphasis will be laid on the steps taken before, during and after the disease occurrence. This might highlight the shortcomings that Mauritius face in order to manage outbreaks of diseases. Objectives of study The objectives of this dissertation are to evaluate the management, procedures and legislation that are implemented in Mauritius during outbreaks of dengue fever. Furthermore, most interest is geared towards the application of chemicals, preventive measures, and health education of the public carried out by the Ministry of Health Quality of Life to prevent the occurrence of the disease and also to annihilate if ever found in the island. To elucidate the effectiveness of fogging, larviciding carried out in the country and health education of the public. CHAPTER TWO LITERATURE REVIEW 2.0 Dengue 2.0.1 General considerations Dengue fever and dengue hemorrhagic fever were first identified in the 1950s, during the dengue epidemics in Philippines and Thailand and by 1975 it had become a leading cause of hospitalization and death among children in many countries found in that region (Lloyd, 2003). In the year 1779 Egypt and Java had dengue-like epidemics, but it is thought that they were caused by the chikungunya virus (Carey, 1971). Dengue virus belongs to the genus Flavivirus, Family Flavivaridae and there are four serotypes of the virus (DEN-1, DEN-2, DEN-3 and DEN 4). All the four serotypes can cause dengue fever, dengue hemorrhagic fever and even dengue shock syndrome (Ramchurn et al, 2009). The four viruses are closely related but are distinct. Millions of people residing in tropical areas of the world are affected by epidemics of dengue fever. Dengue fever is associated with the severe form dengue hemorrhagic fever/ dengue shock syndrome (DHF/DSS) that is seen mostly in children and nevertheless adults also are attained by the disease. In the 19th and early 20th centuries dengue or dengue-like epidemics were reported in the Americas, Southern Europe, North Africa, the Middle East, Asia and Australia and on various islands in the Indian Ocean, South and Central Pacific and the Caribbean (Ehrenkranz et al, 1971). Generally these epidemics consisted of nonfatal feverish illnesses, often coupled with rash and either muscle or joint pains (Carey, 1971). Deaths occurred during dengue epidemics in Australia in 1897 and in Greece in 1928, when over 1000 deaths were reported (Halstead, 1980). Hemorrhagic demonstrations, including gastrointestinal bleeding, were described during dengue epidemics in Texas and Louisiana in 1922 (Scott, 1923). Nevertheless through the first half of the 20th century, dengue was generally described as a self-limited, nonfatal febrile illness, with occasional hemorrhagic manifestations such as red spots, acute hemorrhage from the nostril, nasal cavity, or nasopharynx, gingival bleeding and menorrh agia that only once in a blue moon resulted in more stern or fatal outcomes. During the last decade, dengue infection along with its complications has been on the rise all over the world. Their geographical spread is increasing: only 5 countries documented dengue in the 1950s but to date there are more than 100 countries reporting the incidence of dengue fever and dengue hemorrhagic fever (Guha -Sapi Schimmer, 2005). Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas (WHO, 2009). Dengue fever is a very infectious mosquito borne viral disease characterized by either a mild febrile syndrome or the classic incapacitating disease with abrupt onset of high fever, severe headache, pain behind the eyes, muscle and bone or joint pains, nausea and vomiting and rash. Skin hemorrhages are not uncommon. Leukopenia is usually seen and thrombocytopenia may be observed (WHO 1997). Dengue is a flu-like mosquito-borne disease and has a soaring capacity for epidemic outbreaks, which according to the World Health Organization (2009) affects 50-100 million people each year in the tropical and sub-tropical areas of the world. Dengue is cited as being one of the most significant mosquito-borne disease affecting humans and as a major international public health concern (WHO 2009). Dengue fever is predominantly transmitted by Aedes species which have adapted themselves to living near human habitation (Hales et al., 2002). The dengue virus is a member of the family Flaviviridae virus, transmitted through the biting of infected Aedes aegypti and Aedes albopictus mosquito. The Aedes aegypti mosquito normally bites indoor and late in the afternoon whereas the proficient mosquito Aedes albopictus is an aggressive daytime biter, which is also known to bite early in the morning, late afternoon (Knight and Hull, 1952) and at night (Murray and Marks, 1984). This biter is usually an outdoor biting mosquito, but it also bites indoors (Hawley, 1988). Generally the mosquitoes bite at ground level (MacDonald and Traub, 1960, cited in Hawley, 1988). Females will bite any area of exposed skin, but prefer the ankles and knees (McClelland et al., 1973; Robertson and Hu, 1935). The time amid the bite of a mosquito carrying dengue virus and the apparition of symptoms ranges from 4 to 6 days, with a range of 3 to 14 days. 2.0.2 Pathogenicity of Dengue fever: 1. Asymptomatic and mild infection It is very common. 2. Dengue Fever (primary infection) Dengue fever is characterized by increase in body temperature; severe aching of the forehead; retro-ocular pain; muscle and joint pain; and widespread maculopapular inflammation. Conjunctiva may become red. Other common problems that may arise are diarrhea, vomiting, nausea and abdominal pain. Fear of light, sore throat, increase in the size of the lymph node and bleeding tendencies may also happen. The illness lasts 5 to 7 days. Immunity is lifelong. On the other side the incidence of Dengue Hemorrhagic Fever or Dengue Shock syndrome increases if the person has immunity or has already been infected before with a different serotype. Even after several months of recovery some patients may experience depression and fatigue. 3. Dengue Hemorrhagic fever The well-known feature is bleeding. It happens when a person is infected twice but with a different dengue virus serotypes or infrequently by primary infection is common in kids Under 15 years of Age (Rigall-Pewrez et al.1998). There is sudden rise in temperature and other manifestations of Dengue fever. Petechiae, effortless bruising, gingival bleeding and epistaxis are common. In severe cases bleeding of the gastrointestinal tract can be observed. In children, we can have an increase in the size of the spleen and the liver. 4. Dengue Shock Syndrome The prominent feature is hypotension. It normally occurs in people below 15 years of age. The clinical features include weak pulse with narrow blood pressure, cold and clammy skin (Rigall-Pewrez et al.1998). 2.0.3 Mode of transmission of dengue virus: Chikungunya and dengue viruses are transmitted to humans by the bites of infected mosquitoes. In contrast, Aedes albopictus is abundant and may be the only important vector of these viruses on the islands. Both species bite mainly during the daytime, particularly in the early hours after dawn and for 2-3 hours before darkness. Aedes albopictus is more active outdoors whereas Ae. aegypti typically feeds and rests more indoors (WHO 2008). In the cycle of dengue, the vertebrate host is man and the Aedes species the vectors. The disease is acquired only when bitten by female mosquitoes, as the female feed on blood in order for the development of their eggs whereas the male mosquitoes are not infectious due to the fact that they feed only on nectars rather than blood. In 8-10 days the infected mosquito is able to transmit the virus to other people. Thus the cycle of transmission takes only 14 days. One dengue-infected female mosquito is capable of biting and infecting several people during one feeding session. The dengue mosquito frequents backyards in search of containers holding water inside and outside the home, such as: cans, buckets, jars, and vases, pot plant dishes, birdbaths, boats, tyres discarded with no rims, roof gutters blocked by leaves striking containers, tarpaulins and black plastic. It can also breed in natural containers like: bromeliads fallen palm fronds. In drier conditions it also breeds in water inà ¿subterranean sites such as: wells, telecommunication pits, sump pits, gully traps. Transmission cycle of dengue results from a complex system based on several main constituents like: the density of susceptible hosts, environmental conditions and the presence of one or more serotypes of the dengue virus. The number of confirmed dengue cases has been increasing owing to the fact that the world is undergoing rapid urbanization and its population is also on the rise, disposal of non-biodegradable containers, rapid transportation and poor living conditions such as poor water supply and very rare scavenging services at squatter areas (Satwant, 2001). Various studies have shown that the Aedes albopictus is able to transmit all the 4 serotypes of dengue. Aedes albopictus mosquito can serve as an important maintenance vector of dengue viruses in endemic areas, and new endemic areas may be initiated by importation of vertically infected eggs (Gubler, 2002). That is the infected Aedes mosquito can pass the dengue virus to its progeny and when the eggs will develop into mature mosquitoes they will be already infected, hence capable of causing infection of human beings or even pass the virus to their progeny. Transmission cycle of dengue virus by the Aedes aegypti mosquito starts with a person infected with the dengue virus. The blood of the person will contain the virus thus circulating in his body and this is called a viremia which will last for about 5 days. During this period, an uninfected female Aedes aegypti mosquito bites the infected person and acquires the dengue virus. Within the mosquito, replication of the dengue virus occurs and this process usually takes between 8-12 days, after which the female mosquito can transmit the virus upon a blood meal. Once infected the virus takes 4-7 days to replicate within the new host (the person whom the infected mosquito bite) before inception of symptoms. Symptoms may last from three to 10 days, with an average of five days, after the onset of symptoms. Hence, the disease persists several days after apparition of symptoms (CDC Dengue Slideset). 2.0.4 Lifecycle of Aedes mosquito: The mosquito goes through four separate and distinct stages of its life cycle and they are as follows: Egg, Larva, pupa, and adult. Each of these stages can be easily recognized by their special appearance. Egg: Eggs are laid one at a time and they float on the surface of the water. Aedes species do not make egg rafts but lay their eggs separately. Aedes lay their eggs on damp soil that will be flooded by water. Most eggs hatch into larvae within 48 hours. Larva: The larva lives in the water where they eventually undergo a molting process to become a pupa. Pupa: The pupal stage is a resting, non-feeding stage and is the time the mosquito turns into an adult. It takes about two days before the adult is fully developed and upon complete development, the pupal skin splits and the mosquito emerges as an adult. Adult: The newly emerged adult rests on the surface of the water for a short time before flying away. In the Aedes mosquito family only the female bites because it requires protein to develop eggs, therefore if it bites a person infected with the dengue virus the mosquito becomes infectious after approximately 7 days. The mosquitoes are known to be biting at a highest frequency at dawn and dusk. Some more facts: The average lifespan of a mosquito of the genus Aedes in Nature is 2 weeks Mosquitoes may lay eggs about 3 times in his life, and about 100 eggs are produced each time. The eggs can live in dry conditions until approximately 9 months, after which they can hatch if it is subject to conditions, i.e food and water Source:http://dengue-feverdisease.blogspot.com/2008/02/lifecycle-of-aedes-mosquito.html [accessed on 05.12.09] 2.0.5 Investigation for dengue infections: Laboratory results Decrease in the number of white blood cell and peripheral neutrophils in the blood, abnormal increase in the number of lymphocytes in bloodstream and very low amount of platelets in the blood. Radiology X-ray of the chest normally shows pleural effusion and seldom pericardial effusion Ultrasound Used to detect pericardial effusion and 2) presence of excess fluids in the gap amid the tissues lining the abdomen and abdominal organ. Tests Laboratory diagnosis is done by detection of virus in specimen-serum at the virology laboratory. Culture is done in cell line derived from A. albopictus cell. Immunoflurescent techniques are used to detect viral replications. The virus can be isolated in patients with fever. Serology IgM is detectable in 90 % of patients by the 6th days of illness. Serum collected early may give false negative result. IgM can also be detected 2-3 months after. It is not possible to identify serotype with serological tests. In case where the IgM test is Positive it may imply recent infection with Dengue fever. However definitive diagnosis can only be made if the virus is isolated or the virus genome is detected by PCR. Seroconversion or boost in titer may indicate fresh infection. The appropriate samples for PCR test include plasma and serum. Molecular test is highly sensitive but it can be used in patients only with viraemia (Rigall-Pewrez et al.1998). 2.0.6 Treatment: The managing of dengue fever can be enhanced with bed rest, passable fluid intake, plus control of fever and pain with antipyretics in addition to analgesics (e.g. paracetamol). For the supplementary ruthless manifestations of dengue virus infection, correct management requires early identification and swift intravenous fluid substitution. Blood transfusion may be necessary in cases. There is currently no vaccine is available to shield against dengue infection. The current lack of a booming vaccine against the dengue virus causes prevention methods to be approached by plummeting disease vector population, with Integrated Pest Management programs for mosquito control. These employ a mishmash of control strategies, including mosquito surveillance, source diminution, eradicating larvae and eradicating adult mosquitoes (Ooi et al. 2007). Eradicating adult mosquitoes alone is fruitless in controlling mosquito populations because it is complex to treat the unattainable habitat of the adults. Mosquito larvae are left to carry on their development, and they quickly swap the adults. Nevertheless, mosquitoes can become resistant if pesticides are overused. 2.0.7 Dengue fever in Mauritius: Dengue virus infections are emerging as the major ones in Southeast Asia. Global warming may worsen the occurrence of dengue fever. Since very last few years mixed outbreak of chikungunya and periodic cases of dengue fever have been reported on R‚union Island and other South West Indian Ocean countries. From March 2005 till March 2006 it is estimated that about 204000 people in R‚union Island may have been infected by the chikungunya virus, which furthermore shows that there is presence of the transmitting vectors of the disease on the island which are also the vectors of dengue fever as well. Hereafter, the other South West Indian ocean countries were not spared from infection from the chikungunya virus. An outbreak of dengue fever was reported in Madagascar more specifically in the city of Toamasina that started mid-January 2006 and rare cases of chikungunya were also reported mid-February. Maldives also have suffered from a dengue outbreak in year 2006 where 602 people were suspected to be infected among which there were some severe form of dengue fever that is 64 dengue hemorrhagic fever cases and 9 cases of dengue shock syndrome (WHO 2006). In Mauritius the first case of dengue fever dates to the 1976s and it was contained thus limiting the disease from spreading. Then we had a case of imported dengue from a person who visited an endemic dengue area in January 2008 (CDCU). The main vectors of the disease remain the Aedes mosquitoes, among which the Aedes aegypti mosquito is the primary vector and Aedes albopictus the secondary one. The mosquito found to be spreading dengue fever and Chikungunya in Mauritius is the Aedes albopictus (CDCU 2009). It is to be noted that in Mauritius we had both the Aedes aegypti and Aedes albopictus mosquitoes, due to the intense anti-malaria campaign during the year 1952 the primary carrier of the dengue fever, the Aedes aegypti have been successfully eradicated. Still very minute amounts of this mosquito can be seen whereas the Aedes albopictus is abundant. Dengue is transmitted from person to person through the biting of infected mosquitoes. Most recently we had a short-lived epidemic of re-emerged dengue fever in Mauritius that started in the month of June 2009 which was imported. The mild fever was first localized in the city of Port Louis, where there were 192 cases and then we did have some sporadic cases in other regions of the island. Mosquito fogging and larviciding in whole Port Louis started on 3rd June 2009, and were repeated every seven days. Fogging was carried out outdoors early in the morning, early evenings and sometimes till late in the evenings (Dengue Unit 2009). The Ministry of Health and Quality of Life of Mauritius took the situation as being severe and all medium possible to contain the disease were put into action. Like the Special Mobile Force and manpower from other Ministries which joined the Ministry of Health to fight the dengue fever. Public alertness campaigns on the requisite to hunt and eliminate mosquito breeding sites at home and in the neighbourhood and to protect oneself against mosquito bites were carried out through radio, television and the press through a public private partnership. Detailed information leaflets were also distributed, door to door distribution of pamphlets showing pictures of possible breeding sites for mosquitoes and products to be used to prevent mosquito bite were carried out by the primary health care personnels. Target groups included the public, community groups and school children (Ramchurn et al, 2009). By the end of the month August no new or suspected cases of dengue were recorded in any of the countrys hospital. But still the control and prevention program were continued throughout the island as the summer season was coming near hence reappearance of the dengue fever was possible due to the ambient temperature, favorable for larvae development. The fear of having the virus again was due to the possibility of the infected mosquitoes to pass the virus to their progeny. Fortunately, till February 2010 no suspected case of dengue fever was reported from any in the country (Dengue Unit 2010). 2.1 Vector surveillance and control program Ever since mosquitoes are capable of transmitting diseases like dengue and chikungunya, till now it has not been possible to eradicate the mosquitoes completely from their originating site. The best way to monitor or control vector-borne diseases is to control or limit the population of the vector to such an extent that disease transmission is very low or even stopped. In order to achieve this goal, it is imperative to know all about the mosquito involved in the transmission of the disease. Detailed knowledge of all aspects such as the breeding sites, different features of the mosquito at different stages, feeding habits, mating, resting and structure and most importantly without forgetting the lifecycle of the mosquito, are the main required things in order to be able to break the chain of transmission. Furthermore, the only way to prevent infection of people who have not suffered from dengue is to control the population of dengue vector (Ooi et al.2001) and of course personal precaution has also proved to be effective in reducing the risk of being infected by a mosquito. Since no vaccine is yet available for dengue the only mode to control dengue fever is the control the amount of the disease vector that is of the Aedes mosquitoes. The control strategies of these mosquitoes are 1) carrying out larviciding -spraying a chemical called abate in any water retaining place which kill the larvae of the mosquitoes hence interrupting the cycle to be completed, 2) fogging operation- a thermal fogger is used to propel fumes of Aqua K-Othriner which when is in contact with a mosquito kills it, thus the amount of developed or simply mature mosquitoes are reduced and 3) health education- talks are organized for the members of the public, for children in schools, colleges, etc. Entomological survey is an important and integral part of dengue prevention and control. The effect of the intervention by the community can directly affect the ecology of the vectors that is the Aedes mosquitoes. The Communicable Disease Control Unit (CDCU) is the unit which is mostly concerned for the control of communicable diseases such as Malaria, Dengue fever, Chikungunya, and other infectious diseases. In Mauritius, surveillance, disease prevention and education of infectious diseases are mainly carried out by the Health Inspectorate Cadre. In Mauritius, we have the Public Health Act (Section 32A) which is used in case where there is presence of a mosquito borne disease in the island. The potential for predation to prevent pathogen invasion or reduce disease prevalence in a host population also has implications for the biological control of vector populations. Predators have been introduced, or proposed, as biological control agents of vectors for various diseases such as malaria, dengue fever and Lyme disease (Jenkins 1964; Legner 1995; Stauffer et al. 1997; Samish Rehacek 1999; Scholte et al. 2005; Kumar Hwang 2006; Ostfeld et al. 2006; Walker Lynch 2007). Several recent studies suggest that predator introductions led to a decline in local cases of dengue fever in Vietnam and Thailand (Kay Nam 2005; Kittayapong et al. 2008), and malaria in India (Ghosh et al. 2005; Ghosh Dash 2007). 2.2 Biology of Aedes albopictus (Skuse) Aedes albopictus are two winged insects from the family Culicidae of the order Diptera. They are among the best known groups due to their importance as pests and as vectors of diseases. They are easily identified due to a combination of the following characters: long trunk projecting head; charisma of scales on the wing veins, a tassel of scales along the posterior boundary of the wing, and the typical wing venation, the second, fourth and fifth longitudinal veins being branched (Miyagi and Toma 2000). Female mosquitoes feed on blood and they have highly specialized mothparts for piercing host skin and blood sucking (Wahid et al. 2002). Aedes species are normally day-time bitters and active during the day. During this time, they have peaks of landing and biting activity. The peak time for Aedes albopictus occurred about one hour after sunrise and then before sunset (Abu Hassan et al. 1996). Nevertheless, the rate of biting varies depending on the mosquito age and time of the day (Xue and Barnard 1996). CHAPTER 3 DATA COLLECTION 3.1 Introduction In this chapter, a summary of the various steps that was undertaken to finalize the research is attempted. The research work was started as from the month of September 2009 to the end of January 2010. 3.2 METHODOLOGY In order to assess the effectiveness of the control measures taken to prevent dengue fever, data were collected from the different partners who are involved in the control and prevention of dengue fever in Mauritius. Such data were collected from books, newspapers, published articles, magazines and official statistics from the Central Statistics Office, Dengue Unit, Communicable Disease Control Unit and the Ministry of Health Quality of Life. Moreover, constructive discussions were entertained with people who are in touch with the matters connecting to the piece of work. Search through the internet, review of available documents and properly classifying the information that would be used during the study. 3.3 METHODS OF ANALYSIS OF THE DATA OBTAINED Questions related with the way of application of the different control measures were selected for analysis from the filled questionnaires. Moreover, each particular question was analyzed by using SPSS software which provided the frequency and percentages and hence Microsoft Excel 2007 was used to express the data in forms of percentages, tables, figures, graphs, pie charts and charts. Chapter 4 Part I-Data Analysis 4.01 Introduction This chapter of the thesis will be dealing with the data collected from different stakeholders involved in the fight against dengue fever. Data collected mainly from the Communicable Disease Control Unit, Dengue Unit, and certain Health Offices of the country and the media will be expressed in figures. This section will be divided in to two parts: data analysis and press cot analysis. Much attention will be oriented towards the control measures in Port Louis, as the maximum number of cases occurred there and eventually the island in whole. 4.02 Progress of the disease through June 2009 in Port Louis Figure 4.1: Number of cases each day during the month of June 2009 From figure 4.1 it can be seen that the first case was detected on 2nd June 2009 and the maximum number of cases reported to the hospitals was around the 10th to 13th day of the same month. The number of confirmed cases by the end of June 2009 had decreased to less than five. 4.03 Age of people infected with dengue virus From the above chart (Fig 4.2) it can seen that about 34.55 % of the total number of cases (246 confirmed) of dengue were vulnerable ones that is the young and the elderly. 4.04 Aqua K Othriner used for fogging process Aqua K Othriner is a chemical used in mixture with another chemical substance called Nebolr, in thermal foggers to kill adult mosquitoes. Normally, the fogger produces fumes which in fact are fine droplets of the mixture which when in contact with a mosquito causes its death. The first day of fogging was started on 2nd June 2009 with a minimum cubic centimeter of Aqua K Othriner used, on the 7th day the maximum and throughout the rest of the days varying just a little in amount except for the 14th day. 4.05 Number of inspections carried out during the past 8 years throughout the Country Starting from the year 2001 till 2005 from the graph (fig 4.4) the number of inspections carried out by the health inspectorate cadre shows a slight decrease and suddenly in 2006 the number increases to approximately 3 fold than that in 2005. In year 2007, the amount of inspections carried again decreases to 112,087 and eventually for 2008 the number decreases a bit more. 4.06 Number of sanitary notices served during the past 8 years Public Health Act Sanitary notices are normally issued to the author of nuisance, as for in this case the notices served were to cause removal of water collected in used tyres, drums, roof tops, etc. From the year 2001 till 2005 the number of such type of notices served was ranging between 4933 and 8013. For 2006 the figure was the highest with 10657 of notices served and for the remaining 2 years a gradual decrease was noted. 4.07 Number of contraventions taken for none compliance with the Public Health Laws Notices Figur Preventing Dengue Fever in the Mauritius Preventing Dengue Fever in the Mauritius INTRODUCTION Mauritius is a small tropical island located at latitude 20à ¸ 18 0 S and longitude 57à ¸ 34 60 E. It has a tropical climatic condition. Mauritius has an area of about 2,040 sq km and is located to about 2000 kilometers from east west of Africa and some 800 kilometers from Madagascar. The positioning of Mauritius makes the latter a tropical country with moderately lofty temperature throughout the year. Winter and summer are the seasons that manifest onto the island. The island of Mauritius finds itself as one of the most accessible islands in the Indian Ocean. Situated amid R‚union island and Rodrigues island, the island of Mauritius has gained the reputation, through the course of time of that of the key and star of the Indian Ocean. The Mauritian population estimates for the year 2008 was about 1, 260, 781 with an annual growth rate of 0.7 %. Since the country is undergoing major developmental changes many industries have implanted here and thus the number of expatriates in the country is on the rise. These people may be a carrier of the disease and of course those Mauritians visiting the dengue endemic areas can also become infected and bring the disease in the country. It is an indisputable fact that during the lapsed decades, Mauritius has witnessed a multitude of diseases. The most prominent and recent one being Chikungunya which has infested merely about 12000 Mauritians. Furthermore, the history of diseases in Mauritius is marked with Malaria epidemics since colonial regimes and through the intensive effort of the Public Health sector, the latter has been proclaimed eradicated by the World Health Organization in 1973. Some years ago many of the realms citizens were not aware of what was dengue fever even though it had already occurred in the country but there was not mass infection by the virus. Providentially, the number of cases reported beforehand was only one or two and through the close collaboration between the Ministry Of Health and the infected person the situation was under control and hence no further positive case of dengue were recorded. The Mauritian government is putting forward all steps to prevent an epidemic rather than to rush for controlling it when it has already hit the population. The Ministry of Health is working on a list which highlights all water retaining sites and is identifying the hotspots of such sites that are liable to cause proliferation of mosquitoes; this process is carried out each year. Furthermore, an action plan is being prepared by the ministry which gives a layout of which and what job is to be done by which section of the ministry or other stakeholders (anonymous, 2009). Dengue viruses are transmitted by the Aedes species. Two known species the Aedes aegypti and Aedes albopictus are vectors of the disease. The Aedes albopictus can be found in large quantity all around the island whereas Aedes aegypti is said to be eradicated from the country. Surveillance on the abundance of mosquitoes is carried out by the entomological section throughout the year. All sites where mosquitoes that can be vectors of disease are seen, they are referred to the nearby health office for a larviciding to be carried out at that place and in the vicinity. Aedes albopictus (Skuse) is known as the Asian Tiger mosquito (Robertson and Hu, 1988). Aedes albopictus is native to Southeast Asia, but now occurs throughout the world. The worldwide spread of Aedes albopictus during the precedent 20 years has caused apprehension in the midst of public health officers and scientists over the possibility that the introduction of this species will amplify the risk of epidemic dengue fever and other arboviruses in countries where it has become established (Gubler, 2003). Aim The aim of this study is mainly to evaluate the effectiveness of the control measures taken to prevent dengue fever in Mauritius. Emphasis will be laid on the steps taken before, during and after the disease occurrence. This might highlight the shortcomings that Mauritius face in order to manage outbreaks of diseases. Objectives of study The objectives of this dissertation are to evaluate the management, procedures and legislation that are implemented in Mauritius during outbreaks of dengue fever. Furthermore, most interest is geared towards the application of chemicals, preventive measures, and health education of the public carried out by the Ministry of Health Quality of Life to prevent the occurrence of the disease and also to annihilate if ever found in the island. To elucidate the effectiveness of fogging, larviciding carried out in the country and health education of the public. CHAPTER TWO LITERATURE REVIEW 2.0 Dengue 2.0.1 General considerations Dengue fever and dengue hemorrhagic fever were first identified in the 1950s, during the dengue epidemics in Philippines and Thailand and by 1975 it had become a leading cause of hospitalization and death among children in many countries found in that region (Lloyd, 2003). In the year 1779 Egypt and Java had dengue-like epidemics, but it is thought that they were caused by the chikungunya virus (Carey, 1971). Dengue virus belongs to the genus Flavivirus, Family Flavivaridae and there are four serotypes of the virus (DEN-1, DEN-2, DEN-3 and DEN 4). All the four serotypes can cause dengue fever, dengue hemorrhagic fever and even dengue shock syndrome (Ramchurn et al, 2009). The four viruses are closely related but are distinct. Millions of people residing in tropical areas of the world are affected by epidemics of dengue fever. Dengue fever is associated with the severe form dengue hemorrhagic fever/ dengue shock syndrome (DHF/DSS) that is seen mostly in children and nevertheless adults also are attained by the disease. In the 19th and early 20th centuries dengue or dengue-like epidemics were reported in the Americas, Southern Europe, North Africa, the Middle East, Asia and Australia and on various islands in the Indian Ocean, South and Central Pacific and the Caribbean (Ehrenkranz et al, 1971). Generally these epidemics consisted of nonfatal feverish illnesses, often coupled with rash and either muscle or joint pains (Carey, 1971). Deaths occurred during dengue epidemics in Australia in 1897 and in Greece in 1928, when over 1000 deaths were reported (Halstead, 1980). Hemorrhagic demonstrations, including gastrointestinal bleeding, were described during dengue epidemics in Texas and Louisiana in 1922 (Scott, 1923). Nevertheless through the first half of the 20th century, dengue was generally described as a self-limited, nonfatal febrile illness, with occasional hemorrhagic manifestations such as red spots, acute hemorrhage from the nostril, nasal cavity, or nasopharynx, gingival bleeding and menorrh agia that only once in a blue moon resulted in more stern or fatal outcomes. During the last decade, dengue infection along with its complications has been on the rise all over the world. Their geographical spread is increasing: only 5 countries documented dengue in the 1950s but to date there are more than 100 countries reporting the incidence of dengue fever and dengue hemorrhagic fever (Guha -Sapi Schimmer, 2005). Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas (WHO, 2009). Dengue fever is a very infectious mosquito borne viral disease characterized by either a mild febrile syndrome or the classic incapacitating disease with abrupt onset of high fever, severe headache, pain behind the eyes, muscle and bone or joint pains, nausea and vomiting and rash. Skin hemorrhages are not uncommon. Leukopenia is usually seen and thrombocytopenia may be observed (WHO 1997). Dengue is a flu-like mosquito-borne disease and has a soaring capacity for epidemic outbreaks, which according to the World Health Organization (2009) affects 50-100 million people each year in the tropical and sub-tropical areas of the world. Dengue is cited as being one of the most significant mosquito-borne disease affecting humans and as a major international public health concern (WHO 2009). Dengue fever is predominantly transmitted by Aedes species which have adapted themselves to living near human habitation (Hales et al., 2002). The dengue virus is a member of the family Flaviviridae virus, transmitted through the biting of infected Aedes aegypti and Aedes albopictus mosquito. The Aedes aegypti mosquito normally bites indoor and late in the afternoon whereas the proficient mosquito Aedes albopictus is an aggressive daytime biter, which is also known to bite early in the morning, late afternoon (Knight and Hull, 1952) and at night (Murray and Marks, 1984). This biter is usually an outdoor biting mosquito, but it also bites indoors (Hawley, 1988). Generally the mosquitoes bite at ground level (MacDonald and Traub, 1960, cited in Hawley, 1988). Females will bite any area of exposed skin, but prefer the ankles and knees (McClelland et al., 1973; Robertson and Hu, 1935). The time amid the bite of a mosquito carrying dengue virus and the apparition of symptoms ranges from 4 to 6 days, with a range of 3 to 14 days. 2.0.2 Pathogenicity of Dengue fever: 1. Asymptomatic and mild infection It is very common. 2. Dengue Fever (primary infection) Dengue fever is characterized by increase in body temperature; severe aching of the forehead; retro-ocular pain; muscle and joint pain; and widespread maculopapular inflammation. Conjunctiva may become red. Other common problems that may arise are diarrhea, vomiting, nausea and abdominal pain. Fear of light, sore throat, increase in the size of the lymph node and bleeding tendencies may also happen. The illness lasts 5 to 7 days. Immunity is lifelong. On the other side the incidence of Dengue Hemorrhagic Fever or Dengue Shock syndrome increases if the person has immunity or has already been infected before with a different serotype. Even after several months of recovery some patients may experience depression and fatigue. 3. Dengue Hemorrhagic fever The well-known feature is bleeding. It happens when a person is infected twice but with a different dengue virus serotypes or infrequently by primary infection is common in kids Under 15 years of Age (Rigall-Pewrez et al.1998). There is sudden rise in temperature and other manifestations of Dengue fever. Petechiae, effortless bruising, gingival bleeding and epistaxis are common. In severe cases bleeding of the gastrointestinal tract can be observed. In children, we can have an increase in the size of the spleen and the liver. 4. Dengue Shock Syndrome The prominent feature is hypotension. It normally occurs in people below 15 years of age. The clinical features include weak pulse with narrow blood pressure, cold and clammy skin (Rigall-Pewrez et al.1998). 2.0.3 Mode of transmission of dengue virus: Chikungunya and dengue viruses are transmitted to humans by the bites of infected mosquitoes. In contrast, Aedes albopictus is abundant and may be the only important vector of these viruses on the islands. Both species bite mainly during the daytime, particularly in the early hours after dawn and for 2-3 hours before darkness. Aedes albopictus is more active outdoors whereas Ae. aegypti typically feeds and rests more indoors (WHO 2008). In the cycle of dengue, the vertebrate host is man and the Aedes species the vectors. The disease is acquired only when bitten by female mosquitoes, as the female feed on blood in order for the development of their eggs whereas the male mosquitoes are not infectious due to the fact that they feed only on nectars rather than blood. In 8-10 days the infected mosquito is able to transmit the virus to other people. Thus the cycle of transmission takes only 14 days. One dengue-infected female mosquito is capable of biting and infecting several people during one feeding session. The dengue mosquito frequents backyards in search of containers holding water inside and outside the home, such as: cans, buckets, jars, and vases, pot plant dishes, birdbaths, boats, tyres discarded with no rims, roof gutters blocked by leaves striking containers, tarpaulins and black plastic. It can also breed in natural containers like: bromeliads fallen palm fronds. In drier conditions it also breeds in water inà ¿subterranean sites such as: wells, telecommunication pits, sump pits, gully traps. Transmission cycle of dengue results from a complex system based on several main constituents like: the density of susceptible hosts, environmental conditions and the presence of one or more serotypes of the dengue virus. The number of confirmed dengue cases has been increasing owing to the fact that the world is undergoing rapid urbanization and its population is also on the rise, disposal of non-biodegradable containers, rapid transportation and poor living conditions such as poor water supply and very rare scavenging services at squatter areas (Satwant, 2001). Various studies have shown that the Aedes albopictus is able to transmit all the 4 serotypes of dengue. Aedes albopictus mosquito can serve as an important maintenance vector of dengue viruses in endemic areas, and new endemic areas may be initiated by importation of vertically infected eggs (Gubler, 2002). That is the infected Aedes mosquito can pass the dengue virus to its progeny and when the eggs will develop into mature mosquitoes they will be already infected, hence capable of causing infection of human beings or even pass the virus to their progeny. Transmission cycle of dengue virus by the Aedes aegypti mosquito starts with a person infected with the dengue virus. The blood of the person will contain the virus thus circulating in his body and this is called a viremia which will last for about 5 days. During this period, an uninfected female Aedes aegypti mosquito bites the infected person and acquires the dengue virus. Within the mosquito, replication of the dengue virus occurs and this process usually takes between 8-12 days, after which the female mosquito can transmit the virus upon a blood meal. Once infected the virus takes 4-7 days to replicate within the new host (the person whom the infected mosquito bite) before inception of symptoms. Symptoms may last from three to 10 days, with an average of five days, after the onset of symptoms. Hence, the disease persists several days after apparition of symptoms (CDC Dengue Slideset). 2.0.4 Lifecycle of Aedes mosquito: The mosquito goes through four separate and distinct stages of its life cycle and they are as follows: Egg, Larva, pupa, and adult. Each of these stages can be easily recognized by their special appearance. Egg: Eggs are laid one at a time and they float on the surface of the water. Aedes species do not make egg rafts but lay their eggs separately. Aedes lay their eggs on damp soil that will be flooded by water. Most eggs hatch into larvae within 48 hours. Larva: The larva lives in the water where they eventually undergo a molting process to become a pupa. Pupa: The pupal stage is a resting, non-feeding stage and is the time the mosquito turns into an adult. It takes about two days before the adult is fully developed and upon complete development, the pupal skin splits and the mosquito emerges as an adult. Adult: The newly emerged adult rests on the surface of the water for a short time before flying away. In the Aedes mosquito family only the female bites because it requires protein to develop eggs, therefore if it bites a person infected with the dengue virus the mosquito becomes infectious after approximately 7 days. The mosquitoes are known to be biting at a highest frequency at dawn and dusk. Some more facts: The average lifespan of a mosquito of the genus Aedes in Nature is 2 weeks Mosquitoes may lay eggs about 3 times in his life, and about 100 eggs are produced each time. The eggs can live in dry conditions until approximately 9 months, after which they can hatch if it is subject to conditions, i.e food and water Source:http://dengue-feverdisease.blogspot.com/2008/02/lifecycle-of-aedes-mosquito.html [accessed on 05.12.09] 2.0.5 Investigation for dengue infections: Laboratory results Decrease in the number of white blood cell and peripheral neutrophils in the blood, abnormal increase in the number of lymphocytes in bloodstream and very low amount of platelets in the blood. Radiology X-ray of the chest normally shows pleural effusion and seldom pericardial effusion Ultrasound Used to detect pericardial effusion and 2) presence of excess fluids in the gap amid the tissues lining the abdomen and abdominal organ. Tests Laboratory diagnosis is done by detection of virus in specimen-serum at the virology laboratory. Culture is done in cell line derived from A. albopictus cell. Immunoflurescent techniques are used to detect viral replications. The virus can be isolated in patients with fever. Serology IgM is detectable in 90 % of patients by the 6th days of illness. Serum collected early may give false negative result. IgM can also be detected 2-3 months after. It is not possible to identify serotype with serological tests. In case where the IgM test is Positive it may imply recent infection with Dengue fever. However definitive diagnosis can only be made if the virus is isolated or the virus genome is detected by PCR. Seroconversion or boost in titer may indicate fresh infection. The appropriate samples for PCR test include plasma and serum. Molecular test is highly sensitive but it can be used in patients only with viraemia (Rigall-Pewrez et al.1998). 2.0.6 Treatment: The managing of dengue fever can be enhanced with bed rest, passable fluid intake, plus control of fever and pain with antipyretics in addition to analgesics (e.g. paracetamol). For the supplementary ruthless manifestations of dengue virus infection, correct management requires early identification and swift intravenous fluid substitution. Blood transfusion may be necessary in cases. There is currently no vaccine is available to shield against dengue infection. The current lack of a booming vaccine against the dengue virus causes prevention methods to be approached by plummeting disease vector population, with Integrated Pest Management programs for mosquito control. These employ a mishmash of control strategies, including mosquito surveillance, source diminution, eradicating larvae and eradicating adult mosquitoes (Ooi et al. 2007). Eradicating adult mosquitoes alone is fruitless in controlling mosquito populations because it is complex to treat the unattainable habitat of the adults. Mosquito larvae are left to carry on their development, and they quickly swap the adults. Nevertheless, mosquitoes can become resistant if pesticides are overused. 2.0.7 Dengue fever in Mauritius: Dengue virus infections are emerging as the major ones in Southeast Asia. Global warming may worsen the occurrence of dengue fever. Since very last few years mixed outbreak of chikungunya and periodic cases of dengue fever have been reported on R‚union Island and other South West Indian Ocean countries. From March 2005 till March 2006 it is estimated that about 204000 people in R‚union Island may have been infected by the chikungunya virus, which furthermore shows that there is presence of the transmitting vectors of the disease on the island which are also the vectors of dengue fever as well. Hereafter, the other South West Indian ocean countries were not spared from infection from the chikungunya virus. An outbreak of dengue fever was reported in Madagascar more specifically in the city of Toamasina that started mid-January 2006 and rare cases of chikungunya were also reported mid-February. Maldives also have suffered from a dengue outbreak in year 2006 where 602 people were suspected to be infected among which there were some severe form of dengue fever that is 64 dengue hemorrhagic fever cases and 9 cases of dengue shock syndrome (WHO 2006). In Mauritius the first case of dengue fever dates to the 1976s and it was contained thus limiting the disease from spreading. Then we had a case of imported dengue from a person who visited an endemic dengue area in January 2008 (CDCU). The main vectors of the disease remain the Aedes mosquitoes, among which the Aedes aegypti mosquito is the primary vector and Aedes albopictus the secondary one. The mosquito found to be spreading dengue fever and Chikungunya in Mauritius is the Aedes albopictus (CDCU 2009). It is to be noted that in Mauritius we had both the Aedes aegypti and Aedes albopictus mosquitoes, due to the intense anti-malaria campaign during the year 1952 the primary carrier of the dengue fever, the Aedes aegypti have been successfully eradicated. Still very minute amounts of this mosquito can be seen whereas the Aedes albopictus is abundant. Dengue is transmitted from person to person through the biting of infected mosquitoes. Most recently we had a short-lived epidemic of re-emerged dengue fever in Mauritius that started in the month of June 2009 which was imported. The mild fever was first localized in the city of Port Louis, where there were 192 cases and then we did have some sporadic cases in other regions of the island. Mosquito fogging and larviciding in whole Port Louis started on 3rd June 2009, and were repeated every seven days. Fogging was carried out outdoors early in the morning, early evenings and sometimes till late in the evenings (Dengue Unit 2009). The Ministry of Health and Quality of Life of Mauritius took the situation as being severe and all medium possible to contain the disease were put into action. Like the Special Mobile Force and manpower from other Ministries which joined the Ministry of Health to fight the dengue fever. Public alertness campaigns on the requisite to hunt and eliminate mosquito breeding sites at home and in the neighbourhood and to protect oneself against mosquito bites were carried out through radio, television and the press through a public private partnership. Detailed information leaflets were also distributed, door to door distribution of pamphlets showing pictures of possible breeding sites for mosquitoes and products to be used to prevent mosquito bite were carried out by the primary health care personnels. Target groups included the public, community groups and school children (Ramchurn et al, 2009). By the end of the month August no new or suspected cases of dengue were recorded in any of the countrys hospital. But still the control and prevention program were continued throughout the island as the summer season was coming near hence reappearance of the dengue fever was possible due to the ambient temperature, favorable for larvae development. The fear of having the virus again was due to the possibility of the infected mosquitoes to pass the virus to their progeny. Fortunately, till February 2010 no suspected case of dengue fever was reported from any in the country (Dengue Unit 2010). 2.1 Vector surveillance and control program Ever since mosquitoes are capable of transmitting diseases like dengue and chikungunya, till now it has not been possible to eradicate the mosquitoes completely from their originating site. The best way to monitor or control vector-borne diseases is to control or limit the population of the vector to such an extent that disease transmission is very low or even stopped. In order to achieve this goal, it is imperative to know all about the mosquito involved in the transmission of the disease. Detailed knowledge of all aspects such as the breeding sites, different features of the mosquito at different stages, feeding habits, mating, resting and structure and most importantly without forgetting the lifecycle of the mosquito, are the main required things in order to be able to break the chain of transmission. Furthermore, the only way to prevent infection of people who have not suffered from dengue is to control the population of dengue vector (Ooi et al.2001) and of course personal precaution has also proved to be effective in reducing the risk of being infected by a mosquito. Since no vaccine is yet available for dengue the only mode to control dengue fever is the control the amount of the disease vector that is of the Aedes mosquitoes. The control strategies of these mosquitoes are 1) carrying out larviciding -spraying a chemical called abate in any water retaining place which kill the larvae of the mosquitoes hence interrupting the cycle to be completed, 2) fogging operation- a thermal fogger is used to propel fumes of Aqua K-Othriner which when is in contact with a mosquito kills it, thus the amount of developed or simply mature mosquitoes are reduced and 3) health education- talks are organized for the members of the public, for children in schools, colleges, etc. Entomological survey is an important and integral part of dengue prevention and control. The effect of the intervention by the community can directly affect the ecology of the vectors that is the Aedes mosquitoes. The Communicable Disease Control Unit (CDCU) is the unit which is mostly concerned for the control of communicable diseases such as Malaria, Dengue fever, Chikungunya, and other infectious diseases. In Mauritius, surveillance, disease prevention and education of infectious diseases are mainly carried out by the Health Inspectorate Cadre. In Mauritius, we have the Public Health Act (Section 32A) which is used in case where there is presence of a mosquito borne disease in the island. The potential for predation to prevent pathogen invasion or reduce disease prevalence in a host population also has implications for the biological control of vector populations. Predators have been introduced, or proposed, as biological control agents of vectors for various diseases such as malaria, dengue fever and Lyme disease (Jenkins 1964; Legner 1995; Stauffer et al. 1997; Samish Rehacek 1999; Scholte et al. 2005; Kumar Hwang 2006; Ostfeld et al. 2006; Walker Lynch 2007). Several recent studies suggest that predator introductions led to a decline in local cases of dengue fever in Vietnam and Thailand (Kay Nam 2005; Kittayapong et al. 2008), and malaria in India (Ghosh et al. 2005; Ghosh Dash 2007). 2.2 Biology of Aedes albopictus (Skuse) Aedes albopictus are two winged insects from the family Culicidae of the order Diptera. They are among the best known groups due to their importance as pests and as vectors of diseases. They are easily identified due to a combination of the following characters: long trunk projecting head; charisma of scales on the wing veins, a tassel of scales along the posterior boundary of the wing, and the typical wing venation, the second, fourth and fifth longitudinal veins being branched (Miyagi and Toma 2000). Female mosquitoes feed on blood and they have highly specialized mothparts for piercing host skin and blood sucking (Wahid et al. 2002). Aedes species are normally day-time bitters and active during the day. During this time, they have peaks of landing and biting activity. The peak time for Aedes albopictus occurred about one hour after sunrise and then before sunset (Abu Hassan et al. 1996). Nevertheless, the rate of biting varies depending on the mosquito age and time of the day (Xue and Barnard 1996). CHAPTER 3 DATA COLLECTION 3.1 Introduction In this chapter, a summary of the various steps that was undertaken to finalize the research is attempted. The research work was started as from the month of September 2009 to the end of January 2010. 3.2 METHODOLOGY In order to assess the effectiveness of the control measures taken to prevent dengue fever, data were collected from the different partners who are involved in the control and prevention of dengue fever in Mauritius. Such data were collected from books, newspapers, published articles, magazines and official statistics from the Central Statistics Office, Dengue Unit, Communicable Disease Control Unit and the Ministry of Health Quality of Life. Moreover, constructive discussions were entertained with people who are in touch with the matters connecting to the piece of work. Search through the internet, review of available documents and properly classifying the information that would be used during the study. 3.3 METHODS OF ANALYSIS OF THE DATA OBTAINED Questions related with the way of application of the different control measures were selected for analysis from the filled questionnaires. Moreover, each particular question was analyzed by using SPSS software which provided the frequency and percentages and hence Microsoft Excel 2007 was used to express the data in forms of percentages, tables, figures, graphs, pie charts and charts. Chapter 4 Part I-Data Analysis 4.01 Introduction This chapter of the thesis will be dealing with the data collected from different stakeholders involved in the fight against dengue fever. Data collected mainly from the Communicable Disease Control Unit, Dengue Unit, and certain Health Offices of the country and the media will be expressed in figures. This section will be divided in to two parts: data analysis and press cot analysis. Much attention will be oriented towards the control measures in Port Louis, as the maximum number of cases occurred there and eventually the island in whole. 4.02 Progress of the disease through June 2009 in Port Louis Figure 4.1: Number of cases each day during the month of June 2009 From figure 4.1 it can be seen that the first case was detected on 2nd June 2009 and the maximum number of cases reported to the hospitals was around the 10th to 13th day of the same month. The number of confirmed cases by the end of June 2009 had decreased to less than five. 4.03 Age of people infected with dengue virus From the above chart (Fig 4.2) it can seen that about 34.55 % of the total number of cases (246 confirmed) of dengue were vulnerable ones that is the young and the elderly. 4.04 Aqua K Othriner used for fogging process Aqua K Othriner is a chemical used in mixture with another chemical substance called Nebolr, in thermal foggers to kill adult mosquitoes. Normally, the fogger produces fumes which in fact are fine droplets of the mixture which when in contact with a mosquito causes its death. The first day of fogging was started on 2nd June 2009 with a minimum cubic centimeter of Aqua K Othriner used, on the 7th day the maximum and throughout the rest of the days varying just a little in amount except for the 14th day. 4.05 Number of inspections carried out during the past 8 years throughout the Country Starting from the year 2001 till 2005 from the graph (fig 4.4) the number of inspections carried out by the health inspectorate cadre shows a slight decrease and suddenly in 2006 the number increases to approximately 3 fold than that in 2005. In year 2007, the amount of inspections carried again decreases to 112,087 and eventually for 2008 the number decreases a bit more. 4.06 Number of sanitary notices served during the past 8 years Public Health Act Sanitary notices are normally issued to the author of nuisance, as for in this case the notices served were to cause removal of water collected in used tyres, drums, roof tops, etc. From the year 2001 till 2005 the number of such type of notices served was ranging between 4933 and 8013. For 2006 the figure was the highest with 10657 of notices served and for the remaining 2 years a gradual decrease was noted. 4.07 Number of contraventions taken for none compliance with the Public Health Laws Notices Figur