Problem: What problem is this project trying to address?
Dengue is caused by four closely related viruses transmitted by Aedes Aegypti mosquitoes. Dengue is a worldwide epidemic, persisting in over 100 countries, and is found primarily in urban settings in the tropics. Between 50 and 100 million cases of dengue are reported around the world each year and over 2.5 billion people are at risk of infection. Several hundred thousand dengue cases each year result in dengue hemorrhagic fever, which usually affects children under 15 years of age. The average fatality rate with dengue hemorrhagic fever is five percent.
The majority of people infected with dengue develop Dengue Fever (DF), which is a “flu-like” illness that is not life threatening. However, some infected people develop a severe life threatening form of the disease known as Dengue Hemorrhagic Fever (DHF). Typically, less than five percent of people infected with dengue viruses develop DHF, but the fatality rate of such DHF cases can be very high (30% to 40 % in Sri Lanka prior to the implementation of Dr. Kumar's methodology). Although scientists are still far from understanding why only some dengue infections lead to hemorrhagic disease, it is clear that factors such as age and previous exposure to dengue infections increase risk of severe disease. Of more than 70 countries with dengue as a serious public health problem, only two (Cuba and Singapore) have succeeded in controlling dengue by reducing mosquitoes. Even in these two countries, the mosquito has not been completely eliminated, and dengue epidemics have returned in recent years.
Dengue patients in critical condition should be treated in Intensive Care Units (ICU), but such facilities are in limited supply in many countries. In Sri Lanka, only a few government hospitals have such units and, even where they exist, spare beds are rare. Moreover, the blood transfusion and platelet transfusion services sometimes needed for critically ill dengue patients are not available in most hospitals. Beginning in 1989, clinicians started to observe more cases of DHF in Sri Lanka. Initially, most of the cases were reported from the capital city of Colombo and the southwestern coastal belt. After the year 2000, the magnitude of dengue epidemics increased and the virus started to spread to other parts of the country as well. DHF is reported from almost all districts in the island nation. The years 2004 and 2009 recorded over 15,000 and 35,000 cases of suspected dengue respectively. Between 2009 and mid-September 2010, dengue fever infected over 65,000 people in Sri Lanka and caused 563 deaths. An island-wide outbreak of dengue fever in Sri Lanka in the last three years has underlined the steady deterioration of public health care and preventative measures to contain the disease. The largest caseload was reported in 2009, which had 346 deaths and over 35,000 infections.
The prevalence of dengue is steadily increasing in Sri Lanka and around the world, continuing a decades-long trend. With global temperatures warming, it is expected to become a pandemic in countries that never had dengue before.
Solution: What is the proposed solution? Please be specific!
Dr. Lak Kumar's work is motivated by his belief that dengue fever is a predictable and treatable disease, and therefore conventional methods of treatment can and should be improved upon. His work has also helped to dispel public fear and common misconceptions surrounding dengue fever, and his new approach to treatment has shown that infection of dengue fever does not have to result in patient death.
Dr. Kumar's new approach to treating dengue fever is the result of a close analysis of dengue fever death in Sri Lanka. In 2009, Dr. Kumar studied all 64 child deaths due to dengue fever at Ragama Hosptial, where he was posted as a pediatrician at the time. His work went beyond merely studying patient records; Dr. Kumar visited the homes of each of the deceased in order to analyze the patient’s complete medical condition. During his analysis, he spent time in Thailand with a team of doctors who worked in regions with high incidence of dengue fever. With Thailand-based Professor Suchitra Nimmannitya, Kumar discussed his findings. Nimmannitya's team believed that fluid management was the most important part of reducing dengue fever mortality. Dr. Kumar realized that successful treatment of dengue fever in Sri Lanka, and all over the world, was more about proper doctor training and less about a lack of medical resources. Upon returning to Sri Lanka, Dr. Kumar discovered that standards for fluid management in dengue patients were not uniform in Sri Lanka or globally, leading to many unnecessary and treatable deaths from the disease.
In addition to championing the standardization of fluid management therapy for dengue fever treatment, Dr. Kumar has also established a fully equipped Dengue High Dependency Unit (DHDU) in Sri Lanka that encompasses a national hotline, a 24-hour doctor information service, and a new round-the-clock blood monitor system. As a result, Ragama Hopsital has had zero deaths due to dengue fever.