Porters 5 Market Forces Essay

This model focuses on the study of the competitive influences or ‘forces’ on a business. When we discuss competitive factors on a firm, we usually consider other firms within the same industry selling similar products. [1] and although it is true that other firms in the same industry present competition, Porter challenged this over simplified view by considering other forces that will also affect the firms competitive ability . The diagram below highlights the 5 main forces. 2. Potential Entrants into the market This force is concerned with the new firms that may try to enter the same market thereby creating more competition. If a firm anticipates this happening, it may try to raise the barriers to entry, in other words, try make it difficult for new firms to enter their. What barriers may a firm use and why may governments try to stop the barriers to entry? 3. Technical Threat with Substitute goods This is a different threat from those firms selling similar goods as it’s a threat that comes for firms selling alternative/substitute goods. Technology for example has enabled us to use phones to take photographs and this has presented a huge threat to firms producing and selling cameras and camera related products. It is important for a firm to look substitutes and not just similar goods. What substitutes may exist for a restaurant that could impact its sales? 4. Bargaining power of suppliers The power of suppliers will be able to in turn influence the competitive ability of a firm as they will be able to influence the amount and reliability of suppliers as well as the cost if the suppliers. The fewer the number of suppliers the more power the suppliers would have. For example in the micro chip market there are 2 main suppliers, Intel and AMD. These 2 suppliers can make decisions that will in turn influence the competitiveness of the firm. If the suppliers impose penalties and costs when a firm changes over, this too will impact the competitive ability 5. The bargaining power of the buyers Buyers/customers have enormous control over an industry when there are lots of similar and/or alternative goods. Because they can move from one firm to another. If the industry makes it easy for customers to switch to other firms then this also gives the customer more power. The Government introduced a rule for the mobile phone industry that makes it easier for customers to change from one provider to another? What was this rule? What have mobile companies done to try reduce this movement between providers?

The Opinions of the Renaissance and Reformation

Throughtout the ages of Europe's history, society's views on the education of women has constantly changed. During the Renaissance age, noble women were encouraged to seek an education so they would be able to carry on intellectual conversations at social gatherings. The Reformation brought opinions which were completely opposed to the ideas of women getting an education and most people thought that women shouldn't learn and form their own opinions. The 17th and 18th centuries displayed a betterment in society's views on women's education because people believed that middle class women should also gain some knowledge so they'd be able to help their husbands in his trade. The Renaissance age's views on education were purely involved with noble women and no one else. Women who were below the noble class were not expectd or encouraged to gain an education at all. The women who were noble were encouraged to gain an education so they would make their husbands look good and they'd be useful at social gatherings because they would be able to socialize with other educated people. Society viewed women's potential to learn as equal to a man's, but the women were not completely expected to get involved or pursue the political or professional jobs that the educated men had. The women of the Renaissance's education was almost entirely for entertainment purposes only. The Reformation brought opinions which were far more negative than the views brought on from the Renaissance age. Women were thought to only be useful for taking care of children and carrying out the duties of keeping the house clean. People believed that women were also physically built to do those jobs, so they believed that God wanted them to do only that. Men did not want women to gain any education because they believed that if women formed their own opinions, it would cause chaos. The 17th and 19th centuries brought out more positive opinions toward the education of women compared to the opinions of the Renaissance and Reformation. Instead of just the noble women seeking an education, middle class women were now also encouraged to learn. The reasons why the middle class women should learn was a bit different from why the noble women were encouraged to learn though. While it was just for entertainment purposes with the noble women, middle class women were encouraged to learn so they would be able to help their husbands carry out the duties of his trade. If the husband was to die, the woman had to know how to take over her husband's trade and continue it without him, so she needed to be educated. Women were not encouraged to seek knowledge about other things which did not involved the trade they were involved in though, but nevertheless, the 17th and 18th centuries broadened the scope of education for women and included more women into it. Society's views on the education of women changed throughout the times. There still is no clear distinction between the ages and their opinions because through all the ages, men still did not view women's education as being important. The evolution of women's education was also not a gradual step towards betterment. It was more like a roller coaster; going up and down, switching from positive to negative to positive again. In the end, everything eventually got better and led to the views and opinions on the capabilities of women that we have today.

The Things They Carried Rhetorical Analysis

The Things They Carried Prompt: How do the symbols, imagery, and anecdotes in The Things They Carried help to contribute to the meaning of the text? The Things They Carried, written by Tim O’Brien, recounts the horrible experiences of soldiers at war in Vietnam. Throughout the novel, the author not only tells war stories, but tales about his own life, often referencing and dwelling on those who have made an impact on his life. He stresses the importance of these people and stories, often referring to them as â€Å"war stories† although many of these are not true.They serve as an outlet for O’Brien, allowing him to let go of these horrible memories but also letting him keep the importance that they had on his life. These stories and messages are emphasized through the symbols displayed in the novel, the imagery used throughout, and the anecdotes that recount his memories. The symbols in The Things They Carried help to make the text more meaningful and further comm unicate the theme the novel displays. One of the symbols, the dead Vietnamese soldier, represents the horrors of war and what soldiers have to experience on the battlefield.Although it was never completely clarified whether O’Brien did or did not kill the man, the guilt he relays through the text shows that he does not want to be in war, but it is expected of him to kill others since he is involved. He does so to prevent scorn from society upon his return. The author copes with the death of the Vietnamese soldier as he does with others throughout the novel; he fantasizes about what kind of person the soldier was, what he did before the war, and what he will do after.He creates the soldier’s life in his mind, saying that â€Å"After his years at the university, the man I killed returned with his new wife to the village of My Khe, where he enlisted as a common rifleman with the 48th Vietcong Battalion† (O’Brien, 130). The man is a symbol of who the author h oped to be instead of who he was at war. The author himself was about to go to college, but was unable to do so in his life, so fabricated the soldier’s past to live out his dreams in a different manner.Even though he did not know the man, he still feels and remembers the loss like the soldier had a significant impact on his life. O’Brien keeps those that have passed on alive in his memory, and this is one of the many continuous themes of the novel. The uses of imagery throughout the novel help to bring more meaning and importance to the theme the novel holds. In many of the important events in the novel, imagery is utilized to stress the significance of the event. When Kiowa dies in the novel, the use of imagery shows the importance of Kiowa to the entire troop, and how his death happened.When describing his dead body, O’Brien includes the details that â€Å"A piece of his shoulder was missing; the arms and chest and face were cut up with shrapnel. He was cove red with a bluish green mud† (O’Brien, 175). This description of Kiowa’s dead and decomposing body helps to bring the reader into the war itself, and what the author was feeling at this point in his life. Not only does this imagery convey to the reader the condition of the body, but it also communicates the reality of war and the effect it has on the people involved.However, the author keeps Kiowa both alive through the text and in his memory, stating that a true war story is never completely true. This shows that although most of the novel is most likely fabricated and completely false, it still relates the general experience of the war and these experiences keep the war alive in the author’s memory. Many of the stories within The Things They Carried are short anecdotes, and they give examples of the war stories that O’Brien has both experienced and heard. These tales essentially make up the book, and thus are very important to the meaning of the n ovel.The author often recounts his experiences with those who have passed on even though these stories seem to have no relevance to the text itself. For instance, he remembers his first experience with love and loss on meeting Linda when he was in elementary school. â€Å"When I write about her now, three decades later, it’s tempting to dismiss it as a crush, an infatuation of the childhood, but I know for a fact that what for each other was as deep and rich as love can ever get†(O’Brien, 228). This love he felt for Linda was true, and even similar to the love he felt for many of the men in his troop.Even though O’Brien has not seen Linda or heard of her for three decades, she is immortalized within his memory, and as a result, he thinks about her often, as he does with other deceased characters in the book, such as Kurt Lemon and Kiowa. This memory of Linda shows that the book was not written only to recount his experience in the war, but to also remembe r those who have passed on through the text, and this shows that even when people die, they are never truly forgotten. The symbols, imagery, and anecdotes used throughout the text help to prove that no one single person is every truly gone from someone’s memory, and every memory has an mpact on one’s life. O’Brien uses symbolism to refer to the war at many points, and his memory of the man showed who he wished he was rather than what he really became. The symbolism used when describing Kiowa’s death shows the horror and reality of war, and well as the immortalization of people in the author’s memory. O’Brien’s anecdote involving Linda and his first experience with love shows this remembrance of the dead as well. This anecdote, along with others, brings more meaning to the story. These messages involved in the book help to bring more meaning and importance to the text, and help to leave an impact on the reader’s life.

Regulation of Physiological Process by Thyroid Hormones Essay

Regulation of Physiological Process by Thyroid Hormones - Essay Example On the other hand, each function may be controlled by several hormones, which act in concert. The secretion of the hormones in a normal human being is mainly based on negative feedback control, most of which involves the hypothalamic-pituitary axis that detects changes in the concentration of hormones secreted by peripheral endocrine glands. The hormones may also be secreted in response to changes in a controlled variable (Nussey & Whitehead 2001). The following examples illustrate as to how hormones regulate physiological function. The thyroid hormones, namely, thyroxine (T3) and tri-iodothyronine (T4) are secreted by the thyroid gland. They stimulate the oxygen consumption of most of the cells of the body, help in the regulation of lipid and carbohydrate metabolism, and are essential for normal growth and maturation. The thyroid hormones enter the cells after which T3 binds to the thyroid receptors in the nuclei. T4 binds, but not avidly. The thus formed hormone-receptor complex then binds to DNA via zinc fingers and affects the variety of different of different genes that code for enzymes which regulate cell function. The main physiological effect of thyroid hormones is calorigenic action (Ganong 2003). The hormones increase oxygen consumption of most of the tissues in the body except brain, testes, uterus, lymph nodes, spleen and anterior pituitary. The hormones also increase the metabolism of fatty acids. Due to increased calorigenic action, nitrogen excretion is increased and endogenous protein and fat st ores are metabolized, which may lead to weight loss. The hormones also cause hepatic conversion of carotene to vitamin A. Other functions include an increase in cardiac output by direct action on the heart and also by activating heat dissipation mechanisms. The pulse pressure and heart rate are also increased, thus shortening circulation time. In the central nervous system, the thyroid hormones increase the responsiveness of the brain tissue to catecholamines, thus activating the reticular activating system. The hormones also affect brain development and reflexes. They increase the rate of absorption of carbohydrate from the gastrointestinal tract.

Should Children with Special Needs be mainstreamed into Regular Essay

Should Children with Special Needs be mainstreamed into Regular Classrooms - Essay Example e similar to natural hyperactivity but in greater degrees, to the extent of creating a real handicap for children in performing their day-to-day activities .†( p-9).Because certain similarities in hyperactivity exist in a normal child and a child with ADHD some people hold the view that ADHD can be handled with behavior therapies and other psychological counseling. In SEN magazine, a magazine for special education needs, there is a question put up to Dr.Christine Merrell (a member of National Institute for Health and Clinical Excellence- NICE) whether she views ADHD as not a medical condition but children behaving badly. She clarifies that it is not caused by â€Å"bad parenting† as is considered in one of the many myths regarding ADHD but â€Å"ADHD is a real disorder with real consequences for the child affected and their family and not simply a case of bad behavior† and if ignored â€Å"can have serious implications for the child in later life.†(23 Aug 2009). Dr.Merrell suggests drug treatment for children with ADHD which should be a part of comprehensive treatment plan that includes psychological, behavioural and educational advice and interventions. In the book â€Å"Teaching Young Children with ADHD†, there is an explanation of the role of neurotransmitters – dopamine and norepinephrine – in ADHD and how the medicines for ADHD act on them. There is a quotation in this book from Garber, Garber, and Spizman’s â€Å"Beyond Ritalin (1996) –â€Å"Learning occurs after an electrical impulse produced by a stimulus is transmitted and moves across a neuron- synaptic course several times. If in ADHD these neural bridges are blocked or incomplete, whatever is being learned does not become automatic.† The medicines of ADHD regulate norepinephrine and dopamine levels thereby improving brain function and self-control which directly help in academics. In children with ADHD, there is a lack of math and reading ability and fine motor skills which prove to be

What would you consider to be the most important socio-technical Essay

What would you consider to be the most important socio-technical issues that should be considered in an analysis of CourseNet - Essay Example (Ropohl, 1999) Computer Based Learning - Internet has revolutionized how we do day to day things, including learning. E-Learning or Web based learning is beneficial for individuals as well as organizations as it has many advantages. It not only provides flexibility & ease of access, but also the performances are improved & are better compared to students studying in traditional schools. A thorough investigation of the CourseNet   case requires grasp of most of these items.Setting sight on the entire system helps to avoid the trap of finding a singl point of blame.If an application is not working as desired , has bugs, fails too often it is easy to afix blame on the software programmer. However, this may not be a far-sighted approach. In an organization that does not have documented policies or procedures, it is easy to shift blame. For a project to be successful it is essential that roles & responsiblites clearly defined.Sufficient attention is given to various management aspects for e.g. Cost Management, Risk Management, Scope Management , Time Management etc. Project Management is an approach of planning, organizing & managing resources to achieve flourishing goals & objectives of specific project. All these aspects define the rate of success of a project. Effective project management pricnicpals & use of IT best practises such as defined by ITIL, SOX etc. are always helpful for project to proceed in an organized, phased manner. In the event of missing procedures or insufficient attention towards one of the procedures it is difficult to be reasonable & determine the breakdown in the work flow. Those belonging to the bottom of the food chain are often held responsible for making mistakes though a decision maker would have commited strategic or a tactical error . In the absence of necessary data points required for evaluation & lack of performance parameters can lead employees as well as

Importance of Organization culture to organizations Essay

Importance of Organization culture to organizations - Essay Example Organizational Culture refers to a pattern of learned behaviors that is shared and passed on among the members of an organization. It comprises of the various assumptions, values, beliefs, norms, rituals, language, etc. that people in an organization share. Organizational culture can be thought of as an evolutionary process that has been established, accepted and internalized over a period of time, by a majority of members of the organization. Fred Luthans defined culture as â€Å"the acquired knowledge that people use to interpret experience and generate social behavior.† Culture helps people to interact and communicate with other members of the society. Cultural traits are acquired gradually over a period of time. The differences in values and beliefs held by people all over the world make adjustments and interaction with people belonging to other cultures very difficult for some. To be successful in the global economy, it is important for all managers to be sensitive to the differences between them. People orientation is one of the characteristics of Organization culture. This is one thing that is lacking at Camford University.

Business environment Essay Example | Topics and Well Written Essays - 250 words

Business environment - Essay Example The UK is experiencing an increasingly ageing population which means that there will be a corresponding rise in demand for products targeted to this demography such as medicines, fashion and accommodation (Gillespie, 2007). On the converse, companies will experience increased costs in the form of pension payments to staff that are living longer. One strategy that firms are using to tackle the rising pension costs is to tap into this labour pool of older employees, by keeping them on the job longer. Of note also it that the ageing labour is being replaced by UK high net immigration trend that is the largest in Europe (Walayat, 2010). Economy Watch (2010). The Economy of the UK, GB, British Isles (or Whatever You Want to Call It!). [Online]. 30 June 2010. Economy Watch. Available from: http://www.economywatch.com/world_economy/united-kingdom/. [Accessed: 2 January 2012]. Elliot, L. (2011). George Osborne given stark warning on cuts’ impact. [Online]. 12 September 2011. The Guardian. Available from: http://www.guardian.co.uk/business/2011/sep/12/george-osborne-warning-cuts-impact. [Accessed: 2 January 2012]. Walayat, N. (2010). UK Population Growth and Immigration Trend Forecast 2010 to 2030. [Online]. 2 August 2010. The Market Oracle. Available from: http://www.marketoracle.co.uk/Article21565.html. [Accessed: 2 January 2012]. Weldon, D. (2011). The really big question in UK economic policy: What are low gilt yields telling us? [Online]. 20 December 2011. ToUChstone blog: A public policy blog from the TUC. Available from: http://touchstoneblog.org.uk/2011/12/the-really-big-question-in-uk-economic-policy-what-are-low-gilt-yields-telling-us/. [Accessed: 2 January

International Marketing Communications Plan 03062 Essay

International Marketing Communications Plan 03062 - Essay Example tage comes from its emphasis on social responsibility, ethical trade and delivering value to customers who believe in the same values as The Body Shop. The marketing plan proposes to use these values as a pillar to form the marketing strategy which would be directed towards the younger segment that is prone to adopting new trends early. The Body Shop International was set up by Dame Anita Roddick and sells skin and beauty products. The brand combines activism and marketing to encourage men and women to focus on social and environmental issues. The brand operates in 60 markets worldwide and has more than 2500 stores that work on a franchise based model. They also have the new Hemp Body Care line and The Body Shop at Home line as well. (The Body Shop, 2015) The brand believes in fair trade and has set up its own fair trade program called Community Fair Trade. This program involves 30 suppliers in 20 countries and provides 25,000 people worldwide with income to build their future. The Body Shop also sources its raw materials from their suppliers (The Body Shop, 2015). Since 1994, The Body Shop has helped raise funds and awareness for domestic violence. Since 2004, over 4 million pounds has been donated to partners who prevent, support and protect women and children from domestic abuse (The Body Shop, 2015). Protecting the planet is an important value for the Body Shop. They take full responsibility of their carbon footprint and aim to minimize their impact on the planet. This includes plants to reduce energy consumption and waste generation and change attitudes around the world about ecofriendly products (The Body Shop, 2015). The Body Shop does not face competition from well-known brand names like Mac, Sephora or Chanel because its product offerings and target market is different. In China, the competition comes from brands that originate from Japan or Korea like Missha or the Face Shop. These brands have already established a presence in the Chinese market and

Devil Facial Tumor Disease Essay Example | Topics and Well Written Essays - 1000 words

Devil Facial Tumor Disease - Essay Example As the report declares the DFTD is considered to have commenced in the Mount William National Park’s far north eastern region, from a prospect mutation. During 1996, Tasmanian devils with prominent facial tumors were snapped in the north-eastern Tasmania. After ten years, these features are found to be coherent with DFTD. This discussion declares that the cancer, DFTD, is found to be transmitted from one animal to another through biting either during fighting, eating or mating. It develops quickly, congesting the mouth of animal and then disseminates to other organs. The illness has consumed sixty percent of entire Tasmanian devils population since it was initially detected in 1996, and it has been predicted by some ecologists that it could efface the complete wild population till 2035. DFTD seems to be a cloned cell line, that is transmitted in the form of an allograft from one devil to another and this transmission may be found similar to that in CTVT and a communicable sarcoma infecting Syrian hamsters. The biology and prevalence of such vegetative cell parasites is typically unknown. The examinations of captivated Tasmanian devils suggest that this species has a tendency to develop tumors, specifically carcinomas. Nevertheless, DFTD is found to be significantly different from previously reported d evil cancers, and to determine its etiology is vital for the development of strategies to manage the disease.

Law and Policy Case Study Example | Topics and Well Written Essays - 750 words - 2

Law and Policy - Case Study Example Information security in an organization involves ensuring that only people with rights to read, change, broadcast and use it have access to it. Different organizations have their own policies which guide the implementation of any new system. Policies in an organization need employees to comply with them. Policies describe the rules and procedures for organization employ to comply with (Kiefer, Wu, Wilson & Sabett 2004). The need for information security is to primarily protect information from any unauthorized party. Several threats can pose to make information insecure. There is a need to ensure information is secure while ensuring that the policies and legal guidelines of the organization and the surrounding environment are adhered with (Kiefer, Wu, Wilson & Sabett 2004). Government and organizational policies dictate the implementation of an information security system. The government policies are determined and issued to organizations depending on the type or kind of governing en vironment within the organization’s operation. The government can be federal, state, local or tribal. The on the type of the business industry, the government policies act as a framework for organizations’ administration or management to comply with in order to secure information and information systems (Straub, Goodman & Baskerville 2008). The need for government policies is to control and regulate the relevant market in order to avoid conflicts which might arise among the industry players. The government policies give a procedure and guidelines for organizational governments to follow when implementing information security systems. Organization policies are devised by the organization as a guideline when implementing a new system. The policies are devised to ensure that laws, regulations and policies are complied to. The policies provide a framework for relevant restrictions and privileges for use of information for every employ. The organization policies strive to e nsure that people and information are protected (Straub, Goodman & Baskerville 2008). This is normally accomplished by setting the rules for access of information for each and every employee use of information (Straub, Goodman & Baskerville 2008). Organizational policies assists the organization in complying with governmental policies in order to avoid violation of the latter’s policies. The policies include the rules which control the actions of information users and management. The policies include authorization privileges for use of information, need for probe, monitoring and investigation on the use of information. The policies also include information infringement consequences, the information security baseline position by the organization. The policies restrict users from accessing what they are not supposed to in order to reduce risk and tampering of information (Straub, Goodman & Baskerville 2008). Organizations need information security policies in order to eradicate or minimize any looming risks associated with the use of information. The eminent risks can be unauthorized access to organization information either internally or externally. The policies set the laws required before the use of any information or implementation of

Analysis of Proverbs Essay Example for Free

Analysis of Proverbs Essay These two selections illustrate the paternal relationship God has to humankind and focuses on the role discipline plays in affirming that relationship. The excerpt from Proverbs is direct in its message to the children of God. We are supposed to receive discipline with a sense of gratitude because it gives meaning to the act through its divine motive. Though the initial response to discipline may be to resent or even rebel from it, this passage tells us that the act of discipline should not be perceived as an oppressive force. Instead, His love is proven by His willingness to exact punishment for our deviance. The Hebrews passage delivers a more subtle message through its significantly more complex approach to the subject. Here discipline is understood through the conduit of punishment, and the more general concept of punishment is compared to the pain and suffering Jesus suffered as a blood sacrifice for human sin. When making the comparison between blood sacrifice and human punishment the point is clearly made what is considered â€Å"pain† by humans is relatively trivial. However, the point of this passage is not to demean the children of God. Instead, it addresses the love inherent in such punishment. Like the passage from Proverbs, the Hebrews excerpt is intended to point out the caring nature that is part of the discipline God exercises. Punishment is intended to elicit self-discipline in the minds of Gods children so that the future crucibles in the road of an individuals spiritual life can be faced with assurance and equanimity. Discipline is often misunderstood in the formation of the spiritual life. Too often it is perceived as negative. This is understandable of course when we realize the development of self-discipline normally begins with an external assertion of discipline. As such, an external force working against our inherent nature, we are liable to put up a fair amount of spiritual resistance. This resistance is most often manifested in our individual sense of pride. This pride is the first stumbling block we must overcome on our path to true resignation to the mind of God. The pride we feel is intimately linked with our love of living life according to our own pleasures. Discipline, both in its external and internal manifestation, is a regulatory force that moderates this propensity for individual pride and indulgence. Discipline is a theory as much as it is a practice. The message of discipline is moral. Without the moral guidance provided by discipline and individual is free to follow a pleasure principle exclusive. Such a pursuit leads inevitably to an immersion in sinfulness and weak moral principle. However, discipline is not merely a restrictive force. It is also a transcendent one. By maintaining discipline we step closer to the spiritual goal of resignation to Gods will. The man or woman of true discipline is capable of walking in the path God sets before them because they have attained an intuitive understanding of spiritual faith. Paradoxically, the attainment of true discipline can ultimately become liberating, allowing the individual to feel comfortable amidst a wilderness of worldly temptations. The inner security of a dependable moral compass allows a person to exercise a pious life without having to be continually reminded of prescribed morality. The true inner sense of what is sinful and righteous becomes so intuitive in a spiritually disciplined person that walking the path of goodness is a matter of character, not a matter of choice. The world of goodness will triumph in the mind of someone who understands the way to discipline is through seeking and embracing the rigors of a live lived well. The greatest model for discipline we have as Christians is in the life of Jesus. His resignation to the plan for him conceived in the mind of God is a metaphor for the acceptance we must all eventually come to in order to find spiritual peace. Like Jesus, we are placed into a narrative leading to some ultimate fulfillment. While we are not asked to assume a burden as dramatic as His, we are supposed to find a way to accept the challenges placed before us. His goal was to save all His children from the inherent stain of being human. Our goal is merely to deal with our own confusion of how to be who we are with a sense of loving what is right. The spirit is a thin and airy thing, but it is not fragile. It waits to receive the nourishment only discipline can provide. The mindful attention to doing what is moral is that elusive quality that binds the soul to the body. This bond, once it is secured, is unbreakable. The body and spirit in accord is one of the strongest elements in the world, and one that remains attainable for anyone willing to invest the hard work it requires. Many people believe that discipline then is merely a means to achieving some ethereal reward. However, this is an unethical motive for infusing discipline into ones spiritual life. The only ethical reason for pursuing discipline is for its own rewards. Discipline must ultimately be its own single and self-satisfying goal. By expecting some final reward out of it, we are essentially undermining the self-denying principle of discipline itself. Discipline is the end in and of itself. To expect more than that is to falsify its attainment.

Project management research approaches

Project management research approaches Contents Abstract†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 1.1 Determine and validate appropriate areas for research 3 1.2 Determine a suitable research approach.. 3-4 1.3 Develop suitable research questions/ hypotheses for selected area of research 4-5 2.1 Develop a detailed research proposal for chosen..5-6 2.2 Apply relevant research methods for area and type of research.. 6-7 2.3 Analyse ethical issues relating to research.. 8-9 2.4 Analyse research findings and generate valid conclusions.. 9-11 3.1 Evaluate research methods, techniques 11-12 3.2 Present results and conclusions in a suitable format for audience. 12-13 Bibliography.13 Introduction Research is undertaken within most professions. It is a way of thinking, examining critically the various aspects of the professional work. It is the process of collecting analysizing and interpreting information to answer questioins. Determine and validate appropriate areas for research The first task in a research work is to collect data and information about the topic. The researcher uses the data collected in the survey to find solution , within the boundry of random mistake. Performance management can be defined as a process of taking systematic action to improve organizational, team and individual performance. Project management is the application of knowledge, skills and techniques to execute projects effectively and efficently. Project management process falls into five groups: Initiating Planning Executing Monitoring and Controlling Closing Every study has two aspects: Study population People Subject Area Problems Program Phenomenon Determine a suitable research approach Generally there are two ways of reasoning used for research: Deductive approach Inductive approach Deductive Approach Deductive approach takes into account, developing a hypothesis which takes into account an already existing theory and then formulating a research strategy to check the hypothesis. ( Wilson, 2010, p.7) Deductive means reasoning from the particular to the general. Deductive approach involves in developing a theory, which is subject to accurate test. This approach infers to generalisation. To make a generalisation through deductice approach, it is necessary to select samples of sufficent numerical size. (Collis and Hussey, 2003). Snieder and Larner (2009) informs that in deductive approach reasoning starts with a theory and leads to new hypothesis, that will be confirmed or rejected as a result of research’ Theory — Hypothesis Observation -Confirmation/Rejection Inductive Approach The research using inductive approach is concerned with human’s behaviour and the context in which certain events take place. This approach allows one to provide subjective reasoning with the help of various examples. It lays emphasises on meaningful understanding of human attachment to the event. This is related to development of human resources in the organization (Ritchie and Lewis 2003). Four approaches are Logical theoretical approach Quantitative approach experimental research Qualitative approach – observational research Participatory – action research. Develop suitable research questions/ hypotheses for selected area of research Research questions Generally interest in a specfic area starts the research process, but it is the familarity with the subject that helps to define an appropriate question for study. Knowledge of present trends and technological advances help in formulating research questions. All questions should be developed at the begnining and planning stage of study. Any additional question should never compromise on primary questions. The more the number of questions, more will be complexity of study and its analysis. Hulley and colleagues have suggested the use of FINER ( Feasible, Interesting, Novel, Ethical, Relevant) criteria in preparing qustions for research. Research Hypothesis The research question and hypothesis should be developed before start of study. The formation of hypothesis results a study with focus. It guides as to which data is to be collected and which not. The hypothesis is developed from main research question and thereafter elements of study – sampling strategy, intervention comparision and outcome variables – are summarizedin the form that prepares ground for testing, stastical and finally clinical sagnificance. The hypothesis should be stated at he begnining so as to guide the objective of study. Hypothesis bring clarity, specificity and focus to a research but are not compulsary for a study. A valid research can be conducted without constructing formal hypothesis. As there are so many ways to ask questions, the questionnaire should be flexible, tested carefully before using on a large scale. Questions should be kept simple and short. Avoid leading questions. Open ended questions allow for a larger variety of responses from participants but are difficult to anlyse statistically because data have to be coded or reduced in some manner. Close ended questions are easy to analyse statistically, but they limit the responses that participants can give. Combination of both beginning with a number of closed ended questions, it ends with a section of open ended questions for more detailed response. 2.1 Develop a detailed research proposal for chosen area of research Research Proposal Research is a systematic investigation to find answers to a problem. Both qualitative and quantitative methoods be used appropriately in the research. Research proposal reviewer will lookatthree primary criteria: Relevance of the research from both managerial and an academic perspective. Managerial: will the research bring added value to improve managerial practices? Academic: will your research bring new knowledge to your field? 2 Research feasibility Within specifiedperiod Data accessibilty Primary data collection 3 Proposal Quality Writing style Logical articulation of arguments Structure and organization Some skills that need to be developed in areas of research: Decision making Prioritizing Valuating To respond to problems, experiences and opportunities and to learn from them To generate ideas without limits of policy ir structure or feasibility Involving other people Communicating. 2.2 Apply relevant research methods for area and type of research There are two types of data Primary Data – collected for the first time. Secondary Data – which has already been collected and analysed by some one else. Primary data collection Observation Method It is collection of primary data by researcher’s own team under his observation, without asking from respondents. Observatons can give information which people are not willing or unable to provide.e.g. observing a large number of plates containing uneaten portions of same menu item indicates that food was not satisfactory. But because of certain limitations, research is generally supplemented with survey research. Survey method This approach is suited for collecting descriptive information. Structured Survey- uses formal list of questions for all the participnts of the survey. Unstructured Survey – in this process interviewer probes the participants and guide the participants according to their answers. Research can be direct or indirect. In direct approach researcher asks direct questions about behaviour and thoughts, e.g., why don’t you eat at this restaurant? But in indirect approach the question asked will be, what kind of people eat at this particular restaurant? Contact Methods Survey can be conducted by collecting information through mail, telephone, or postal interview. Mail questionnaires is used to collect large amount of information at low cost. As no interviewer is involved to bias the respondents answers. In this case response rate is lw and there is no control over who answers. Telephone interviewing is a quick method, allows greater sample control and response rate is higher than mail. Its cost is higher. Interviewer’s manner of talking maay effect answers. Personal interviewing is very flexible and can be used to collect large amounts of information. It may cost more than telephonic survey. It can be biased by the interviewer. Sample design The conclusions are genarally drawn by taking a group as a sample. A sample is a segment of popukation selected to represent as a whole. Secondary Data Collection Secondary data is others data, and is shared by other people as a view of their perception. Many researchers requires collection of primary data to support the secondary data. The secondary data is collected from existing sources e.g. official ststistics, annuak appraisals, journals, history and articles. Types of Research There are different types of research for different purposes Audience research Market research Production research 2.3 Analyse ethical issues relating to research The collection of data through any methos involve some ethical issues relating to both the researcher and the participants. Ethical issues concerning Participants Collecting Information: If one cannot justify relevance of the research, he is wasting his participants time ,which is unethical. Seeking Consent: In every field it is unethical to collect information without knowledge of participant and their expressed willingness and informed consent. Consent should be voluntary and without any kind of pressure. Providing incentives: Giving a present before data collection is unethical. Seeking Sensitive Information: Certain information is considered sensitive or confidential by some people. For most people questions on income, age, marital status, drug use, etc. are intrusive. It is not unethical to ask such questions, if we tell the participants type of information you are gong to collect clearly, and give him sufficient time to decide if he wants to participate. Possibility of causing harm to participants: Collection of data should not harm participants in any way. If the way information sought creates anxiety or harrashment, steps be taken to prevent it. Maintaining Confidentiality: Sharing information about a participant with others for purposes other than research is unethical. Information provided by participant be kept anonymous. It is unethical to identify an individual’s responses. Ethical issues relating to Researcher: Avoid Bias: Bias is an attempt to either hide orhighlight something disproportionate to its true position. Bias on the part of researcher is unethical. Provision or deprivation of treatment: Both provision and deprivation of a treatment/ intervation may pose ethical dilemma for a researcher. Ensuring informed consent, minimum risk and frank discussions as to the implications of participation in the study will help to resolve ethical ssues. Using appropriate research methodology: It is unethical to use a method or procsedure known as inappropriate e.g. selecting a highly biased sample, using an invalid instrument or drawing wrong conclusions. Incorrect reporting: To change report findings in a way to serve your own or someone else’s interest is unethical. Inappropriate use of the information: The use of information in a way that it dirctly or indiretly affects the participants is unethical. 2.4 Analyse research findings and generate valid conclusions When analysing data start from review of research goals, this will help organizing data and focus analysis. For example if one want to improve a programme by identifying its strengths and weaknessess, you can organize data into program strengths, weaknesses and suggestions to improve the program. Processing and analysing data is based on a number of closely related operations performed for summing up the data collected and arranging these in a manner that they answer the research questions. Data Processing operations are: Editing Classification Tabulation Basic analysis of quantitative information Make copies of data , and sore your master copy. Use copy for making edits,cuttings and pastings etc. Tabulate the information i.e. add up the number of ratings, rankings, yes’s, no’s for each question. For ratings and rankings consider computing a mean or average Cosider conveying range of answers e.g., 20 people ranked ‘1’, 30 ranked â€Å"2† etc. Basic analysis of qualitative information Read through all data. Organize comments into similar catogeries, suggestions,strengths, weaknesses, similar expriences, program inputs, recommendations, outputs, outcome indicators.etc. Label the categories in themes, e.g., concerns or suggestions, etc. Attempt to identify patterns or associations and casual relationship in themes. Keep all commentry for a long period after completion in case need arise for future reference. Qualitative research involves collectiuon, analysis and interpretation of data that can not be easily rsduced to numbers., as this data relate to social world and the concepts of the behaviors of people within it. It can be found in all social sciences and all applied fields that derive from them. The initial phase of data analysis is to examine the quality of data ( presence or absence of extreme observations), the quality of measurements and if the implementation of study was in line with research design. In main phase of analysis either an exploratory or confirmatory approach can be adopted. Both approaches have their place in reserch, both have their strengths and weaknesses. In some studies one has to combine both approaches. For example to find types of cuisine/accomodation available in a city and extent of their popularity in the city. Types of cuisine is a qualitative aspect of study and extent of popularity is a quanititative aspect as it is based on finding the number of people who visit restaurant. Quantitative data can be analysed by regression analysis, where relationship between dependent and independent variable is measured. It help one to find out how the value of dependant variable changes when one of the independent variable is varied, and other independent variables are held fixed. Qualitative data can involve coding, key concepts and variables are assigned a shorthand and data gathered is broken downinto those concepts of variables. Coding is the process of categorizing the qualitative data so that data becomes quantifiable and thus measureable. How data is coded depends on researchers, the same qualitative data can be coded in so many different ways giving attention to different aspects of the data. One such example is given in the figure below. Coding Without a valid design, valid scientific conclusions cannot be drawn. Internal validity concerns the degree to which conclusions about the casuality can be drawn. External validity concerns the extent to which results of the study are generalizeable. 3.1 Evaluate research methods, techniques and findings and comment on validity of research. Evaluation of the project is planned for right from the onsetand is going on as the different milestones are tackled. Type of evaluation that goes on during the project is referred as formative evaluation, because the project is being formed. The evalustion conducted at the end commonly referred as summative evaluation, because the project is being summed up. All research, no matter how well they are controlled, carries the potential to be wrong. Most After conducting research, analyzing it and evaluating the results is an important work. Statistics are manuplated everyday to change the conclusions drawn. Before accepting the results of a study one must evaluate the research techniques used, the study protocol and other factors to determine if the study’s claims are valid. There must be randomization of the sample groups and necessary care and intelligence shown in allocation of controls. Internal validity and trustworthness are at the core of any research design. External validity is the process of examining the results and questioning whether there are any possible casual relationship. Any scientific study only puts forward a possible cause for the studied effect. There are always chances of another unknown factors contributing to the results and findings. If the study was designed to contain validity and reliability then scientific community is more likely to accept the findings. The high degree of validity and reliability provides not only confidence in data collected but trust in successful application and use of results. The validity of a research settles down to whether the study is giving results what it was claiming to do. For example if someone is buying a research report from an organization claiming to calculate how people prefer marketer’s production than its competitors’ products, the marketer should know how the data was secured to help knoiw if the research really gives the information the way the research company wants it to do. Since most analysis are based on observational studies rather than on results of a controlled experiment, avoid drawing results concerning casuality. When studying changes over time, short term trends should not be focused without checking them in light of medium and long term trends. Where possible avoid arbitrary time reference points. 3.2 Present results and conclusions in a suitable format for audience Information on how the survey was done, as anyone may want to repeat it. This information is often included in the appenixes to the main report. It includes full questionnaire, detailed sample design, fieldwork procedures, interviewer’s instructions, data entry instructions and recommendations for futures study- as how to do better next time. This report should containall the details given below. Focus the article on important variables and topics. Arrange ideas in a logical order. Keep languge as simple as possible. Use graphs in additiuon to text and tables to communicate the message. When tables are used take care that overall format adds to clarity of data and prevents misrepresentation. Explain rounding practices and procedures. Satisfy confidentiality requirements of the source whose data isbeing analysed. Include information about data sources used and shorcomings in the data that may have affected the analysis. Include information about analytical method and tools ysed. Include information regarding quality of results. Ensure that all refercences are accurate. Check for errors in the article. Check accuracy of external data and simple arithmatics. Ensure that intentions stated in the introduction are fulfilled. Get the results reviewed by others for relevance, accuracy and comprehensibility. As a good practice consider presenting the results to peers prior to finalizing the text. Refer to available documents that could provide further guidance for improvement. Bibliography Stolley, Karl.Primary Research. Purdue Online Writing Lab. Retrieved 21 May 2013. Snieder, R Larner, K, 2009, The Art of Being a Scientist: A Guide for Graduate Students and their Mentors, Cambridge University Press http://www.ihmctan.edu/PDF/notes/Research_Methodology.pdf www.boundless.com/sociology/sociological-research/the-research-process/analyzing-data-and-growing-conclusions/ www.managementhelp.org/businessresearch/analysis.htm

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