Page 362 - Bahrain Gov annual reports(V)_Neat

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PUBLIC HEALTH DEPARTMENT ANNUAL REPORT
(Report by Dr. J. D. Grant)

The virtual disappearance of Malaria from Bahrain and the reappearance of Smallpox,
after an absence of six years, were the outstanding Public Health features of the year. The
major problems of slum clearance, village sanitation, sewage and drainage and measures for
improving the general standard of hygiene remain unsolved but owing to political unrest it
was a difficult time in which to make progress and anyform of official action was greatly resented.
In fact, an attempt to enforce a sanitary bye-law in Manama in March resulted in a serious
breach of the peace. Towards the end of the year, public opinion became more favourable and
a lay council was set up to advise on health matters. Their work so far augurs well for the
future.
The successful outcome of the Anti-Malaria campaign is well illustrated by figures showing
the incidence rate of malaria among a selected group of the population over the past three years
(Table A). Control work continued to be based on a combination of residual insecticide
spraying and anti-larval measures. Spraying of all houses in the rural areas and the living
quarters of the lower income group in towns with a Gammexane Lindane preparation was
carried out at the beginning of each transmission period. This measure was very popular as in
addition to malaria protection it brought temporary relief from flies and other insects, provid­
entially, there are still no signs of resistance to this insecticide. The most widely practised
anti-larval measure and the one requiring the strictest supervision was the treatment of breeding
places by a locally prepared larvicidal oil. Due to rapid town expansion, the lack of proper
drainage and sewage and the increasingly neglected irrigation systems in the gardens; this aspect
of control work grows from year to year. The figures showing the number of breeding places
treated and the quantities of larvicidal oil used over the past two years gives some indication of
this trend. (Table B). Entomological studies of local vectors have shown that A. stephensi is
the most predominant species, A. fluviatilis is on the decline and that A. superpictus has com­
pletely disappeared from Bahrain. (Table C). It was interesting to note from the meteorological
statistics now available that in Bahrain the association between temperature and relative
humidity and the transmission periods of Malaria is in accordance with accepted principles.
The Smallpox outbreak began about the middle of October. The first case, in Dumistan
was a young child who had been on a visit to Iraq with his parents and developed symptoms
seven days after his return to Bahrain. The patient showed no signs of vaccination, made an
uneventful recovery and there was no spread of the disease in the area. A few weeks later,
eight cases were reported from Maqsha and once again investigation showed that the original
case had contracted the infection in Iraq and had arrived in Bahrain during the pre-eruptive
stage of the disease, so escaping detection by the Port Health Inspectors. The outbreak
spread from Maqsha to the surrounding villages and to the Naim district of Manama but it
went no further and eventually died out in the middle of January. The total number of cases
was 68 with 12 deaths. Most of the patients were babies and children in the 8—12 years age
group and twice as many males as females were affected. None of the cases had been vaccin­
ated and conversely no vaccinated person' contracted the disease. With the exception of three
non-locals, domiciliary medical treatment was provided as parents refused to allow the patients
to be removed to hospital. Tliis arrangement was unsatisfactory from an epidemological as
well as a medical point of view. The high vaccination state of the community which has been
built up over the past few years prevented the outbreak from assuming more serious proportions.
It was estimated that 85 per cent, of the population had been protected in this way but when the
outbreak started over 50,000 re-vaccinations were carried out as a further precautionary
measure.
The Boys’ School Medical Service has grown to a capacity beyond one doctor and a second
one is being recruited to assist him. A Central Clinic for Manama Schools has been sanctioned
and when completed, will help to make the service more efficient in that area. The general
health of the pupils was better than last year and there has been an improvement in the hygienic
and sanitary conditions in the schools. The most prevalent diseases were trachoma, boils,
minor injuries and eye and ear infections. (Table D). During the year an attempt was made
to introduce B.C.G. Vaccination. The scheme did not meet with the full approval of parents or
headmasters and it was confined to 373 pupils from three schools. The results are recorded
(Table E) but the survey was not extensive enough to afford any reliable indication as to the
incidence of Tuberculosis among school boys in Bahrain.