Indian journal of public health最新文献

Summary: The Integrated Health Information Platform (IHIP) captured 44% of laboratory-tested malaria cases from primary health centers (PHCs) in Raigarh, Chhattisgarh, in September 2023. Our quality improvement (QI) project aimed to improve the sensitivity (% of laboratory-tested malaria cases entered in IHIP compared to registers) to 80% among four selected PHCs with poor sensitivity. We conducted a quasi-experimental time-series study using the Plan-Do-Study-Act method. We identified inadequate laboratory technicians' knowledge of data entry in IHIP and poor feedback from the district surveillance unit (DSU) as the root causes. By implementing refresher training for laboratory technicians and a weekly feedback mechanism from DSU, we achieved 100% sensitivity within 5 weeks across selected PHCs. Our study highlighted the feasibility of using the QI initiative to identify and address the root causes. We recommend adopting QI methods to address setting-specific root causes and improve the outcomes.

Summary: North-east India is a nonendemic region for dengue. In Aizawl, Mizoram, the first and last Dengue outbreak reported was in 2016 with 58 confirmed cases and no deaths. However, in 2022, the dengue outbreak reported 1868 confirmed cases, with five deaths in Aizawl. We conducted an outbreak investigation in Bethlehem Vengthlang and Chite Veng through a house-to-house survey to confirm the transmission of dengue virus infection. The overall attack rate was 11.4% with no gender difference. Currently, Mizoram has only two sentinel sites. Study findings will be useful for the selection of sites related to the upcoming phase 3 dengue vaccine trials.

Background: In the Tiruvallur district of Tamil Nadu State, Annual new case detection rate (ANCDR remained static and has been above State or National levels since 2011.

Objectives: In the absence of district-specific analysis for action, we described the distribution of ANCDR by time, place, and person during 2017-2022. Materials and Methods: Data extracted on age, gender, community, type of leprosy, deformity, and mode of detection of new cases from program registers for fiscal years 2017-2022. ANCDR calculated and computed by type of leprosy, grade 2 deformity (per million), and mode of detection.

Results: During 2017-2022, new 842 cases reported. ANCDR ranged from 7.6 (2017-2018) to 5.5 (2021-2022) and was more in three border sub-districts, rural areas, among tribal population, males and those aged 16-60 years. Multibacillary leprosy was more among rural population, males and 16-60 years age group, whereas, paucibacillary was more in urban, females and <15 years age group. Detection by active search was more in urban, tribals, young children, and females. Self-reporting was predominant among the rural population. Grade 2 deformity (per million) was more in urban, among tribals, 16-60 years age group and males. Detection among case contacts through surveys remained low across years.

Conclusion: Five-year district-level NLEP data indicated fluctuating ANCDR, poor detection through contact tracing, and higher rates in males, the 16-60 age group, and rural and tribal populations.

Summary: In July 2023, we investigated a cluster of jaundice cases in Madurai district, Tamil Nadu, to identify outbreaks, etiology, and source and to propose control measures. A door-to-door survey identified 119 cases, with an attack rate of 8.3 per 1000. An environmental investigation and matched case-control study confirmed that the outbreak was linked to contaminated urban local body (ULB) water. Consuming ULB piped water caused 33% of cases (odds ratio [OR] 9.9, 95% confidence interval [CI]: 2.5-38.6), whereas drinking unboiled water caused 81% (OR 15.1, 95% CI: 5.4-42.3). The outbreak highlighted the need for improved water and sewage management in the district.

Background: India ranks first among fatal road traffic accidents (RTAs) and accounts for one-tenth of global RTAs. North Goa district in Goa reported a higher burden of fatal RTAs than the national average.

Objectives: To estimate the burden of fatal RTAs and describe them by human, vehicle, and environmental characteristics.

Materials and methods: A cross-sectional analysis of four-years (2017-2020) data obtained from the Traffic Authority of Goa was conducted, and the characteristics were classified using the Haddon's Matrix. The mortality rate and case fatality ratio (CFR) were calculated.

Results: Overall, 6412 RTAs (487 deaths) were reported in North Goa, with an average mortality rate of 17.7, decreasing from 25.7 (2017) to 15.4 (2020), highest in Pernem subdistrict (23.8). The average mortality rate across four years was higher among individuals aged 25-34 years (22.6) and males (32.5). The overall CFR was 76, with an increase from 76 (2017) to 82 (2020). The highest average CFR was in Pernem subdistrict (150) and on state highways (80). A higher CFR was noted during peak tourism months (82) than during rainy months (63). The highest CFR was found on Sundays (89) and during midnight to early morning hours (87). Among fatalities, 60% were riders, 60% had two-wheeler as the impacting vehicle, 90% involved overspeeding, 30% involved a head-on collision, 50% wore helmet (two-wheelers), and 70% wore seat belts (four-wheelers).

Conclusion: Lower mortality but higher case fatality was reported in North Goa in 2020 during the COVID-19 pandemic lockdown. Various precrash and crash factors influencing fatality among RTAs were identified, which needs evaluation to mitigate fatal RTAs in the district.

Background: Kyasanur forest disease (KFD) is a tick borne zoonotic viral infection endemic to southern India. Despite preventive strategies, including vaccination, an outbreak occurred in March 2023 in Caranzol village, Sattari sub district, North Goa.

Objectives: This study aimed to describe the outbreak by time, place, and person and to explore contributing factors.

Materials and methods: An unmatched case-control study (1:4 ratio) was conducted from February to April 2023 after a village wide active case search among 484 residents. Presumptive and confirmed cases were identified using RT PCR/immunoglobulin M enzyme linked immunosorbent assay. Data on demographics, exposure history, and preventive practices were collected through structured interviews. Attack rates were calculated, and risk factors were assessed through logistic regression. Tick surveillance and verification of monkey mortality were also undertaken.

Results: Thirteen presumptive cases were identified; five were laboratory confirmed. The epidemic curve showed onset in early March with decline by the 5th week. The attack rate was 3.1%, highest among females (4.6%) and those aged 45-59 years (5.1%). Common symptoms included fever, weakness, myalgia, and headache. Forest visits without protective clothing, lack of repellent use, and poor postexposure hygiene were significantly associated with illness. Six cases reported prior vaccination, received 5 years earlier. Tick pools tested negative for KFD virus, and no monkey deaths were recorded.

Conclusion: The outbreak underscores the need for strengthened surveillance, public awareness, and intersectoral collaboration between health, animal husbandry, and forest departments. Emphasis on personal protective measures and reassessment of KFD vaccine efficacy and booster requirements is recommended.

Summary: We investigated a cluster of acute gastroenteritis reported from a college in Kerala on December 1, 2021. We defined a suspect case as an occurrence of vomiting or at least three episodes of loose stools within 24 h. We identified 113 suspected case patients; 63 (55.8%) were boys, and 110 (97.3%) were hostel inmates. All five stool samples and three out of eight water samples we collected tested positive for norovirus. We conducted a retrospective cohort and did univariate and multivariable binomial regression to calculate the adjusted risk ratio (aRR). Norovirus infection risk was higher among those who had a symptomatic roommate (aRR - 4.69; 95% confidence interval [CI]: 3.05-7.22) and who drank water from the jar (aRR - 1.41; 95% CI: 1.08-1.86) and filter in boys' canteen (aRR - 1.40; 95% CI: 1.04-1.89) and filter in Boys' hostel (aRR - 2.02; 95% CI: 1.63-2.49). We recommended changing water filters and frequent handwashing with soap.

Background: In September-October 2021, Palakkad district, Kerala, faced an H3N2 influenza outbreak among medical and paramedical students.

Objectives: We described the outbreak and determined the agent, source, and risk factors.

Materials and methods: To investigate the outbreak, we conducted an active case search using an online questionnaire. We defined a case as fever with any of the associated symptoms of cough, running nose, headache, sore throat, tiredness, or breathlessness. We described cases by time, place, person, and attack rates (ARs), and adjusted risk ratios (aRRs) were calculated.

Results: Among 780 students, 607 responded, with 122 cases of H3N2 (20.1%). Higher ARs were observed among females (23%), MBBS students (24%), and ladies' hostel inmates (22%). We conducted a retrospective cohort study among all the students to determine the risk factors. Univariate analysis identified MBBS students, residing in the ladies' hostel, improper mask use and having close contact at a common place as risk factors for being a case. Multivariable analysis confirmed improper mask use (aRR-2.2 [95% confidence interval (CI):1.4-2.7]) and residing in ladies' hostels (aRR-2.6 [95%CI: 1.6-4.4]) as significant risk factors, supported by environmental factors like poor ventilation.

Conclusion: The outbreak was caused by the H3N2 influenza virus. Residing in the ladies' hostel, poor compliance with mask-wearing and close contact during gatherings were identified as risk factors for the outbreak. We recommended proper mask use among students as well as isolation of cases. Swift public health action contained the outbreak by November 2, 2021.

Background: Koraput showed over 80% reduction in malaria cases in the year 2017-2018 attributed to the distribution of long-lasting insecticidal nets and Malaria Camps. Unfortunately, this decline was not sustained, suggesting a resurgence in 2023. Hence, understanding the epidemiology of malaria by analysing trends, geographical distribution, and demographic patterns is essential for targeted malaria control and elimination efforts.

Objectives: This study aims to describe the epidemiology of malaria in the Koraput district by time, place, and person, and calculate the program indicators for the National Vector Borne Disease Control Programme (NVBDCP) from 2019 to 2023.

Materials and methods: We conducted a descriptive epidemiological study using NVBDCP surveillance data from 2019 to 2023 for the Koraput district, Odisha. We calculated the annual blood examination rate (ABER), Annual Parasite Incidence, Test Positivity Rate, Test Falciparum Rate and Annual Falciparum Incidence.

Results: Koraput reported an ABER of 28% and annual parasite incidence annual parasite incidence (API) of 2.7 per 1000 with a sharp rise in 2023 to 4.5 per 1000. Narayanpatna had the highest API of 38 per 1000, followed by Bandhugaon, which had an API of 25 per 1000 in 2023. The API for males was consistently high compared to females, with a similar rise in 2023 among both genders.

Conclusion: The consistent seasonal peak in cases gives a prime opportunity to implement pre-emptive measures before the monsoons. The surveillance system for malaria needs strengthening to withstand public health emergencies such as the COVID-19. The migration of malaria surveillance to the Integrated Health Information Platform will aid in real-time surveillance of malaria.