Indian journal of public health最新文献

Background: The Integrated Health Information Platform (IHIP), a digital tool under the Integrated Disease Surveillance Program (IDSP), was introduced in Odisha in 2021.

Objectives: We described the epidemiological profile of patients registered in the IHIP-P Form in Odisha's Jagatsinghpur (JP) and Ganjam (GM) districts from April 2021 to October 2022.

Materials and methods: We conducted the secondary data analysis of P-form data. We calculated cases per one lakh population (Notification Rate [NR]) by gender, age, block, and disease.

Results: IHIP registered 255,071 (NR: 6618) and 63,895 (NR: 5146) patients in GM and JP. Males (NR: 6824) and adults >60 years (NR: 9347) had higher NRs. NR was variable across the blocks. Acute respiratory illness had the maximum NR in both districts (JP: 1746, GM: 2026).

Conclusion: We recommended regular follow-up analysis to identify the pattern changes and explore the factors contributing to the low NR in certain blocks.

Summary: Hypertension is a leading risk factor for cardiovascular disease in India. However, many individuals attending out-patient departments (OPDs) remain undiagnosed. The study was conducted in government primary health centers (PHCs) in four districts of Chhattisgarh to estimate the coverage and yield of opportunistic screening during April 2023. The sample consisted of 150 eligible OPD patients per facility in 5 PHCs with a minimum of 750 participants. The data were abstracted from the OPD register and noncommunicable disease register for individuals aged 30 years and above and were analyzed. The coverage and yield of opportunistic screening were observed to be 60% and 20%, respectively. Coverage was higher among participants aged 50-59 years (75%) and among males (63%), whereas yield was higher among men (22%) and highest in Raipur district (28%). On average, 8 out of 100 eligible individuals were missed for diagnosis despite visiting a health facility. Further investigation is needed to understand the reasons for noncoverage, and measures should be taken to improve screening and diagnosis.

Background: Understanding the epidemiological pattern of malaria can help identify the focus areas in high-prevalence states like Chhattisgarh.

Objectives: We analyzed the National Malaria Program's surveillance data from all government health facilities in Kanker.

Materials and methods: We abstracted aggregate data from the National Vector-Borne Disease Control Programme monthly reports and analyzed them by time, place, and personal characteristics. We calculated indicators such as the Annual Parasite Index (API), Annual Falciparum Index (AFI), Annual Blood Examination Rate (ABER), Test Positivity Rate (TPR), and Test Falciparum Rate (TFR).

Results: The API and AFI decreased from 3.0 to 1.3 and from 2.5 to 1.1, respectively, from 2019 to 2022. Nearly 2/7 blocks and 1/7 blocks had API and AFI more than 2 in 2022, respectively. The proportion of Plasmodium falciparum cases increased to >90% from 2020 to 2021. The TPR and TFR declined by half from 2018 to 2022, keeping ABER around 30% across all the years.

Conclusion: Reasons need to be explored for the higher API in two blocks.

Background: Leptospirosis outbreaks have risen in India over the past three decades, especially in coastal regions. On September 9, 2022, a cluster of fever with myalgia and diarrhoea was reported in Village X, Koraput district, Odisha. A rapid response team confirmed the outbreak, and an investigation was initiated on September 11.

Objectives: Our objective was to describe the event in terms of time, place, and person, and to identify potential sources.

Materials and methods: On confirmation of the outbreak, we diagnosed leptospirosis in seven cases by immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA). We initiated the investigation on September 11 to describe the outbreak and identify its source. We defined a probable case as an individual who reported at least one listed symptom on or after August 9, 2022, and conducted an active surveillance by door-to-door survey. We conducted a descriptive analysis of the reported cases by plotting an epidemiological curve and calculating the attack rate by place and person.

Results: We identified 26 cases from September 3 to 17, 2022. The epi-curve indicated a continuous source outbreak. Higher attack rates were observed in low-lying areas, especially Majhi and Harijan Sahi. Adults aged 45-60 years and males were more affected. Most cases reported close contact with livestock and walking barefoot. All seven samples tested were positive for leptospirosis by IgM ELISA.

Conclusion: Heavy rainfall and subsequent flooding likely increased rodent infestation, which may have led to the outbreak. Chemoprophylaxis for contacts reduced cases, and chlorination of drinking water was recommended to prevent further outbreaks.

Background: Under-five mortality remains a significant public health challenge in India, particularly in underserved districts such as Nabarangpur, Odisha, which reports a higher mortality rate than state and national averages.

Objectives: This study analyses child death review (CDR) data from 2017 to 2021 to understand the epidemiological patterns, causes, and systemic delays contributing to under-five deaths in the district.

Materials and methods: We also performed time-series analysis on mortality rates (neonatal mortality rate [NNMR], infant mortality rate [IMR], under-five mortality rate [U5MR]) using the Chi-square test for trend, and P < 0.05 were considered significant.

Results: A total of 4871 under-five deaths were recorded: 47% neonates, 41% postneonates, and 12% aged 1-5 years. A significant gender disparity was observed, with 58% of deaths occurring among males (P = 0.0002). Most deaths (63%) occurred at home, indicating substantial barriers to healthcare access. The leading causes of death were low birth weight (28%), pneumonia (17%), and birth asphyxia (8%). Among identifiable delays, decision-making was most common (33%), followed by transport and hospital delays. Postneonatal deaths increased twofold over the 5-year period. Time-series analysis showed a steep decline in NNMR, IMR, and U5MR up to 2019, followed by stagnation and modest reversal of IMR and U5MR during 2019-2021. Poisson regression confirmed a nonsignificant upward slope in overall deaths in the later years.

Conclusion: This study demonstrates the utility of CDR data in informing evidence-based and context-specific interventions. Formal time-series analysis underscores both progress and recent setbacks. Strengthening antenatal care, immunization, and resilient maternal-child health services is critical to sustain reductions and achieve Sustainable Development Goal 3.

Background: Chhattisgarh state accounts for 18% of the malaria burden and 40% of malaria deaths in India. Malaria surveillance is implemented through the Integrated Disease Surveillance System (IDSP).

Objectives: We evaluated the malaria surveillance system in six districts of Chhattisgarh, India, in 2023.

Materials and methods: A descriptive cross-sectional study was conducted using the Centers for Disease Control guidelines for evaluation. We included 1276 syndromic (S), 110 Presumptive (P), and 100 Laboratory (L) form reporting units through simple random sampling. We interviewed the surveillance officer, epidemiologist, and data manager at the state and district levels. We abstracted the P and L forms from the sampled facilities. We analyzed timeliness (forms reporting within 24 h of identification), sensitivity (reported to surveillance after identification), data quality (complete and valid entry in key variables), and usefulness attributes.

Results: Among 1442 P-forms, the surveillance system reporting is sensitive to capture 84 (5.8%) of cases. Similarly, among 11,510 L-forms, the system captured 3334 (29%) cases. All the reported cases in surveillance had complete entries in key variables. Among cases reported in the system, 44/84 (52.4%) of P-forms and 2461/3418 (72%) of L-forms had valid entries in key variables. Malaria surveillance is useful at the district and state levels to monitor the disease trend, detect clusters, and act early to prevent outbreaks.

Conclusion: Malaria surveillance has inadequate reporting on sensitivity and data quality. Identifying the factors for low sensitivity and implementing quality improvement initiatives for better reporting of the malaria surveillance system.

Summary: Opportunistic screening for diabetes mellitus (DM) is a key component of India's noncommunicable disease programme, yet its coverage remains poorly assessed. We conducted a cross-sectional study in ten primary healthcare facilities in West Sikkim over 7 weeks using register reviews and staff interviews. Among 4323 outpatient department attendees aged ≥30 years, 1515 (35%) were screened and 175 (12%) were newly diagnosed. Screening coverage ranged from 9% to 100% and yield from 0% to 36%. Fishbone analysis identified staff shortages, inadequate supplies, and low provider motivation. Targeted quality improvement strategies are recommended to improve screening and DM management.

Background: Kerala, a state in southern India with a 21% prevalence of diabetes mellitus (DM), has implemented a DM management program since 2011.

Objectives: This study evaluated the DM management program in the Thiruvananthapuram district of Kerala to assess if it was operating as intended and identify improvement opportunities.

Materials and methods: We conducted a cross-sectional survey in 11 public primary care facilities between April and August 2021. The study documented the availability of various resources in the health facilities using a data abstraction form. We interviewed 125 healthcare providers and 504 patients using a semi-structured questionnaire. We analyzed the input, process, and output indicators as proportions and estimated the proportion of registered DM patients under glycemic control with a 95% confidence interval (CI).

Results: Screening registers were not updated in eight facilities, but nine out of 11 had updated treatment registers. Nearly two-fifths of the medical officers were trained in DM management. Metformin and glimepiride were stocked for at least 2 months in six out of 11 facilities. Almost four-fifths of all registered patients were treated and followed up appropriately at least once a month. Of 504 patients, 165 (33%; 95% CI, 29-37) had blood sugar under control.

Conclusion: The evaluation found training, documentation on screening, and adequacy of drug stocks as key areas for improvement in the program. Despite follow-up, most DM patients had poor glycemic control. The study recommends conducting training of medical officers, strengthening the reporting and registration of screening activities, and improving the minimal drug stocks.

Summary: Cervical cancer is a major public health issue, particularly in low- and middle-income countries where 90% of cases and deaths occur. This study proposes a comprehensive framework for evaluating cervical cancer screening programs, addressing gaps in existing models that overlook critical components, such as follow-up and treatment. Using a forward logic approach, the framework outlines inputs, processes, outputs, and outcomes across four components: behavior change communication, screening, confirmation and diagnosis, and treatment. The methodology includes reviewing national guidelines, defining key inputs, activities, and developing indicators to assess each screening stage. Key challenges identified include low screening coverage, inconsistent referrals, and high attrition rates. The logic model provides a structured approach for evaluating program performance, facilitating data collection, analysis, and timely interventions. The results highlight the need for comprehensive evaluation frameworks to enhance cervical cancer control efforts and achieve the WHO's elimination targets by 2030. Further validation in diverse settings is recommended.

Background: Acute diarrheal diseases (ADDs) remain a concerning public health burden in India, particularly in rural areas. In May-June 2023, Village X, Kalahandi district, Odisha, faced an H3N2 influenza outbreak.

Objectives: We investigated the outbreak to identify its etiology and inform prevention strategies.

Materials and methods: We defined cases as individuals experiencing three or more watery stools within 24 h during the outbreak period. We conducted active case search through household surveys and interviews, and we collected data on demographic data, water source use, sanitation practices, and hygiene. Water samples were analyzed for coliform contamination, and rectal swabs from cases were cultured for enteric pathogens. We described cases by time, place, and person, and attack rates (ARs) were calculated.

Results: A total of 41 ADD cases were identified among 272 residents (AR = 15%). The AR was higher in Tala-Sahi (32%) compared to Upar Sahi (8%). The primary source of drinking water for most cases was a contaminated tubewell in Tala-Sahi. Laboratory analysis confirmed coliform contamination in the tubewell water.

Conclusion: This outbreak highlights the critical role of contaminated drinking water and poor sanitation in driving ADD in rural India. Interventions to improve water quality, promote safe sanitation practices, and enhance hygiene awareness are essential to prevent future outbreaks and protect public health.