Bora D

Unnatural deaths in Delhi during 1991

An analysis was undertaken of 3623 post-mortems conducted in the Civil Hospital, Delhi, during 1991, covering 75 per cent of civil police stations and all three railway police stations. The study showed that the death rate was highest in the age group of 30–39 years (29.6%), road traffic accidents being the most common cause (33.9%). In general four times more deaths occurred in males than in females. However, in deaths by burning it was three times higher in females. The attention of all concerned should be drawn to this huge, untimely and tragic loss of lives.

Epidemiology of Cholera in Delhi—1992

Cholera is endemic in Delhi and is a highly seasonal disease. Suspected cholera cases are referred to Infectious Diseases Hospital, Delhi. Rectal swabs from 2783 cases were bacteriologically examined during 1992, out of which 1075 were found to be positive for Vibrio cholerae O1 biotype El Tor. First isolation was made on 3 April and the last on 14 December. About 87 per cent isolations were made between May and September, which are summer and monsoon months in Delhi. Detailed epidemiological information was collected for about 198 cases of diarrhoea out of which 103 were confirmed cases of cholera. Half of these cases occurred in children below 10 years of age. The other major group affected was adult females, especially housewives. All the cholera cases occurred in those who were illiterate or educated up to primary level. Important risk factors were: contact with person having similar illness, storage of water in wide-mouthed containers, use of glass or mug to draw water from containers, absence of sanitary latrines and habit of washing hands with water alone after defecation, before cooking and eating food. About 30 percent cases had access to piped water supply which was found safe in Delhi during 1992. The findings suggest that the hygienic practices were more important than contaminated water sources for transmission of cholera in Delhi during the year 1992.

Community studies on hepatitis B in Rajahmundry town of Andhra Pradesh, India, 1997-8: unnecessary therapeutic injections are a major risk factor.

In Rajahmundry town in India, 234 community cases of jaundice were interviewed for risk factors of viral hepatitis B and tested for markers of hepatitis A-E. About 41% and 1.7% of them were positive for anti-HBc and anti-HCV respectively. Of 83 cases who were tested within 3 months of onset of jaundice, 5 (6%), 11 (13.3%), 1 (1.2%), 5 (6%) and 16 (19.3%) were found to have acute viral hepatitis A-E, respectively. The aetiology of the remaining 60% (50/83) of cases of jaundice could not be established. Thirty-one percent (26/83) were already positive for anti-HBc before they developed jaundice. History of therapeutic injections before the onset of jaundice was significantly higher in cases of hepatitis B (P = 0.01) or B-D (P = 0.04) than in cases of hepatitis A and E together. Other potential risk factors of hepatitis B transmission were equally prevalent in two groups. Subsequent studies showed that the majority of injections given were unnecessary (74%, 95% CI 66-82%) and were administered by both qualified and unqualified doctors.

Epidemiological evaluation of oral polio vaccine efficacy in Delhi.

Forty seven cases of poliomyelitis and 94 controls were studied for immunization status. Unmatched analysis with one control per case and two controls per case was done to find out the ratio of the odds of immunization in diseased individuals as compared with the nondiseased (odds ratio). This ratio (OR) was used further to calculate oral polio vaccine efficacy. OPV efficacy was found to be 93% with 95% confidence limits of 75–98%.

Epidemiologic Consequences of Moderate Coverage Levels of Measles Vaccine in a District Headquarter Town (Alwar) in India, 1996

This paper describes the epidemiology of measles in a medium size town (population 240,000) in India where vaccine coverage levels have remained constant at around 70 per cent in the past 7 years. A retrospective community survey covering 4023 children under 10 years old detected 252 cases of measles in the previous year. This gave an annual incidence of 6.3 per cent (95 per cent CI 5.5-7). About half of the cases occurred in vaccinated children. Only 5 per cent of the cases occurred in children below 9 months of age. This age is appropriate for routine measles immunization. Despite modest coverage levels with only 54 per cent effective vaccine (estimated by a screening method), there was a modest upward shift in the age distribution of measles cases; the median age was more than 48 months.