Rajan R Patil

A community-based health education programme for bio-environmental control of malaria through folk theatre (Kalajatha) in rural India

BackgroundHealth education is an important component in disease control programme. Kalajatha is a popular, traditional art form of folk theatre depicting various life processes of a local socio-cultural setting. It is an effective medium of mass communication in the Indian sub-continent especially in rural areas. Using this medium, an operational feasibility health education programme was carried out for malaria control.MethodsIn December 2001, the Kalajatha events were performed in the evening hours for two weeks in a malaria-affected district in Karnataka State, south India. Thirty local artists including ten governmental and non-governmental organizations actively participated. Impact of this programme was assessed after two months on exposed vs. non-exposed respondents.ResultsThe exposed respondents had significant increase in knowledge and change in attitude about malaria and its control strategies, especially on bio-environmental measures (p < 0.001). They could easily associate clean water with anopheline breeding and the role of larvivorous fish in malaria control. In 2002, the local community actively co-operated and participated in releasing larvivorous fish, which subsequently resulted in a noteworthy reduction of malaria cases. Immediate behavioural changes, especially maintenance of general sanitation and hygiene did not improve as much as expected.ConclusionThis study was carried out under the primary health care system involving the local community and various potential partners. Kalajatha conveyed the important messages on malaria control and prevention to the rural community. Similar methods of communication in the health education programme should be intensified with suitable modifications to reach all sectors, if malaria needs to be controlled.

Climate change: The challenges for public health preparedness and response- An Indian case study.

Extremes weather changes surpassing their usual statistical ranges and tumbling records in India could be an early warning bell of global warming. Extreme weather events like the recent record setting in western Indian city of Mumbai or all time high fatalities due to the heat wave in southern Indian states or increasing vulnerability of easten Indian states to flood could all be a manifestation of climate change in the Asian subcontinent. While the skeptics may be inclined to dismiss these events as simple local aberrations, when viewed in an epidemiological paradigm in terms of person, time and space couple with frequency, intensity and fatalities, it could well be an early manifestation of climate change. Global warming poses serious challenge to the health sector and hence warrants emergency health preparedness and response. Climate-sensitive diseases are among the largest global killers, hence major brunt of global climate change in terms of adverse health impact will be mostly borne by poor and developing countries in Asia, given the levels of poverty, nutional levels and poor public health infrastructure.

Perceptions of mosquito borne diseases

We report our findings from a community based study on Knowledge Attitude Practice of community on various vector (mosquito) borne diseases, conducted in 1998. The respondents (n=850) in a sample (systematic random) were chosen from the population of 10 000 of an urban locality in India. Knowledge of mosquito being the vector for dengue was very low (0.5%), as compared with malaria (61.1%). Concerning knowledge of breeding grounds …

Urbanization as a Determinant of Health: A Socioepidemiological Perspective

Urbanization is a process that leads to the growth of cities due to industrialization and economic development and that leads to urban-specific changes. Urbanization is associated with profound changes in diet and exercise that in turn increase the prevalence of obesity with attendant increases in risk of type II diabetes and cardiovascular disease. The growing burden of disease among vulnerable populations and pervasive socioeconomic inequities within urban systems exaggerates the adverse impacts of urbanization on health. More than one half of children younger than age 5 of urban poor are stunted and/or underweight. More than one half of the child births occur at home, in slums, putting the life of the mother and newborn in serious risk. Inadequate reach of services due to illegality, social exclusion of slums, hidden slum pockets, and weak social fabric have resulted in a rapid proliferation of the unqualified private health sector, leading to high health expenditures and continuing a vicious cycle of poverty and ill health in urban slums.

Anthrax: public health risk in India and socio-environmental determinants.

Zoo authorities of Central Indian State of Chattisgarh reported a hyena suffering from the fatal anthrax disease in Nandanvan zoo in capital city Raipur. After laboratory confirmation of anthrax, the zoo was closed for 15 days as precautionary measure. According to the veterinarians of the zoo, all symptoms of anthrax were found in one of the hyenas. The Forest department officials decided to vaccinate animals within the 5 km radius of zoo to contain the disease. All employees of Nandanvan zoo had been put on prophylactic antibiotic medicine.(1) The report of death of a hyena due to anthrax in the state of Chattisgarh in India during June 2007 was very disturbing and was unusual occurrence by any standards. Chattisgarh state has never reported anthrax case either in animal or in humans. Anthrax is generally an epizootic disease which infects and kills herbivorous animals e.g. cattle, sheep, and goat.(2) Cattle get mostly infected by eating vegetations contaminated by spores. Elephants have been known to die of anthrax in north-east. They and other herbivores develop bacteriamic phase followed by death. So do poor humans. Occasionally dogs, horses, etc. are also found to be infected but are rarely fatal in them. Terminally ill animals tend to bleed from the nose, mouth, and bowel, thereby contaminating soil or water places with B. anthracis that can subsequently sporulate and persist in the environment. On further literature review, the Chattisgarh incident turns out to be the first case of death of non-herbivorous animal like hyena dying due to anthrax in India.(3) This event has a great epidemiological as well as public health significance. The reports of anthrax infection in hyena leading to death is a pointer towards the larger fact that the anthrax bacteria are in circulation in Chattisgarh, also it is a matter of concern from public health point of view, as once anthrax affected, the locale is always anthrax prone on account of longevity of viable spores lasting many decades. From public health point of view, it is very important that Chattisgarh should step up their mechanism for animal screening for anthrax. Since Chattisgarh never had history of anthrax, capacities and skills for the same need to be instituted. Once anthrax is fully established as enzootic disease in a region, it is only a matter of time before zoonotic transmission begin and human case of anthrax begin to appear posing as big public health problem. The case in point is Orissa, where anthrax is an endemic disease and already a major public health problem of Orissa; 14 out of 30 revenue districts in the state have witnessed outbreaks of anthrax as many as 61 times during the last 10 years affecting 750 people of which 418 had died.(4) The anthrax outbreaks are an annual phenomenon Orissa. With good forest cover, the soil being highly organic in with good moisture to support anthrax spores. Due to scanty agriculture, tribals mainly depend on forest for livelihood. Risk of infection increases due to anthrax spores in the wild. Outbreaks of anthrax in these indigenous populations very often occur as food poisoning following consumption of contaminated cattle meat. Tribals for that matter, any given community, in these states particularly if underprivileged, eat carcass of dead animals. Such people are vulnerable. Even if they do not eat, if they de-skin carcasses of infected animals, they are also vulnerable for anthrax infection. Anthrax is known to occur generally in underdeveloped regions.(5) Ecologically speaking, from vulnerability point of view, Chattisgarh shows striking parallels and Orissa, as far as potential proneness and risk of anthrax outbreaks in the human population in the coming years: Chattisgarh and Orissa rank almost similar on human development indices (HDIs); Like Orissa, Chattisgarh has very high concentration of tribal population (>35%); Both the states have extensive forest cover; The indigenous population of both these states depend less on agriculture and more on forest and animal produce for food; Overwhelming majority of people in both these states live below the poverty line. Both the states have poor public health infrastructure. This is the perfect amalgamation and interface of risk factors that are conducive for zoonotic transmission of anthrax to the human population. Hence the probability of occurrence of anthrax outbreak in the human population would increase on logarithmic scale, each time an episode of anthrax detected in animal population in a state like Chattisgarh. So, epizootology and epidemiology should be both applied not only for anthrax, but for every zoonotic disease, hence the importance of veterinary and doctors putting heads together.

Global review of studies on traffic police with special focus on environmental health effects

Since occupation is a major determinant of health, traffic police personnel face multiple occupational hazards. They are continuously exposed to vehicular emissions and work in a noisy and polluted environment. The objective of the present review is to explore the impact of occupational health hazards on the health of traffic police personnel. Published research papers on traffic police reporting occupational health issues were accessed and reviewed. Attempts were made to access papers that reported negative associations in order to present a balanced review. The majority of the studies have reported a decrease in the lung function and increased respiratory morbidity. The research on the cytogenetic abnormalities or genotoxic effect of vehicular emissions arising due to long-term exposure to benzene and other polyaromatic hydrocarbons has provided conflicting results, since more or less equal numbers of studies have given evidence for and against the causal association. There is a vast accumulation of epidemiological evidence on the casual association between vehicular pollution and its carcinogenic effect. Multiple studies have concluded that traffic police are highly stressed. A number of occupational factors have been attributed to stress among traffic police. Occupational health studies help us to understand the effects of vehicular pollution and its adverse influence on workers. They also provide opportunity for defined exposures measurements and precise risk assessment. The findings from these studies are easily generalizable and can help us understand the impact of air pollution on the general population.

Monitoring data quality in syndromic surveillance: Learnings from a resource limited setting

Background: India is in the process of integrating all disease surveillance systems with the support of a World Bank funded program called the Integrated Disease Surveillance System. In this context the objective of the study was to evaluate the components of the Orissa Multi Disease Surveillance System. Materials and Methods: Multistage sampling was carried out, starting with four districts, followed by sequentially sampling two blocks; and in each block, two sectors and two health sub-centers were selected, all based on the best and worst performances. Two study instruments were developed for data validation, for assessing the components of the surveillance and diagnostic algorithm. The Organizational Ethics Group reviewed and approved the study. Results: In all 178 study subjects participated in the survey. The case definition of suspected meningitis in disease surveillance was found to be difficult, with only 29.94%, who could be correctly identified. Syndromic diagnosis following the diagnostic algorithm was difficult for suspected malaria (28.1%), ‘unusual syndrome’ (28.1%), and simple diarrhea (62%). Only 17% could correctly answer questions on follow-up cases, but only 50% prioritized diseases. Our study showed that 54% cross-checked the data before compilation. Many (22%) faltered on timeliness even during emergencies. The constraints identified were logistics (56%) and telecommunication (41%). The reason for participation in surveillance was job responsibility (34.83%). Conclusions: Most of the deficiencies arose from human errors when carrying out day-to-day processes of surveillance activities, hence, should be improved by retraining. Enhanced laboratory support and electronic transmission would improve data quality and timeliness. Validity of some of the case definitions need to be rechecked. Training Programs should focus on motivating the surveillance personnel.

Assessing perceptions about malaria among the elected representatives in rural India

Objective: The short-term objective of our endeavour was to understand the perception of Grama panchayat presidents and secretaries on the issues related to malaria and its control, being the key leaders of the Panchayat Raj Institutions (PRIs) at a Grama panchayat level. This was necessary to achieve the long-term objective of the role of PRIs in malaria control and their enhanced participation/partnership with the public health sector. Materials and Methods: Grama panchayat presidents and secretaries representing all the 28 Grama panchayats of Chikkanayakanahalli taluk Tumkur district in Karnataka were invited for a 1-day workshop. Deliberations with the participants (n = 32) shed light on their perceptions with respect to knowledge, attitude and practice vis-a-vis malaria and its control strategies. Results: Their knowledge of malaria as a disease was fairly good as they were well aware of it being a communicable disease and its transmission by mosquitoes. However, knowledge about the breeding sources of malaria mosquitoes (Anophelines) was very poor. Many practices in vogue to control mosquitoes at the community level were unscientific. There was a general negative attitude toward the government′s handling of the malaria problem and the credibility of the health care system. Conclusion: Existence of health committees in every Grama panchayat coupled with their jurisdiction and responsibilities toward sanitation, water supply and health care resources makes PRIs a natural partner to the health sector. While health education and public health intervention strategies should be based on generic principles of science, the implementation and operational specifics should definitely be based on a sociological perspective of the stakeholders.

Caste-, Work-, and Descent-Based Discrimination as a Determinant of Health in Social Epidemiology

Social epidemiology explores health in the context of broad social determinants of health, where the boundary lines between health and politics appear increasingly blurred. Social determinants of health such as caste, discrimination, and social exclusion are inherently political in nature, hence it becomes imperative to look at health through a broader perspective of political philosophy, ideology, and caste that imposes enormous obstacles to a persons full attainment of civil, political, economic, social, and cultural rights. Caste is descent based and hereditary in nature. It is a characteristic determined by ones birth into a particular caste, irrespective of the faith practiced by the individual. Caste denotes a system of rigid social stratification into ranked groups defined by descent and occupation. Under various caste systems throughout the world, caste divisions also dominate in housing, marriage, and general social interaction divisions that are reinforced through the practice and threat of social ostracism, economic boycotts, and even physical violence—all of which undermine health equality.

Dynamics of the antibodies in cohorts of cured cases of visceral leishmaniasis: its implication on the validity of serological test, value in prognosis and in post therapeutic assessment.

The major disadvantage of a Serological test like Direct Agglutination Test (DAT) for Visceral Leishmaniasis (also called Kala-azar) is its inability to distinguish between recent and past infection. The objective of our study was to look at rate of decline of antibodies in fully cured cases of Kala-azar and length of time it takes for DAT to become negative. Cohort Study involving completely treated Kala-azar cases from Government Hospital during one calendar year of study. Cases were selected on the basis of treatment cohorts 0,3,6,9 &12 mo after completion of treatment.. Phase I- The cases were traced and after obtaining the informed consent they were subjected to Direct Agglutination Test (DAT). Phase II-The five treatment cohorts, constituting 82 cured cases (average of 15 cured cases per each treatment cohort) were tested again with DAT three months after the first test. The titers of Phase-I and phase-II tests were analyzed for the dynamics of the antibodies for the period. Cutoff- Values of DAT below 1:800 are considered negative. Values of 1:800, 1:1200, 1:1600 and so on are considered positive. The mean titer [Geometric Mean Titer (GMT)] at the start of treatment was 1:1120, which showed steady decline up to six months, plummeting below the cutoff titer for the DAT (1:800) at the ninth month. Antibodies continue to linger for about one year in cured Kala-azar cases even after correct and complete treatment. Single DAT results may be misleading due to high false positivity up to one year after the cure. Paired test defined as two tests 3 mo apart on the same subject. Paired test is highly recommended for diagnosis and prognosis. DAT is still a very useful tool for diagnosis if used along with clinical correlation