Investigating diphtheria outbreak: A qualitative study in rural area

Abstract

Background: Even after three decades of implementation of the Universal Immunization Programme in India, cases of diphtheria continue to occur. It is pertinent to study the social and epidemiological determinants of diphtheria. Aims & Objective: The present study was undertaken to investigate epidemiological and social determinants of Diphtheria outbreak in a district in Central India and to understand response of health care system to this outbreak. Materials and Methods: Explanatory case study method, a qualitative method was employed involving interviews with stakeholders including family members of the affected children, specialists from tertiary care teaching hospital who treated these cases, health workers, public health functionaries at primary care and district level. Results: Both cases belonged to migratory community and non-immunization was identified as the chief proximal reason. Both, knowledge and utilisation of immunisation was poor in these communities and was limited to pulse polio immunization. Epidemiologically, the two cases were possibly linked. Vaccination drive to immunize all unimmunized children was conducted in the district where the cases were identified but not in the district where possibly the cases have originated. Conclusion: Social determinants including poverty, migration, poor access to health care all contributed in creating epidemiological situation where transmission of disease agent was easy, resulting in an outbreak. Migration creates vulnerability and our health systems should gear up themselves to address this vulnerability; appropriate strategies and micro-planning should be in place to cater to the needs of this underprivileged community. Strong surveillance system with adequate public health response addressing outbreaks is necessary.