Abstract
BackgroundThis qualitative investigation was conducted to determine the socio-epidemiological factors related to the plague outbreak (2002) in Himachal Pradesh (HP), India.MethodsThe data for socio-epidemiological factors related to the plague outbreak (2002) in HP was obtained from residents through 150 in-depth Interviews (IDI) and 30 Focus Group Discussions (FGD) during six visits (from May 2011 to April 2012) by the research team. Natives, health officials and the nomadic population were interviewed. According to their opinion and viewpoints data was collected and their lifestyle and hunting practices were studied in detail. Tape recorders were used during various FGDs and IDIs. The interviews and FGDs were later transcribed and coded. In-depth analysis of the recorded data was done using an inductive thematic analysis approach.ResultsThe study reports that the outbreak in 2002 in a few villages of Himachal Pradesh was that of plague and it occurred by the contact of an index case with wild animals after hunting and de-skinning. The first wave of plague transmission which took 16 lives of residents was followed by a second wave of transmission in a ward of a tertiary care hospital where one visitor acquired it from relatives of the index case and succumbed. The life-style practices of residents (hunting behavior, long stay in caves and jungles, overcrowding in houses, poor hygiene and sanitation, belief in ‘God’ and faith healers for cure of diseases) was optimal for the occurrence and rapid spread of such a communicable disease. The man-rodent contact is intensified due to the practice of hunting in such a rodent-ridden environment. The residents harbor a strong belief that plague occurs due to the wrath of gods. Various un-reported outbreaks of plague were also observed by officials, residents and old folk. The persistence of plague in HP is favoured by its hilly terrain, inaccessible areas, inclement weather (snow) in winters, unhygienic lifestyle, hunting practices of residents, and treatment practices through faith healers.ConclusionsThis study suggests that the lifestyle of the natives of HP and other socio-epidemiological factors played a role in the outbreak of plague in that area.
Highlights
This qualitative investigation was conducted to determine the socio-epidemiological factors related to the plague outbreak (2002) in Himachal Pradesh (HP), India
The present study was undertaken to ascertain various socio-epidemiological factors related to the 2002 outbreak of plague in Himachal Pradesh that occurred almost a decade later than earlier outbreaks of similar disease in India. Material and methods This qualitative study was conducted in the area of Himachal Pradesh (HP) that was affected during the 2002 plague outbreak
A total of 30 Focus Group Discussions (FGD) and 150 in-depth Interviews (IDI) were conducted amongst affected families, natives, Gujjars and health officials involved during the 2002 (HP) plague outbreak
Summary
This qualitative investigation was conducted to determine the socio-epidemiological factors related to the plague outbreak (2002) in Himachal Pradesh (HP), India. Plague continues to remain endemic [1] even in this day and age across various parts of the world [2] including India [3]. Plague is an internationally notifiable disease, it has ceased to exist in the list of priority diseases circulated by the Government of India and other agencies. In India, plague outbreaks were reported in the year 1994 in the two states of Beed (Maharashtra) and. A local outbreak of plague had occurred in Himachal Pradesh (2002) and Uttaranchal (2004). It was maintained that plague had ceased to exist in India after 1966 [3]. Most practicing doctors are not aware of the manifestation and management of plague
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