Integrated Disease Surveillance Programme Research Articles

Tracking the implementation to identify gaps in integrated disease surveillance program in a block of district jhajjar (haryana).

Context:To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The responsibility for effective implementation of IDSP at the sub-center level lies with the health workers.Aims:The aim of the following study was to assess the knowledge and practice of health workers regarding IDSP and to assess the quality of IDSP reports at the sub-center level.Settings and Design:It was cross-sectional study carried out in the area under Community Health Center Dighal which is the rural field practice area attached to Post Graduate Institute of Medical Sciences, Rohtak in the State of Haryana, India. Subjects and Methods: All the 24 sub-centers in the area were visited and 46 health workers (22 male; 24 female) who met the inclusion criteria i.e. who had completed 1 year of their service or had been trained for IDSP, were included in the study. Data were collected on a self-designed, semi-structured and pre-tested schedule by interviewing the study subjects and observation of the records/reports.Statistical Analysis Used:Percentages and proportions.Results:Only 14/46 (~30%) of the workers could expand the abbreviation “IDSP” correctly. Only 4/46 (~9%) workers could narrate any of the trigger events and none could tell all the trigger events. Only at 12 such sub-centers, diagnoses were being written in their out-patient registers according to the defined syndromes. 43/46 (~93%) workers were not aware of the zero reporting.Conclusions:The surveillance system is much less alert and intense than the desired level and needs to be strengthened.

Acute Diarrhea in Children after 2004 Tsunami, Andaman Islands

To the Editor: The Andaman Islands, population ≈350,000, are a territory of India located in the Bay of Bengal, northwest of Indonesia. On December 26, 2004, these islands were struck by an earthquake measuring 9.1 on the Richter scale (1) and by the ensuing Great Asian Tsunami (2). The fault slip, which caused permanent land subsidence of several meters (3) and ingression of sea water, resulted in the displacement of most survivors, many of whom were forced to live in temporary camps on higher ground for periods of more than a year. About 80% of the water supply lines were broken (4) and so were most sewage lines, making the situation ideal for transmission of water-borne diseases. Because an outbreak of cholera had occurred in the Andaman and Nicobar Islands in 2002 (5), we were apprehensive about outbreaks of infectious diseases after the tsunami, particularly among children, who are less immune to most infections; therefore, we increased our efforts to identify and contain these possible outbreaks as quickly as possible. However, except for a cluster of cases of rotaviral diarrhea (6), no major infectious disease outbreak occurred among residents of the Andaman Islands in the year that followed the tsunami. Although the incidence of severe cases of diarrhea among children admitted to G.B. Pant Hospital in Port Blair, the only referral hospital in the Andaman Islands, varied greatly from month to month during 2001–2007, the incidence began decreasing after 2005, as indicated by the 12-month moving average (Figure). The mean number of cases per year fell from 361.4 during 2001–2005 to only 255.0 during 2006 and 2007 (p = 0.00025). Figure Estimated monthly incidence (black dots) of acute diarrhea among children <15 years of age in the Andaman Islands and 12-month moving average of the monthly incidence (black line), 2001–2007. Data based on cases of disease among children ... The estimated annual incidence of acute diarrhea per 100,000 children in the Andaman and Nicobar Islands was 609 in 2001, 580 in 2002, 595 in 2003, 601 in 2004, 571 in 2005, 370 in 2006, and 420 in 2007. For these incidence estimates, the population at risk during the years 2002–2007 was calculated by extrapolating from the 2001 census population on the basis of an annual population growth rate of 1.53% (the average for 1991–2001) and assuming that children <15 years old constituted 36.2% of the total population each year (as they did in 2001). The reduction in the number of acute cases of childhood diarrhea began several months after the tsunami, when the water and sewage systems of the islands had been repaired and renovated in many areas. According to official reports, the cost of the restoration and renovation of the water and sewage systems after the tsunami was 389.9 million rupees, >2× the projected cost of work on the water and sanitation systems (172.9 million rupees) prior to the tsunami (4). In the aftermath of the tsunami, 52 km of new pipelines were laid and 12.5 km of old pipelines were replaced. Water supplies were augmented in 49 areas (4). The revamped water and sewage systems eliminated many sources of fecal contamination. Moreover, by the middle of 2005, post-disaster assistance had been provided by voluntary organizations, missionaries, nongovernmental organizations, and government agencies from mainland India and abroad. This assistance resulted in further improvements in the area’s public sanitation infrastructure and hygiene, particularly in the temporary shelters that displaced residents were living in; it also raised awareness among island residents about the threat of water-borne diseases. All of these factors were likely contributors to the decline in the number of cases of acute diarrhea in children after the tsunami. Although out-migration of island residents or a reduction in case detection after the tsunami also could have contributed to the observed decline in cases of diarrhea, no large-scale migration was reported during the period, and disease surveillance systems were in fact strengthened after the tsunami and further strengthened with the introduction of the Integrated Disease Surveillance Program. In summary, we found that the incidence of acute diarrhea among children of the Andaman Islands decreased within months after the 2004 tsunami. This result highlights the importance of public health and sanitation measures after a natural disaster.

Cas cliniques de l’ADF

Development of oral cholera vaccines (OCVs) experienced exciting times over the last two decades. A two-dose OCV, found efficacious through field trials, has obtained license for use in India. However, the current policy discussion revolves around ‘to use or not to use’ this vaccine covering entire population in the country, which has its own cost implications. We conducted a systematic review to address this conundrum. The disease burden and distribution, potential impact, programmatic issues, and competing priorities were kept in consideration. Peer reviewed articles and ‘Integrated Disease Surveillance Program’ data, generated by Government of India, were accessed. Our synthesis highlights that cholera burden estimates for India have been hamstrung by their extrapolation from a single incidence study conducted in Kolkata. Heterogeneity of 685 Indian districts regarding vulnerability to cholera is also obvious. Analysis of outbreak reports indicated that some settlements and sub-populations were more vulnerable to diarrhea/cholera than others. Infrastructure failure leading to contamination of drinking water and behavioral issues were of concern. Investment in safe water, sanitation and hygiene (WASH) and addressing inequity of health services pertaining to vulnerable population groups are the needs of the hour. OCV could play an important role as one of the elements in such multi-component cholera prevention effort. OCV administration through public health system in Odisha identified logistic challenges, with low uptake of the second dose at 46%, while 61% of the target population received the first dose. We identified accumulating global evidence on the advantage and efficacy of single-dose based approach, where the same OCV, as licensed in India, was used. The short-lasting nature of cholera outbreaks in India also argue in favor of such pragmatism. Failure to implement multi-component prevention strategy today runs the risk of perpetuating inequity, recurring cholera outbreaks in future, and its retinue of costs.