Impact assessment of India’s Swachh Bharat Mission – Clean India Campaign on acute diarrheal disease outbreaks: Yes, there is a positive change (original) (raw)
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Seasonal Variations of Acute Diarrheal Disease Outbreaks in India (2010 -2018
ACTA SCIENTIFIC MEDICAL SCIENCES, 2019
During diarrhea, a patient will have a frequent abnormal passage of loose, liquid or watery stools and causes depletion of body fluids, resulting in profound dehydration. Acute diarrhea refers to the episodes of infectious diarrhea, which have a rapid onset and lasts for about 3 to 7 days but may last up to 10 to 14 days. When two or more people in a community or geographical area have a similar illness or proven infection due to common exposure then it is termed as an outbreak. Variations in weather and climate conditions will influence the intensity of disease outbreaks and thus understanding the influence of the seasons on the infectious disease outbreaks is very important for public health monitoring. The objective of this study is to understand the seasonal variations of the acute diarrheal disease (ADD) outbreaks in India. We analyzed the weekly ADD outbreaks data from 2010 till 2018 that is published as a part of the Integrated Disease Surveillance Programme by National Centre for Disease Control, Directorate General of Health Services. The results of the analysis show that in India, ADD outbreaks will be more during the month of May (peak summer) but predominantly maximum during the month of July (when monsoon prevails).
The Indian Journal of Pediatrics, 2007
Objective. Effective early management at home level and health seeking behavior in case of appearance of danger signs are key strategies in Acute respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) where majority of episodes are selflimiting and viral in origin. Integrated Management of Childhood illnesses (IMNCI) also envisages that family and community health practices especially health care seeking behaviors are to be improved to reduce childhood morbidity, mortality and cost of admissions to hospitals. Thus, a study was undertaken at an urban slum area -'Gokul Puri' in Delhi, among under-5 children with the aim to assess the magnitudes of ARI and ADD.
Alexander 2013 Overcoming Barriers in evaluating outbreaks of diarrhea in resources poor settings
Background: Diarrheal illness remains a leading cause of global morbidity and mortality, with the majority of deaths occurring in children <5 years of age. Lack of resources often prohibits the evaluation of outbreak characteristics and limits progress in managing this important disease syndrome, particularly in Africa. Relying only on existing medical staff and hospital resources, we assess the use of a questionnaire survey tool to identify baseline outbreak characteristics during recurrent diarrheal outbreaks in Chobe, Botswana. Methods: Using historical surveillance data (2006)(2007)(2008)(2009), the temporal pattern of recurrent diarrheal outbreaks was evaluated among patients <5 years of age presenting to health facilities in Chobe District. Using a questionnaire survey tool, medical staff from selected health facilities assessed patients (all ages) presenting with diarrheal disease during two diarrheal outbreaks (2011)(2012). Cluster analysis and classification and regression trees (CART) were used to evaluate patient attributes by outbreak. Results: We identified a bimodal, annual pattern of acute diarrhea in children <5 years of age across years (Wilcox test, W = 456.5, p = 0.052). Historical outbreak periods appeared to coincide with major hydrological phenomena (rainfall/flood recession). Across health facilities, a significant percent of patients in the prospective study were in the ≥5 age class (44%, n = 515 and 35%, n = 333 in the dry and wet season outbreaks, respectively). Cluster analysis of questionnaire data identified two main branches associated with patient age (<5 and ≥5 years of age). Patients did not cluster by outbreak or village. CART examination identified sex and hospitalization as being most predictive of patients <5 years and household diarrhea in patients ≥5 years. Water shortages and water quality deficiencies were identified in both outbreaks.
International Journal of Pediatrics, 2017
Introduction.Acute diarrheal disease (ADD) is a common cause of morbidity and mortality in children under 5 years of age. Understanding of the etiology of ADD is lacking in most low and middle income countries because reference laboratories detectlimited number of pathogens. The objective of this study was to determine the feasibility to conduct a comprehensive case-control study to survey diarrheal pathogens among children with and without moderate-to-severe ADD.Materials and Methods.Microbiology and molecular-based techniques were used to detect viral, bacterial, and parasitic enteropathogens. The study was conducted in Bucaramanga, Colombia, after Institutional Review Board approval was obtained.Results.Ninety children less than 5 years of age were recruited after a written informed consent was obtained from parents or guardians. Forty-five subjects served as cases with ADD and 45 as controls. Thirty-six subjects out of 90 (40.0%) were positive for at least one enteropathogen, th...
BMC Public Health
Background: Spatial analysis has been vital in mapping the spread of diseases and assisting in policy making. Targeting diarrhea transmission hotspots is one of the potential strategies for reducing diarrhea cases. This study aimed to examine the spatial-temporal variations and to identify the modifiable determinants of diarrhea while controlling for the spatial dependence in the data. Methods: An ecological study on diarrhea data from DLHS-3 and NFHS-4 in India. Moran's I and LISA were used to detect the spatial clustering of diarrhea cases and to test for clustering in the data. Spatial regression was used to identify the modifiable factors associated with the prevalence of diarrhea. The study comprised of the prevalence of diarrhea among the children below the age of five years (U-5 s) across different states in India. The determinants of diarrhea were obtained using spatial lag models. The software used were GeoDa 1.6.6 and QGIS 2.0. Results: The presence of spatial autocorrelation in DLHS-3 and NFHS-4 (Moron's I = 0.577 and 0.369 respectively) enforces the usage of geographical properties while modeling the diarrhea data. The geographic clustering of highprevalence districts was observed in the state of UP consistently. The spatial pattern of the percentage of children with diarrhea was persistently associated with the household with a sanitation facility (%) (p = 0.023 and p = 0.011). Compared to the diarrhea cases in the period 2007-2008, no much reduction was observed in the period 2015-2016. The prevalence of diarrhea and percentage of household with sanitation were ranging between 0.1-33.8% and 1.3-96. 1% in the period 2007-2008 and 0.6-29.1% and 10.4-92.0% in the period 2015-2016 respectively. The least and highest prevalence of diarrhea being consistently from Assam and UP respectively. Conclusion: Despite improvements in controlling spread of diarrheal disease, the burden remains high. Focus on widespread diarrheal disease control strategy by addressing the social determinants of health like basic sanitation is crucial to reduce the burden of diarrhea among U-5 s in India. The identification of hotspots will aid in the planning of control strategies for goal setting in the targeted regions.
2020
Acute diarrhoeal illness is very common worldwide and estimated to account for 1.8 million childhood deaths annually, predominantly in developing countries (World Health Organization, 2005). Conservative estimates place the global death toll from diarrhoeal diseases at about two million deaths per year (1.7-2.5 million deaths), ranking third among all cases of infectious disease death worldwide. Most of these deaths occur in children under five years of age. Diarrhoea continues to be an important contributor to childhood deaths in India. About 10% of infants and 14% of 1-4 year children die every year due to diarrhoea in India. In Bihar, Acute Diarrhoeal Disease (including Gastroenteritis) constituted 28% of total outbreaks reported & responded in the last two years i.e. 2011& 2012. Around 302 and 272 cases of Acute Diarrhoea were reported in village Arer (PHC:Benipatti) and village Kharra (PHC:Rahika) of Madhubani district in Oct 2013.The objective of the research was to find out the causes of the outbreak, the social and the environmental factors contributing to the outbreak and to suggest remedial measures to control the outbreak. To find out the reasons of the outbreak, discussion with the district authorities, medical and paramedical staffs and physicians who treated the cases was done to know about the clinical presentation of cases, results of laboratory investigations and outcome of cases, interview and clinical examination of some of the cases was done, rapid epidemiological survey by house to house visit and collection of stool, blood and water samples from cases as well as controls who suffered from Acute Diarrhoea for microbiological tests in order to trace the aetiological agent behind the outbreak was also done. In addition, examination of water storage practices, environmental investigation, knowledge, attitude and practices of the community were also analyzed as per pre-planned questionnaire. With all the available evidences, it was concluded that the present outbreaks of diarrhoea were food borne in nature and was a point source outbreak that was caused due to consumption of stale meat consumed during Bakrid in Muslim community and due to consumption of stale food cooked in Durga Puja mela in Hindu community in village Arer. In Kharra village, majority of the Muslim community were affected due to consumption of stale meat. Majority of the affected population belonged to low socioeconomic strata (agricultural labour class). As majority of the affected population were illiterates/less educated/aware, they also had poor awareness regarding personal hygiene. Public health interventions to prevent disease outbreaks should focus on sanitation measures for safe water supply, food hygiene, proper sewage systems/disposal of excreta, public health education.
Health Organisation (WHO) reported it as the second leading cause of children's death worldwide. Nearly 1.7 billion cases occur annually with varied temporal and spatial factors. Identification of the spatiotemporal pattern and hotspot areas of U5-children diarrhea can assist targeted intervention and provide an early warning for more effective response measures. This study aimed at examining spatiotemporal variability along with the detection of hotspot areas for U5-children diarrhea in the Bench Maji Zone of southwestern ethiopia, where resources are limited and cultural heterogeneity is highest. Retrospective longitudinal data of ten years of diarrhea records from January 2008 to December 2017 were used to identify hotspot areas. The incidence rate per 1,000 per year among children was calculated along with seasonal patterns of cases. The spatiotemporal analysis was made using SaTScan version 9.4, while spatial autocorrelations and hotspot identification were generated using ArcGIS 10.5 software. A total of 90,716 U5-children diarrhea cases were reported with an annual incidence rate of 36.1 per 1,000 U5-children, indicating a relative risk (RR) of 1.6 and a log-likelihood ratio (LLR) of 1,347.32 (p < 0.001). The highest incidence of diarrhea illness was recorded during the dry season and showed incidence rate increment from October to February. The risky clusters (RR > 1) were in the districts of Bero, Maji, Surma, Minit Shasha, Guraferda, Mizan Aman Town, and Sheko with annual cases of 127.93, 68.5, 65.12, 55.03, 55.67, 54.14 and 44.97 per 1,000, respectively. The lowest annual cases reported were in the four districts of Shay Bench, South Bench, north Bench, and Minit Goldiya, where RR was less than a unit. Six most likely clusters (Bero, Minit Shasha, Surma, Guraferda, South Bench, and Maji) and one lower RR area (North Bench) were hotspot districts. The U5-children's diarrhea in the study area showed an overall increasing trend during the dry seasons with non-random distribution over space and time. The data recorded during ten years and analyzed with the proper statistical tools helped to identify the hotspot areas with risky seasons where diarrhea could increase.
BMC Public Health, 2013
Background: Diarrheal illness remains a leading cause of global morbidity and mortality, with the majority of deaths occurring in children <5 years of age. Lack of resources often prohibits the evaluation of outbreak characteristics and limits progress in managing this important disease syndrome, particularly in Africa. Relying only on existing medical staff and hospital resources, we assess the use of a questionnaire survey tool to identify baseline outbreak characteristics during recurrent diarrheal outbreaks in Chobe, Botswana. Methods: Using historical surveillance data (2006-2009), the temporal pattern of recurrent diarrheal outbreaks was evaluated among patients <5 years of age presenting to health facilities in Chobe District. Using a questionnaire survey tool, medical staff from selected health facilities assessed patients (all ages) presenting with diarrheal disease during two diarrheal outbreaks (2011-2012). Cluster analysis and classification and regression trees (CART) were used to evaluate patient attributes by outbreak. Results: We identified a bimodal, annual pattern of acute diarrhea in children <5 years of age across years (Wilcox test, W = 456.5, p = 0.052). Historical outbreak periods appeared to coincide with major hydrological phenomena (rainfall/flood recession). Across health facilities, a significant percent of patients in the prospective study were in the ≥5 age class (44%, n = 515 and 35%, n = 333 in the dry and wet season outbreaks, respectively). Cluster analysis of questionnaire data identified two main branches associated with patient age (<5 and ≥5 years of age). Patients did not cluster by outbreak or village. CART examination identified sex and hospitalization as being most predictive of patients <5 years and household diarrhea in patients ≥5 years. Water shortages and water quality deficiencies were identified in both outbreaks.
Surveillance of communicable disease from a tertiary care teaching hospital of central Kerala, India
International Journal of Medicine and Public Health, 2015
Background: Surveillance is the back bone of any disease control program. Communicable disease is a major cause of morbidity. Precise data on the pattern of communicable disease will enable us to identify the epidemic early so that timely response will be possible. Aims: (1) To find out the morbidity and mortality pattern of communicable diseases. (2) To study the disease trend and seasonality of acute respiratory infections (ARIs) and acute diarrheal diseases (ADD). Materials and Methods: Retrospective record-based descriptive study was done to find out the morbidity and mortality pattern of communicable disease and trend of seasonality. Five years surveillance data from 2009 to 2013 were collected and analyzed. Results: Maximum morbidity (47.6%) was observed in air borne diseases. ARI accounted for 53%, and pulmonary tuberculosis 27% of morbidity among air borne diseases. Admissions from water borne diseases were mainly done for ADD (47%), followed by hepatitis (34%). 90% of the morbidity from vector borne disease was due to dengue fever. ADD showed a rise during the summer season, and ARI showed peak during the rainy season. The difference in incidence observed between seasons for ADD and ARI were statistically significant (P = 0.001). Leptospirosis and chickenpox were present throughout the years. Increase in mortality from all communicable diseases was observed from the year 2011 onwards. 48% of mortality was due to air borne diseases such as pulmonary tuberculosis, pneumonia, and chickenpox. Conclusion: Maximum morbidity and mortality were due to airborne diseases. Incidence of ADD was more during the summer while ARI was more during the rainy season.
BMC Public Health, 2022
Background This study aims to measure the burden of diarrhea in India and analyze the trend of mortality associated with it for the past 30 years. We also intend to find the prevailing etiology and risk factors associated with diarrheal mortality in India. Methods The study has used the latest round of Global Burden of Disease (GBD) study-2019. GBD data is available across age groups and gender-wise over the period from 1990 to 2019. The study has identified 13 etiologies for the cause of diarrhea deaths and 20 risk factors to analyze the burden of disease. Results Our study shows, childhood diarrhea has declined over the years significantly, yet contributes to a larger share of DALYs associated with the disease. Among all the death cases of Diarrhea, in 2019, the most prevalent disease-causing pathogen is found to be Campylobacter. But Adenovirus is the major contributor to childhood diarrheal deaths. Though the burden of diarrhea is declining over the period, still there is a need...