Seasonal Variations of Acute Diarrheal Disease Outbreaks in India (2010 -2018 (original) (raw)
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Journal of Family Medicine and Primary Care, 2019
Background: Enough evidence exists to attribute the occurrence of diarrheal disease outbreaks due to open defecation practice and unsafe sanitation methods. Open defecation enables pathogens such as virus, bacteria, and protozoa to infect humans by means of fecal–oral transmission methods through contaminated fluids, water, and fomites. To curb the malefic effects of open defecation, the Indian government had initiated pro sanitation program namely Swachh Bharat Mission (SBM) in 2014. SBM became the world's largest toilet-building initiative. More than 95 million toilets have been built across rural and urban India since the launch of this mission. This articulation summarizes the trend analysis of acute diarrheal disease (ADD) outbreaks over a 9-year period with emphasis on changes due to the building of toilets under the clean India campaign. Methods: Weekly ADD outbreaks data from national-level Integrated Disease Surveillance Program between 2010 and 2018 were used for trend analysis along with the number of toilets constructed in rural areas under SBM from the year 2014. Results: ADD outbreaks were analyzed from 2010 to 2018. The number of ADD outbreaks per year during the past 2 years (i.e., 2017 and 2018) of SBM regime was lesser than in any year during the investigation period. Seasonal variations during the months of May, June, July, and August account for 55%–60% of ADD outbreaks in any of the years; but for 2018, the total outbreaks were 46%, which is significantly lower than that of regular range of outbreaks in the peak season. Conclusion: The recent pattern of ADD outbreaks exhibits a declining rate.
Background: Diarrheal disease forms one of the two major killer diseases in children under five years of age in the developing world. Data on the prevalence and related factors of diarrhea in Bundelkhand region is quite scanty. A community-based cross sectional study was undertaken among 301 under-five children of field practice area Medical College Jhansi during 2015-16, to find out the burden of diarrheal diseases and the effect of seasonal variation on the pattern of diarrheal diseases. Methods: Cross sectional study was carried out using pre-tested interview schedule. Results: Overall period (last 2 weeks) and point (24 hrs) prevalence rates of diarrheal diseases among children under-five age were calculated which came to the order of 36.1% and 12 % respectively. Prevalence of diarrhea decreased significantly with increasing age and was found to be higher during summer months. Conclusion: The burden of diarrheal disease in Bundelkhand region is quite high, like places in the developing world. The age pattern and seasonal pattern of the diarrheal disease also resembles that found in studies across India and the developing world.
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.
Scandinavian Journal of Infectious Diseases, 1998
During the spring peak of diarrhoea in Bangladesh, 113 consecutive patients who represented a systematic 4% sample of all patients attending an urban diarrhoea treatment facility between 18 and 23 April 1995 were studied. The study was conducted to characterize enteric pathogens associated with the spring peak of the diarrhoea outbreak in Bangladesh and to describe clinical and epidemiological features of the patients. The spring peak is traditionally thought to be mostly due to V. cholerae O1. However, the most common cause of diarrhoea among the study patients was enterotoxigenic Escherichia coli (36%) followed by Vibrio cholerae O1 (23%). The V. cholerae O1 patients attended significantly (p B0.01) sooner after onset of diarrhoea than enterotoxigenic E. coli (ETEC) patients. Studies of behavioural and environmental characteristics are important to determine risk factors for observed higher proportion of ETEC infection during seasonal diarrhoea peaks.
Pakistan Journal of Public Health, 2019
Background: On July 24, 2017, two cases suspected of acute watery diarrhea (AWD) were reported from tertiary care hospital, Rawalpindi. District health authorities directed to conduct outbreak investigation, identified risk factors and recommend control measures. Methods: A descriptive followed by age-sex matched case control study (1:3) was done from Jul 27 to Aug 02, 2017. Case definition was "sudden onset of loose watery stools (? 3 in past 24hrs) with any of symptoms i.e. vomiting, nausea, abdominal cramps or fever in residents of Amar Pura from July 19 to August 02, 2017". Active and passive case finding technique were done in addtion to hosptial record review. Total 02 stool and 03 water samples were collected for microbiological testing. Odd ratios computed on 95% confidence interval and P value <0.05. Results: Total 18 cases were identified (mean age: 16 year; range: 02 m-55yrs), predominate were male 2.6:1. Overall attack rate (AR) was 7.2/1000 and preponderate...
Seasonal variation and etiologic inferences of childhood pneumonia and diarrhea mortality in India
eLIFE, 2019
Future control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate-region, and clinical syndromes from 243,000 verbal autopsies in the nationally-representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99%CI 1.51-1.82; versus the April minimum). Higher RRs at 1-11 months suggested respiratory syncytial virus (RSV) etiology. India's humid subtropical region experienced a unique summer pneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48-1.85) and January (RR 1.37, 1.23-1.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1-59-months in 2015 with prevalence surveys, we estimate 40,600 pneumonia deaths from Streptococcus pneumoniae, 20,700 from RSV, 12,600 from influenza, and 7,200 from Haemophilus influenzae type b and 24,700 diarrheal deaths from rotavirus. Careful mortality studies can elucidate etiologies and inform vaccine introduction.
Epidemiology and Infection, 2001
Two epidemics of acute, watery diarrhoea in villages in North Arcot district, India, were investigated. The attack rates were 10n03 and 15n53 per 100 population, the median duration was 5 days and enteric pathogens were present in 56n8 % and 60n3 % of specimens from the two villages, but no predominant pathogen was identified. Examination of stools from a 20 % age-stratified random sample of the population of one of the villages after the epidemic found 22n9 % of asymptomatic subjects excreted bacterial enteric pathogens. Despite the high background of enteric pathogen carriage, the isolation rates for shigellae, enteropathogenic Escherichia coli and Shiga-toxin producing E. coli were significantly higher (P 0n001, P 0n02, P 0n05) during the epidemic. The epidemics may have been caused by faecal contamination of well water following rain. Point-of-use techniques for water disinfection may be most effective for preventing such outbreaks, but further research into the development of appropriate technology is required.