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National Institute of Communicable Diseases |
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ANNUAL REPORT 1997 |
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Epidemiology Division The
Division of Epidemiology undertakes the following activities: §
Organise
and co-ordinate training courses in epidemiology to develop trained health
manpower. §
Investigate
and recommend remedial measures for the outbreak of diseases of known/ unknown
aetiology to the States/Uts of the country. §
Carry
out field research on different aspects of epidemic-prone diseases. §
Provide
support to various National Health Programmes in the form of evaluation of
different components/indicators. §
Provide
teaching materials in the form of Modules etc. on various diseases to different
health institutions and Guidelines for disease control to State Health
Departments. §
Provide
administrative and technical supports to three units at Alwar (Rajasthan),
Jagdalpur (Madhya Pradesh) and Coonoor (Tamil Nadu). §
Monitoring
of Yaws Eradication Programme. §
Provide
technical support to Director in Planning and Implementation of National
Disease Surveillance Programme (NDSP) and publication of monthly Bulletin “CD Alert”. §
Statistical
guidance to all the Officers of the Division / Institute engaged in various
Research activities and Disease control programmes. Specialised Services and Activities §
Prepared
material for framing reply to Parliament Questions. §
Surveillance
of meningitis in Delhi. §
Surveillance
of Japanese Encephalitis in India. §
Provided
technical support to State Government for outbreak investigations. §
Imparted
training in Field Epidemiology for the state and district levels health
officials. §
Implementation
of Yaws Eradication Programme in India. §
Surveillance
of Acute Diarrhoeal Diseases and Cholera in Delhi. §
Cholera
surveillance in Delhi: Zone-wise Compilation and analysis of Cholera cases in
Delhi, and preparation of weekly reports on Cholera for perusal of DGHS. §
Sentinel
Surveillance: Compilation of sentinel surveillance data on morbidity and
morality status of eleven selected communicable diseases, received monthwise,
from 40 identified “Surveillance Centres” in the country. §
Weekly,
district-wise information on morbidity and mortality status of communicable
diseases, received from the State of Maharashtra was tabulated and summarised. Supply of Teaching Materials to other Health Institutions §
Yaws
recognition cards for use in Yaws affected areas. §
Operational
manual on Yaws Eradication Programme (YEP) for field workers. §
Guidelines
for Medical Officers on Yaws Eradication Programme to Health Directorates of
Govt. of Orissa, Madhya Pradesh and Andhra Pradesh. §
Material
on control of communicable diseases, occupational health, malaria and Kala Azar
to Railways Staff College, Vadodara (Gujarat). National Disease Surveillance Programme (NDSP) NDSP
has been initiated in five pilot districts, namely; Allepy (Kerala), Alwar
(Rajasthan), Gurgaon (Haryana, Kolar (Karnataka) and Mehsana (Gujarat). The
progress made during 1997 to implement the programme is as follows:
i.
Situational
analysis of these pilot districts is completed.
ii.
Training
of State and District level ‘Rapid Response Team’ of identified states and
districts is completed.
iii.
Information
(such as diagnostic facilities and equipments available) collected from State,
District and Referral Laboratories have been analysed to plan for further
strengthening of these laboratories. A few observations are as follows: §
The entire
data obtained so far from individual labs on the availability status of various
laboratory facilities/ equipments has been computerised into an EXCEL file. §
Files
have been created based on the information available for statewise list of labs
that have responded and the percentage of labs presently equipped with each of
the selected laboratory facility. Eight
nine laboratories from 14 States have so far furnished information on the
facilities existing with them. Some of the findings revealed by the analysis
are that microscopic examination of cholera is undertaken by more than 50% of
these labs. Provision
for bacteriological examination is very poor, in the region of 20%. Whereas 84%
of the labs have Refrigerators available with them, only 20% are equipped with
Deep freezers ( - 200C). Microbiology trained medical officers are
stationed only in about 50% of the labs. Research Projects 1. Aetiology of joundice in urban
population – A community based multicentric study, 1997-98 A
community based survey was initiated in Bangalore, Calicut, Coonoor and
Rajahmundry districts of South India with the objective to ascertain the
aetiology of jaundice in urban population. The survey is likely to be completed
by the end of the year 1998. 2. Pre-and extra-material hetero-sexual
behaviour of an urban community in Rajasthan, India. There
are about 2.5 million persons infected with HIV in India, heterosexual contact
being the most prevalent mode of transmission. Recent trends indicate that HIV
infection is spilling over from the so called high risk groups to the general
population. Due to vast population size and wide socio-cultural diversity,
study of sexual behaviour among the general population of India is neither
feasible nor of utility. School teachers, however, can make an important study
group as they are role models for general population and specifically for
students. The present study was conducted among the teachers of senior
secondary schools of a city in Rajasthan state, India, to know the magnitude of
pre-and extra-marital hetero-sexual practices and some related characteristics.
The
study was conducted between April and September 1997. The study population
consisted of all the teachers (totaling 708 with 362 males and 346 females) of
all 18 senior secondary schools (up to 12th standard) of the city. Two types of
self-reporting questionnaires were used to collect information. Main
questionnaires was administered in 13 randomly selected schools and in rest 5
schools, a brief check questionnaire was used for internal validation. Informed
consent was obtained from the respondents and confidentiality of their
responses maintained. The
study elicited an overall response rate of 73 per cent (males : 72.7%),
females: 74.6%). The check questionnaire was representative of 14.6 percent of
study population. Pre-material hetero-sexual act (HAS) was present in 34.3 per
cent unmarried and 19.6 per cent married males respectively (X2 =
5.8, p < 0.02). The same for unmarried and married females was 11.8 per cent
and 1.5 per cent respectively (X2 = 5.3, p < 0.02). The
proportion of extra-marital HAS among married males was 15.5 per cent. Ten per
cent of married males had both pre-and extra-marital HSA (OR = 15.2). Only one
married female had extra-marital HAS. Friends, relations and acquaintances
mostly constituted the sexual partners and role of commercial sex workers was
negligible. All the values obtained from check questionnaire, except for
pre-marital HSA in females, were consistently higher. The
present study revealed that hetero-sexual act, with person other than the legal
spouse, is very much prevalent among this educated middle class urban
professionals, commercial sex workers being the least preferred partners.
Increase in pre-marital HSA among younger (unmarried) generation has also been
observed. This situation is conducive for the spread of HIV infection among
general population and may adversely influence the sexual attitudes of
students. A response rate of 73 per cent, with equal proportions of males and
females, is sufficient to represent the study population. Some degree of
under-reporting, particularly in the females was possible. The study results
suggest that, while intensifying the health education of school students on HIV
/AIDS, serious considerations about the sexual behaviour of their teachers
teachers are needed. Since authors are unaware of any such study in South East
Asia, more research activities willenrich our knowledge in this regard. 3. Record analysis of cases of
poliomyelitis reported in Kalawati Saran Children Hospital, Delhi for the years
1993-96 In
India, National immunization programme (EPI) has been in operation since 1978.
Though, trend of polio cases has shown decline, it is still a public health
problem. A retrospective data analysis was carried out by the participants of
the National FETP course with the objective to study the line list of polio
cases. Kalawati
Saran Children’s Hospital (KSCH), Delhi is a ‘Sentinel Surveillance Centre’ for
many communicable diseases, including poliomyelitis, and accounts for about 80%
of the reported poliomyelitis cases of Delhi. The line-list of polio cases
during the period Jan. 1993 to October 1996 was obtained from KSCH. One
thousand and ninety seven (1097) cases of poliomyelitis were analysed. 38% of
total cases were from Delhi and the rest were from the adjoining States. About
30% of Delhi cases were from Shahdara Zones (11 & 12). These Zones are
situated at the bank of Yamuna river. Maintaining
the line list of polio cases is important tool for the programme manager of
Delhi. 98.8% of the total cases were under the age of 5 years. Out of 1097,
41.3% were infants. The male to female ratio was 1.5:1. 84.2% of cases had
lower limb involvement. Trauma within four weeks of the onset of the paralysis
has been shown to be a highly significant risk factors for paralytic
poliomyelitis (p<0.001). As per the records, 26% of cases were fully
immunised with 3 doses of OPV. It is seen that unimmunised children are at a
significantly greater risk for developing paralytic poliomyelitis than the
immunised children (p<0.01) (A child having less than three doses of OPV was
considered as unimmunised regardless of age). The
time lag between onset of illness and collection of stools for virus isolation
was also analysed. Of the 208 stool samples, 54.8% was collected during the
first week. The highest percentage of polio virus isolation was in this period,
which was 66.7%. This is
explained by the intermittent excretion of the poliovirus from the patient,
which is maximal in the first week, gradually declining thereafter. Most of
this data is with regard to a single collection of stool sample. 4. Epidemiological analysis of Weekly
reports of epidemic prone diseases, Maharashtra for the years 1995-96 Epidemiological
surveillance of diseases is an important component of health information
system. An efficient health information system is important in planning
epidemiological services and evolve epidemiological strategies accessible to
personnel of all levels of health hierarchy. NICD is regularly collecting
weekly reports on morbidity and mortality of selected 11 epidemic – prone
communicable diseases from 30 districts of Maharashtra State. Record analysis
of these weekly reports for the period 1995-96 was carried out by the
participants of the National FETP course with the objective to study the trend
and seasonality pattern of diseases in Maharashtra. 2,06,119 and 2,99,914 cases
were recorded for 11 communicable diseases during the years 1995 and 1996,
respectively. The number of cases increased by 45.5%. About 99% of cases were
of 7 diseases, viz; Acute gastroenteritis, diarrhoea, dysentery, influenza,
measles, jaundice and typhoid, the remaining four (cholera, Polio, Encephalitis
& diphtheria) accounted for 1%. For comparability between the diseases,
further analysis was carried out by converting the data into ‘Index’ form. The
index was the highest for the diarrhoea and lowest for measles and typhoid.
Data shows the seasonality of diarrhoea, gastroenteritis and dysentery during
the months June to September. Since it was a retrospective analysis based on
weekly reports, months June to September. Since it was a retrospective analysis
based on weekly reports, information like age, address, date of onset,
laboratory information could not be obtained. 5. Epidemiological analysis of
Cholera cases reported from different zones of Delhi during 1994-96 To
study the epidemiology of cholera reported to Infectious Diseases Hospital,
Delhi during the years 1994-96 was carried out by the participants of National
FETP course 2023, 1818 and 887 cases were reported respectively during the
years 1994, 1995 and 1996. All the Municipal Zones were affected Civil Line
Zone (No. 5) and Shahdara Zones (No. 11 & 12) are the worst affected during
these years. Cases start occurring during the months May to September with peak
in July – August. All the age groups were affected and more than one-third of
cases were under the age of five. 6. Knowledge and practices of urban
mothers regarding case management of diarrhoea and acute respiratory infections
at household level in Varanasi A
combined survey on diarrhoeal diseases and Acute Respiratory Infections (ARI)
was conducted by nine participants of Field Epidemiology Training Programme in
the urban areas of Varanasi District (U.P.) having a population of 14.47 lakhs.
30 clusters were surveyed during 22-27 December 1997 with the following
objectives:
i.
To
assess the knowledge and practices of mothers of under fives in respect of
diarrhoeal diseases regarding a) the use of Oral Rehydration Salt (ORS), b) use
of Home available Fluids (HAF), c) feeling practices including breast feeding,
d) the knowledge regarding the recognition of early symptoms of dehydration and
e) knowledge and practices of referral.
ii.
To
assess the knowledge and practices of motors of mothers of underfives in
respect of management of ARI regarding, b) identification of early symptoms of
pneumonia and c) referral outside home.
iii.
To
evaluate the coverage of OPV during the first round of pulse polio Information
related to ORT, ARI and Pulse-Polio programmes was collected simultaneously,
either from mother or caretaker of underfive children on modified and
pre-tested questionnaire. Out of
1386 under 5 yrs children surveyed, 225 were found to be suffering from
diarrhoeal diseases within the last two weeks giving 2.3 episodes / child /
year (with seasonal correction factor). Out of 225 diarrhoel cases mothers of
220 children could be interviewed regarding
the practices adopted for case management during the diarrhoeal episode.
76.6% continued to breasfeed their infants and 87.6% continued to feed their
children either solid or semisolid food. ORS use rate was found the be 20.5%
and the correct preparation of ORS (i.e. dissolution of pkt of ORS in 1 litre
of potable water) was fond to be only 6.7%. Use of home available fluid (HAF)
like sugar salt solution (sss), rice water, dal ka pani, mild tea was 56.5% by
the mothers. 76.8% mothers had the knowledge regarding the early symptoms of
dehydration. However 70 (31.8%) children developed symptoms of dehydration
during diarrhoeal episodes. Out of 70, 9 mothers (12.8%) attended government
health facilities for management of dehydration and 54(77.1%) mothers contacted
private doctors. On inquiry about not contacting govt. doctors for management
of dehydration, the reasons given were (i) place inconvenient (42.9%), (ii)
medicine not available (27%), (iii) not attended properly (28%) and (iv) no
faith in govt. doctors. Out of the 1386 under 5 children surveyed 377 (27.2%)
cases of ARI within the last two weeks were found giving 10.1
episodes/child/year (with seasonal correction factor). Out of the 377 cases of
ARI, mothers of 298 cases could be interviewed regarding the ARI case
management at household level. 88.1% of the mothers continued breast feeding
their infants, 96.1% of mothers continued to feed their children either solid
or semi-solid food. 68% of the mothers had the knowledge of danger symptoms
associated with ARI. 67 (25.9%) of children developed the danger symptoms of
pneumonia. Out of 67 only 8 (11.9%)
mothers contacted the government health facilities and 56 (83.6%)
contacted private doctors. On being enquired about the reasons for not
contacting the government health facilities for the management of pneumonia the
reasons given were (i) medicine not available (38.9%), (ii) not attended
properly (28.9%) and (iii) no faith in government doctors (28.8%). |
