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National Institute of Communicable Diseases |
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ANNUAL REPORT 1997 |
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NICD Branch, Alwar The
National Institute of Communicable Diseases, (NICD) is primarily devoted to
research and training in the field of communicable diseases. Advancement and
dissemination of knowledge relating to the epidemiology and control of
communicable diseases have become an important objectives of the institute. It
also guides the state health organisation in their activities specially in control of communicable diseases. Field
Practice Unit, Alwar was established in the year 1973, with an idea to impart
field training to different categories of medical and para medical health
personnel admitted to various training courses being conducted at National
Institute of Communicable Diseases, Delhi. The Deputy Director is the head of
the unit. Main functions of this unit are research, training and service in the
field of communicable diseases. This institute has done some modest research
work on bacterial, protozoal and helminthic infections in man. This branch of
NICD provide the basic diagnostic facilities including Widal test, Malaria
Parasite (MP), VDRL, stool & water culture for vibrio cholerae for the people
of Alwar and adjoining districts of the Rajasthan State. This Institute also
undertakes investigation of outbreaks and formulations of measures to control. This
unit has developed good co-ordination with (NICD) headquarters, state and
district health authorities to carry out its activities under the leadership of
the Deputy Director (Medical). Routine Services/Activiites & Maintenance of stock cultures of
various animals, pathogens & parasites
Regular
supply of VR fluid media bottles for collecting stool samples & water
samples from the most peripheral areas of Alwar, Bharatpur and adjoining
districts of the Rajasthan State for cholera culture. Diagnostic services
Public health and other bacteriological, biochemical services In the
outbreak situation, this unit regularly provides expert epidemiological
assistance for prevention and control of epidemic. Bacteriological services
e.g. Widal Test, VDRL Test, Cholera culture, Blood for MP, Coliform count. Identificaion Services For the
cross confirmation, this unit regularly receives blood slide for MP from Dy.
C.M. & H.O. (Malaria) office, Alwar. Research Projects 1. An epidemiological study of
malaria in rural areas of Alwar district Aims
and objectives of the project are to find out the prevalence and incidence of
malaria, its seasonal distribution and to suggest the measures for control and
prevention of malaria in the area. The
criteria for the selection of the study area was high API i.e. 9.45% in the village. This research
project has been started in the year 1995. The observation
made during the year 1997 were SPR was 39.64% and SFR 43.34%. All the positive
cases were given radical treatment. It is interesting to note that not a single
malaria death was reported from the study village. 2. Vital hepatitis carreer survey in
the Alwar district Viral
hepatitis in its different types is prevalent in the Alwar district, and the
cases occur throughout the year. Endemicity of the disease is responsible for
presence of a large number of carriers. This study is proposed to find out the
carrier rate of hepatitis B in the district. During the year 1996, a total
427 blood samples were collected from the rural as well as urban areas of the
district. Out of the them, 22 blood samples were found positive for HbsAg. The
career rate was found 5.15 percent in the district. Viral
hepatitis carrer survey in the Alwar district.
In the
year 1997, a total of 155 blood samples were collected for the Viral Hepatitis
study. The laboratory results of the above samples were not received. Thus it
is not included in the total samples collected for the study. Distribution
of the blood samples collected during the year 1997 for the Viral Hepatitis
Carrier Survey
in the Alwar
3. An epidemiological surveillance of
Acute Flaccid Paralysis (AFP) in the Alwar The
study was carried out to find out wild polio virus circulation in the community
in relation to occurrence of a case of acute flaccid paralysis (AFP) and to
find out asymptomatic wild polio virus infection in the community which is >
99%. The
existing district health infrastructure i.e. subcentre in the rural areas to
district hospital at district level was utilised in receiving information
regarding occurrence of poliomyelitis (AFP) case in the district and
subsequently in collection of stool samples from the cases. The usefulness of
testing stool specimens from acute flaccid paralysis (AFP) contacts has been
the subject of considerable recent discussion. The testing of contact stools
resulted in an increase case detection by 10%. Five
contact stool samples were also collected from family and neighbourhood contact
below the age of 5 years as recommended by WHO. The
stool samples were collected in a autoclaved Plastic Vial specially supplied
for the collection of the Poliomyelitis Stool samples from the Himedia
Laboratory. A total
4 suspected cases of poliomyelitis were reported from the district. From each
case two stool samples were collected within the time interval of 24 to 48
hours & five family/ neighbourhood contact stool samples were collected for
each case. 4. Effect of mass pulse polio
immunisation on polio virus activities A total
88 stool samples were taken from the children in the age group of 0-5 years.
These stool samples were taken before completion of first phase of mass pulse
polio imunisation i.e. on 7.12.96. Samples were taken in HBSS media and sent to
NICD. Delhi
for polio virus culture 69 stool samples as second stool samples of these
children was taken one month after the completion of second phase of mass
pulose immunisation i.e. on 9.1.97 and sent to NICD, Delhi for polio virus
culture. Laboratory
analysis of first phase stool samples revealed that only one of these samples
was found positive for Polio Type II & from the second phase of stool
samples three were found positive for Polio Type III, one for Polio Type II
& for 38 stool samples results awaited. 5. Viral hepatitis in Alwar town a
repeat study Viral hepatitis
is a major public health problem in India. Earlier a study was conducted in the
year 1994 in which 192 viral hepatitis cases were detected in 70,444 population
in the Alwar town. The present study is planned to find out change in the trend
of viral hepatitis in Alwar town. This study was started during the month of
December, 1996 and was completed by the end of April, 1997. During the month of
December, 1996 a population of 17,669 in 6 randomly selected wards has been
covered and 125 cases of jaundice have been identified. The incidence of
jaundice was 7.07 per one thousand of population. However a lower incidence of
jaundice i.e. 2.73 per one thousand population was observed in the study
conducted during the year 1994. During
the months of February, 1997 to April, 1997, a population of 56,746 of the
Alwar town was covered by house to house survey in the 14 randomly selected
wards. A high incidence of Viral Hepatitis was detected in this study i.e. 5.74
per one thousand population. 6. Field training on epidemiology and
control of Malaria (Enhanced
Malaria Control Project 17th to 21st Nov.97) Enhanced
Malaria control project of NMEP envisages decentralisation of Malaria Control
Plan and its implementation at district level and below. This also includes
capacity building, community participation, inter-sectoral approach involving
different agencies which are indirectly linked for mosquitogenic problems, NGOs
and private practitioners etc. Due emphasis is on the process appraoch with
flexibility to modify control strategies according to local conditions since
malaria is a local and focal phenomena and thus an epidemiological approach
leading to appropriat control strategy is essential. The modified strategy consists of: §
Early
case detection and prompt treatment (EDPT). §
Selective
vector control. §
Prediction,
early detection and effective response to malaria out breaks. §
Capacity
building at district level. §
IEC,
community participation and intersectoral involvement. Keeping
this in view field exercises was carried out at Alwar (Raj.). Objectives of the
Studies were i) Collection of epidemiologial and entomological profile of Alwar
district. ii) Knowledge, Attitude, Belief and Practice (KABP) on malaria. iii)
Environmental & other factors for malaria. The
participants were divided into seven groups for epidemiological & KABP
studies, and into five groups for the purpose of entomological studies. All the
samples were examined at NICD, FPU laboratory, Alwar. Briefing and
demonstration and a workshop on inter sectoral co-ordination was conducted at
FPU, Alwar. During
the field exercise a total of 792 blood slides were taken, laboratory result of
the slides are awaited. Knowledge, attitude, belief and practice study in
respect of malaria and its control measures was carried out in three villages
of Alwar (Barkhera, Baleta & Laxmangarh). Adults above 18 years were
interviewed by structured questionnaire. A total of 252 individuals were
interviewed. In
vilage Baleta 45 individuals (Males 25 and females 20) were interviewed.
Llliteracy was to the tune of 69% (31 out of 45). Amount the 14 literate person
8were primary,4 were middle and 2 in high school. Among the 45 interviewed the
occupational break-up was- Agricultural labour 32, Skilled worker 6 and
Housewives.Out of 45 interviewees only 4 said that MPW is visiting their house
everyu fortnbightly,5 told that the MPW has not visited at all while 36 persons
said that the MPW is visiting iregylarly. Of the
persons interviewed, 25 would go to the Dispensary if their familuy mnembers
gets fever while 16 would prefer to go to the private practitioners for getting
their family members treated for fever and only 4 did not know where to go for
getting treated for fever 24interviewees said that they get their house mud
painted/plastered every 6 months and monthly respectivel. In
village Barkhera, 83 individuals (Males 49 and females 34) were interviewed.
Illitearcy was to the tune of 50% (41 out of 83). Among the 42 literate person
16 were primary, 15 middle and 9 in high school. Among those interviewed the
occupational break-up was Agricultural labour- 33,skilled worker 15 and
Housewives 32. Out of 83 interviewees 44 said that MPW is visiting their house
everyu fortnightly while the others said MWP were either irregular/not visiting
at all. Of the persons interviewed 66 would go to the Dispensary if their
family members gets fever while 17 would prefer to go to the private
practitioners for getting their fgamilyu members treated for fever. In
Laxmangarh 124 individuals( Males 63 and females 61) were interviewed.
Illiteracy was to the tune of 26% (32 out of 124). Among the 88 literate,person
15 were primary, 30 middle and 45 in high school or above. Among those
interviewed, the occupational break-up was- students 5, business 36, labour
15 and housewives 53. Out of 124 interviewees,9 said that MPW is visiting ther
house every fortnightly while the others said MPW were either irregular/not
visiting at all. Of the persos interviewed 1099 would go to the Dispensary if
their famuiluy members gets fever while 7 would prefer to go to the private
practitioners for getting their family members treated for fever. The
village named Balana (Population 4500)
under CHC Malakheda of Alwar district Rajasthan was selected for the study.
This village is near Jaisamand Lake, which forms a large water reservoir (Lake)
for irrigation. The Entomological survey was done from 6 AM to 8 AM on
17.11.97. The main objectives of the study
were: To
demonstrate to the participants anout the vector prevalence, its breeding and
resting habits, its breeding behaviour and To
monitor the insecticide susceptinbilityu status against different vonventional
insecticides etc. from this identified Malaria Prone and high risk areas of
Alwar district. The
people are of low socio-economic status and are mainly agricultural labourers.
The village is having a numbher of sepages form the reservior and a variety of
breeding grounds providing high mosquitogenetic potential and prone to Malaria.
There is no transmigration of the population as the people are inflected with
agricultural activities. However being a project area, sufficient irrigation
facilities have been provided to the farmers. Mosquito Prevalence:
During the survey a total of five anopheles species were encountered from
this village, namely An. Culicifacies, An
annularis, An Splendidis, An Subpictus and An., Aconitus. A total of 52 houses (Human
dwelling)were covered for the adult mosquito collections. The area falls under
DDT spray since very long, where the vector An. culicifacies is susceptible to
nboth DDT and Malathion. This year, only one round of DDT was sprayed , as
there were several finacial and administrativbe constraints for the second
round. Larval survey : In order to detect the different
nbreeding places, an intensive searcxh was carried out.A total of at least 58
breeding places were searched out of which 32 breeding were found positive for
anopheles and culex breediong which contrinute 55.2% for moisquito breeding.
The seepage water was coming out of the dam from samll streams having marginal
aquatic vegetations all along the anopheles mosquitoes. However no An. fluviatities larvae could nbe
collected for, these slow moving streams. Biological control of mosquitoes: In Alwar town, larvivours fishes
are introduced tin ornamental water tanks as biological method of mosquito
contorl. Because of the presence of these fishes (gambussia affinis) no larve could nbe encountered from these
ornam,ental water tanks. Wall Bio-assay: In order to assess the potencyu of
an insecticide deposit for adult mosquitoes at various times after application
on different surfaces and then to detect the onset of a definite decline in the
toxic effect of the deposit, this techniques was observed by demonstration. It
was also explained that supplementay mathods of window-trap collections and
survival tests sbe read with Bio-assay tests. Susceptibility status: Demonstration on the method of
determining the susceptibility resistance of adult mosquitoes to
organochlorine, organophosphate and carbamate insecticides was carried out. The
purpose of this test was thoroughly discussed and the need to conduct such
tests to detect the presence of resistant mosquitoes as soon as possible was
emphasised so that alternative control plans can be made in time for change of
insecticide. Laboratory studies: The field collected biological
specimens were brought to the laboratory and processed for the following
demonstration. §
Identification
of different species of mosquitoes. §
Processing
of abdominal blood meal for precipitin test. §
The
working of CDC (Communicable Diseases Centre Atlanta) Light trap for
collection of mosquitoes. Pyrethrum
catch (Total catch) collection window-trap collection & Meagan trap
collection etc. were also explained. Statement
showing different species of mosquitoes collected from Balana village
Consolidated
statement showing the breeding places checked for the presence of mosquito
larvae collected from Balana village
7. Mass Pulse Polio Immunisation
Phase I 7.12.1997 During
the first phase of Mass Pulse Polio Immunisation, two polio vaccination centre
were opened, one at FPU, NICD, Alwar and another with the coordination of local
private practitioner in the area of Naya Bas, Alwar. A total of 340 OPV dosages
were given to children in the age group of 0 to 5 years. This community service
is provided in coordination with district health authority to achieve the goal
of A WORLD FREE OF POLIO by 2000 A.D. as targeted by member countries of WHO.
8. An epidemiological study of
measles in Alwar town Measles
is endemic in all parts of the INdia & is a major cause of morbidity and a
significant contributor to childhood mortality. This study was conducted in the
Alwar town. §
To
find the incidence of measles in the Alwar town. §
To
find out the factors responsible for occurrence of the cases in endemic and
epidemic form. §
To
find out the change in measles morbidity and mortality after introduction of
measles vaccine in the UIP. Measles
survey in Alwar town Feb. 1997 to March 1997
* These
wards were partially covered A total 34,192 population has been covered in randomy selected 11 wards of the Alwar town. Total 783 cases of measles were identified on the basis of history given by mother and that also been supported by typical presentation of the measles case. 338 blood samples were taken over the filter paper strip. The incidence rate of measles was found 22.90 per 1000 population. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
