Monitoring the efficacy of temephos application and use of fine mesh nylon strainers by examination of drinking water containers in guineaworm endemic villages.

Application of temephos in unsafe water sources for destroying cyclops, the intermediate hosts of guineaworm, and distribution of fine mesh nylon strainers for promoting prophylaxis against guineaworm are accepted methods of guineaworm control in different endemic countries. The existing methods of monitoring the efficacy of these guineaworm control methods are not fully informative. Examination of drinking water stored at household levels for presence of cyclops with or without Dracunculus larvae can provide information on the efficacy of these control/prophylactic methods, besides serving as a means of interpersonal health education to the community. This paper presents observations carried out in two villages in peninsular India in 1991, which revealed that while in one village complete absence of cyclops from stored water containers was attributable to the use of temephos in the village and straining of drinking water, in the other village, with no temephos application, 15.6 per cent of containers contained varying numbers of cyclops in them. Implications of these observations for guineaworm eradication activities are discussed.     

Explanation and implications of increasing trend of villages with only one case of guineaworm for guineaworm eradication in India.

Under the Guineaworm Eradication Programme (GWEP) in India, active case search data are consolidated in the lists of year-wise guineaworm affected villages, first prepared in 1985. These lists contain valuable information on many parameters of guineaworm eradication in India. Among other things, they show that in a given year there is always a proportion of villages with only one case relative to the total number of infected villages, and this proportion seems to increase with the progress of the eradication programme. The proportion for seven years between 1986 and 1992 in nineteen districts chosen for analysis was observed to be 22.2, 26.6, 35.0, 38.0, 40.0, 46.7, and 55.8 per cent. Correlation coefficient (gamma) for nineteen districts as a whole was found to be -.57 significant at 0.05 level. It is argued that this observation can be explained on the assumption that the single case in a village originates from any of numerous extradomestic unsafe water sources, in agricultural fields, which because of their great multiplicity lie outside the purview of the control measures. When guineaworm disease is widespread and at a high intensity transmission level, the existence of such foci is masked under the main village foci as during active case searches a distinction as to the origin of guineaworm cases cannot be made. Extradomestic foci become increasingly manifest as the main village foci disappear under impact of control measures. Thus, increase in the proportion of such villages could be used as a crude indicator of the successful implementation of the GWEP. The analysis of district data shows that guineaworm disappears when the proportion of such one case village reaches a high level.(ABSTRACT TRUNCATED AT 250 WORDS)     

Outbreak of dracontiasis in the Bhiwandi town of Maharashtra: a report.

In May 1990, dracontiasis or guineaworm cases were reported for the first time from Bhiwandi, a thickly populated urban industrial complex about 50 kms north of the metropolis of Bombay. The report of guineaworm cases from a typical urban situation was considered an unforeseen setback to an otherwise satisfactory progress towards guineaworm elimination target in Maharashtra State. To elucidate the factors responsible for the outbreak of guineaworm cases in Bhiwandi, an investigation was taken up in third week of September 1990. The investigation revealed that all the guineaworm cases occurred in a small area of about 1 sq. km. where, because of the inadequate piped water supply, people were forced to resort to step wells for drinking water and other needs. Except for the two cases, who were local residents, all the other cases involved floating population from nonendemic areas. The vector involvement, could not be elucidated, as all the 31 water sources were free of cyclops, because of treatment with temephos undertaken by the Municipal Council prior to the investigation. It has been suggested that transmission of dracontiasis in the contiguous vulnerable urban settlements is a possibility which should be kept in mind while formulating control or eradication strategies against guineaworm disease.     

Calculation of water volume in step wells for cyclopicide application and its eco-epidemiological implication: mathematical validation of some theoretical considerations

Chemical treatment of step wells to kill cyclopoid vectors of guinea worm by temephos (50 per cent E. C.) at the dose of 1 ppm is now an important activity of the guineaworm eradication programme in India. Calculation of correct volume of water in step wells, to determine the exact quantity of temephos to be applied, therefore, deserves adequate attention to prevent over and underdosing of stepwells by the chemical. The prescribed method of calculation of water volume includes two formulae; pi r2h and 1 x b x h (where h = mean depth for uneven bottoms and is a single depth measurement for almost even bottoms). Field observations revealed that in many stepwells there were marked variations in depth within the same well. These differences in depth ranged from small to very large in some wells. Since these depth variations would lead to miscalculation of water volume by existing method and the dose of temephos to be applied, with eco-epidemiological consequences, new formulae have therefore been deduced for conceivable patterns of depth variations by geometrical and algebric applications. The new formulae will permit calculation of, nearest to, exact quantity of temephos required for application. These formulae have been validated by an example.     

Incidence of australia antigen (HBs Ag) in Himachal Pradesh

2405 high risk subjects (1193 patients attending STD clinics, 1012 blood donors and 200 hospital personnel) and 500 apparently healthy individuals representing all the twelve districts of the State of Himachal Pradesh were screened for HBs Ag employing reverse passive haemagglutination (RPHA) technique. HBs Ag positivity was found to be 6.77 per cent in test groups and 3.6 per cent in the control group. Maximum positivity was found in STD patients (9.55 per cent) followed by hospital personnel (8 per cent) and blood donors (3.26 per cent). The highest incidence was noticed in district Kullu and no positive case was found in Lahaul and Spiti district of Himachal Pradesh. Remedial measures for prevention of Hepatitis-B virus infection have been emphasized.     

Japanese Encephalitis epidemic in Anantapur district, Andhra Pradesh (October-November, 1999).

Epidemic of Japanese Encephalitis has occurred in Andhra Pradesh during October-November, 1999 affecting 15 out of 23 districts. In total, 873 cases with 178 deaths have been recorded up to the day 29.11.99. The epidemiological investigation has been done in Anantapur district in western Andhra Pradesh, where the outbreak has started in the third week of October. In the district 47 PHC have been affected. On an average 4.5 per cent of 3175 villages have been affected. Average number of cases per affected village have been 1.5. Rural population has been primarily affected. Age groups 1-14 years including infants have been affected but nearly 86.8% of cases have been among 1-9 year age group. The overall case fatality rate has been 18.4 per cent. Clinical features have been high fever, headache, altered sensorium, convulsions and coma. A marked seasonal onset of a few cases per village and 93.75 per cent of human serum samples collected from hospitalised cases showed the evidence of J.E. virus infection indicating that the present outbreak was due to JE virus. High density of Culex vishnui complex mosquitoes has been observed in the area. All the environmental and ecological conditions, temperature, rainfall and relative humidity have been in favour of JE transmission. Analysis of the data for the last 10 years showed that the human JE cases occurred in Anantapur in September-October months, which shifted to October-November, 99. Prolonged draught conditions were observed till October. Possibly the delayed monsoon and congenial atmospheric conditions after monsoon were favourable to the vector species for extra-human cycle of transmission in 1999. Low level transmission leading to small number of cases continued during the succeeding years every September-October till the present epidemic. In all 24 PHCs and urban towns were identified with 212 cases and 39 deaths till 29.11.99.     

Incidence of different types of viral hepatitis in Delhi, Uttar Pradesh and Rajasthan areas

A total of 428 sera samples from patients of acute sporadic viral hepatitis collected from Delhi (172), Uttar Pradesh (192) and Rajasthan (64) were tested for Hepatitis A Virus (HAV) and Hepatitis B Virus (HBV) markers. Non A non B was diagnosed by exclusion. The prevalence of HAV, HBV and non A non B in such cases was almost comparable at three places. The prevalence of HAV ranged between 15.7 and 20.3 per cent, HBV between 41.3 and 51.6 per cent while non A non B ranged between 28.1 and 43 per cent. The study signifies the role of non A non B in non-epidemic situations.     

Kala-azar in Ballia district, Uttar Pradesh.

Door to door search during 1991 in 85 villages in Ballia district of Uttar Pradesh revealed 29 sporadic cases of Kala-azar in four villages. Epidemiological investigations indicated indigenous transmission in Phulwaria village (PHC: Dubhar) with 25 cases while the remaining three villages showed four imported cases from the endemic states. No kala-azar cases had been reported in Ballia between 1947 and the present investigation. Phlebotomus arqentipes, the known vector of kala-azar in India, was encountered in 10 PHCs including the four villages having kala-azar cases. Regular vigilance in Ballia and the neighbouring districts in Uttar Pradesh bordering Bihar is suggested in view of indigenous transmission detected in one village with multiple infection in families. The presence of high vector density, ambient environmental factors and absence of regular residual insecticidal spray warrant constant surveillance in Kala-Azar prone areas in Uttar Pradesh.     

Epidemiological profile of Japanese encephalitis in Gorakhpur district, Uttar Pradesh, 1982-1988.

An in-depth study of Japanese Encephalitis (JE) situation in Gorakhpur district of Uttar Pradesh from 1982-1988 showed increasing trend in the incidence of JE. Total number of annual cases and case fatality rate (CFR) rose from 118 and 23.7 per cent in 1982 to 772 and 32.2 per cent in 1988 respectively. A definite increase was noticed in the number of cases per block following lull years in 1984 and 1987. Among the total affected 1201 villages, 1083 were affected only once. All age groups were affected and the disease showed marked seasonality during August to November. JE, which came in epidemic form in earlier years has established in the area in endemic form.     

Clinicoepidemiological profile of kala azar patients in Delhi

Search for livelihood makes many people move from kala azar endemic areas to metropolitans like Delhi from where indigenous cases have not been reported. During 1986-1989, 211 laboratory confirmed kala azar cases were detected in Delhi. Of these 202 (95.73 per cent) were from Bihar and remaining nine (4.27 per cent) belonged to Uttar Pradesh. Younger age groups were affected more and maximum cases (54.02 per cent) were in the age group of 5-15 years. Male:female ratio was 2:1. Fever (100 per cent) along with mass in abdomen (99.05 per cent) were the major presenting complaints. Splenomegaly was seen in all the patients whereas hepatomegaly was a feature in 184 (87.20 per cent) cases. Response to sodium antimony gluconate (SAG) was variable and number of injections administered reached upto 80 in some (23) cases. All 37 patients responded to pentamidine after two full courses of SAG failed to bring about any clinical and parasitological cure.     

Guinea worm in southern Ghana: its epidemiology and impact on agricultural productivity.

In southern Ghana guinea worm disease was found to occur almost exclusively in villages dependent upon pond water during the dry season. The recent occurrence of guinea worm for the first time in many villages in the survey area suggests that the disease is spreading. The risk of increasing disease in the Accra plains is serious, because almost half of the 159 villages surveyed use pond water, and residents frequently travel to endemic areas. In this study adult male farmers were at greatest risk of becoming infected. The average work loss in untreated adults was more than 5 weeks. Because guinea worm disease is seasonal, conciding with peak agricultural activities, and few alternative labor sources are available for the incapacitated farmer, a marked reduction in agricultural output occurs. Additional research is needed to guide health education programs, to evaluate the effectiveness of chemical control of cyclops in ponds, and to develop low-cost improved rural water supplies.     

Outbreak investigation of scrub Typhus in Himachal Pradesh (India)

Scrub Typhus outbreak investigation was undertaken during September 2003 in the three worst affected districts Shimla, Solan and Sirmaur in Himachal Pradesh (India). A total of 113 cases and 19 deaths (17.27 percent case fatality rate) were reported from the eight districts, which were reporting cases. Cases were prevalent in all age groups and in both the sexes among the persons frequenting forest for occupational work. 35.7 percent of the patients serum samples showed a titer of > 1: 80 against OX 19 and OXK antigen is suggestive of Scrub Typhus. Entomologically Rattus rattus (39.5 per cent) was the most prevalent species followed by Suncus murinus (22.91 percent), Bandicoota bengalensis (29.16 percent) and Bandicoota indica and Mus musculus (4.16 percent each). Vector species Leptotrombidium deliense and Gahrliepia (schoengastilla) sp. were recorded. The chigger index 23.0 was found to be highest in Vill. Baldian and 5.0 in Vill. Bhatakuffer (Shimla) and 1.0 in Vill. Rebon (Solan), which is above the critical limit of 0.69 per rodents. Other mite species, ixodid ticks, fleas and lice have been recorded.     

2006和2007年湖北省洪湖市高砷水筛查结果

目的 调查湖北省洪湖市高砷水源分布情况,为地方性砷中毒(简称地砷病)的防治工作提供依据.方法 2006-2007年,以仙桃市沙湖镇附近的乡(镇、管理区)为重点,即在东荆河流域、内荆河流域、长江流域共22个乡(镇、管理区),68个自然村进行筛查.每个自然村按水井数的10%抽取水样,每年抽取1000份水样.使用水砷快速检测试剂盒进行半定量检测,对≥0.03 mg/L的水样用国标法进行复核,同时选择超标水井数和超标值较高的村(队)进行病情调查.结果 2006-2007年共筛查了68个自然村2000份水样,共有48个自然村401份水样超标,超标率为20.05%(401/2000),水砷最高为0.71 mg/L.高砷水源多分布于东荆河流域与内荆河流域,但病情调查未发现地砷病病人.结论 高砷水源主要分布于东荆河流域与内荆河流域,建议相关部门切实做好改水工作,使高砷区的居民吃上安全水.     

Arterial counterpulsation in continuing myocardial ischaemia after acute myocardial infarction.

Twenty-six patients underwent arterial counterpulsation for refractory heart failure without shock complicating acute myocardial infarction. Patients were divided into a group of 12 with continuing myocardial ischaemia, evidenced by anginal pain associated with abnormal ST segment elevation, and a group of 14 without continuing ischaemia. Clinical features (apart from pain) and prognostic indices were similar in the two groups when counterpulsation was started but short- and long-term results were different. Hospital survival was 92 per cent (11/12) and 43 per cent (6/14), respectively, in the groups with and without ischaemia and four-year survival was 73 per cent and 7 per cent. Counterpulsation is of greatest value in acute infarction when used to relieve myocardial ischaemia.     

Clinical manifestations, disability and use of folk medicine in dracunculus infection in Nigeria.

A cross-sectional survey of households was carried out in a dracunculiasis endemic village in Oyo state Nigeria. Data were collected on history of dracunculiasis, occupational and domestic sources of drinking water, clinical manifestations, disability, use of folk medicine, and incorporation of previous dracunculiasis control programmes. The findings indicated that dracunculiasis patients were usually unaware of their infection 3-5 days before the appearance of a bleb; that religious affiliation appeared to be positively related to increasing morbidity; and that ulcers were predominantly in the ankles and feet, particularly among young children. Severe disability was related to age, site and number of ulcers, and the form of selected treatment. Indigenous remedy was the treatment of choice, although traditional healers in the community indicated no knowledge of any efficacious remedy. Mortality from secondary tetanus infection was associated with outbreak of dracunculiasis. The impact of dracunculiasis on agricultural, economic and recreational activities was considerable, with the infected farmers being unable to attend to their farms at the critical farming period. Sixty-one per cent of the residents were opposed on religious and aesthetic grounds to the treatment of the local surface water which contained cyclops species. Sixty-three per cent regarded the boiling and filtration of portions of their domestic water as an additional burden, cumbersome and impracticable.(ABSTRACT TRUNCATED AT 250 WORDS)     

HIV/AIDS in Bangladesh: a national surveillance.

Nationwide surveillance of HIV/AIDS from 1989 through 1996 in Bangladesh included several risk groups such as professional blood donors, patients with sexually transmitted diseases (STDs), pregnant women at antenatal clinics, commercial sex workers (CSWs), patients with tuberculosis, long-distance truck drivers, sailors, and non-residents. The population was enrolled by convenience sampling after taking informed consent. Among 70,676 persons tested, 80 (1.13 per 1000) were HIV positive. The prevalence rate was steady until 1994, and then increased rapidly. The rate among male heterosexuals was significantly higher than that in females (3.40 per 1000 versus 0.29 per 1000; odds ratio (OR) 11.60; 95% confidence intervals (CI) 6.45 to 21.16; P < 0.0001). Twelve per cent of patients with STDs had HIV. The HIV cases concentrated in 2 districts, Sylhet (25/72) and Chittagong (20/72), that border India and Myanmar (formerly Burma), respectively. Frequent movement of people of Bangladesh to India, Pakistan, Myanmar and Thailand, where HIV rates are higher, is one of the possible sources of spread of the cases. Bangladesh has the potential to avert epidemic spread of HIV at its early stage.     

Arterial counterpulsation in continuing myocardial ischaemia after acute myocardial infarction

Twenty-six patients underwent arterial counterpulsation for refractory heart failure without shock complicating acute myocardial infarction. Patients were divided into a group of 12 with continuing myocardial ischaemia, evidenced by anginal pain associated with abnormal ST segment elevation, and a group of 14 without continuing ischaemia. Clinical features (apart from pain) and prognostic indices were similar in the two groups when counterpulsation was started but short- and long-term results were different. Hospital survival was 92 per cent (11/12) and 43 per cent (6/14), respectively, in the groups with and without ischaemia and four-year survival was 73 per cent and 7 per cent. Counterpulsation is of greatest value in acute infarction when used to relieve myocardial ischaemia.     

Efficacy of a low dose oral quinine therapy in Plasmodium falciparum cases of Assam, Meghalaya and Arunachal Pradesh in India.

A low dose oral quinine schedule with 1050 mg in two divided doses daily for five days was tried for treatment of Plasmodium falciparum cases in Assam, Meghalaya and Arunachal Pradesh, in areas where resistance to chloroquine was confirmed. The drug schedule was found effective in 76.92 per cent cases. The treatment was also found effective in 45.55 per cent of the known chloroquine resistant P. falciparum cases. The drug in this low dose was well tolerated and clinical response was quick.     

Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India

Background

A high prevalence of gallbladder diseases (GBD) in Northern India warranted a population survey into environmental risk factors.

Methods

In 60 villages of Uttar Pradesh and Bihar from 13 334 households, 22 861 persons aged >30 years were interviewed for symptoms of GBD, diet and environmental factors. Subsequently ultrasonography (US) was performed in 5100 and 1448 people with and without symptoms, respectively. Heavy metal and pesticide content in soil and water were estimated.

Results

US revealed a prevalence of GBD of 6.20%. GBD was more common in 5100 persons with symptoms (7.12%) compared with 1448 without (2.99%) (P < 0.05). Adjusted odds ratio (ORs) [95% confidence interval (CI)] revealed a significantly increased risk of GBD in females >50, 1.703 (CI 1.292–2.245); multiparity 1.862 (CI 1.306–2.655) and a genetic history 1.564 (CI 1.049–2.334). An increased risk noted in males with diabetes was 4.271 (CI 2.130–8.566), chickpea consumption 2.546 (CI 1.563–4.146) and drinking unsafe water 3.835 (CI 2.368–6.209). Prevalence of gallstones was 4.15%; more in females 5.59% than males 1.99% (P < 0.05). Cluster analysis identified a positive correlation of nickel, cadmium and chromium in water with a high prevalence of GBD in adjacent villages in Vaishali district, Bihar.

Conclusion

A high risk of GBD was observed in older, multiparous women and men with diabetes, intake of chickpeas, unsafe water and villages with heavy metal water pollution.     

Abate--its value as a cyclopscide.

Guinea worm disease is highly endemic in Kurnool district in Andhra Pradesh. The effect of Abate on the vector cyclops was studied and was found to be very encouraging.