Aim of study was to evaluate clinical and laboratory characteristics associated with dengue fatality.
Retrospective case control study included fatal and nonfatal "severe dengue" by WHO (2009) criteria admitted to AIMS between 2012-14. Clinical and laboratory features were compared between groups. Statistical significance was assessed using Fischer’s exact test for categorical variables and T test for continuous variables.
Of 896 “probable dengue” adult cases admitted, 21 patients had fatal outcome.26 age and severity matched non-fatal cases were controls. 86% of the patients in fatal group compared to 38% from non-fatal group had > one co-morbidities. Significant association of fever, nausea/vomiting, abdominal pain, shortness of breath and altered mental status was seen in the fatal cases. Tachycardia hypotension, hypoxia correlated with fatality. Admission metabolic acidosis, oliguria and sepsis heralded death .Statistically significant upward trend in the WBC counts in fatal group compared to controls seen. Average neutrophil counts for the fatal group cases were higher (60-80% in fatal & 45-60% in non-fatal). Decline in monocyte counts in fatal group while elevated for nonfatal group significant thrombocytopenia in fatal group 20% fall in the HCT with drop in HGB among the fatal grp. Prolonged PT in fatal group. Serum total bilirubin in fatal cases elevated (7- 20 mgs/dl) compared to the < 5 mgs/dl in controls. 50% of controls required < 72 hours of ICU. The average length of stay for fatal subgroup was 5.8 days, & non-fatal was 8.5 days.
Chikungunya struck Kerala in a devastating form in the years 2006 and 2007and it’s after effects continued to 2008. In May 2008, a post epidemic study of the awareness of vector habits and prevalence of the vectors was done. A cross sectional study was conducted in a randomly selected Panchayat affected by Chikungunya in a rural area of Kerala, India. 93.3% respondents were aware that mosquitoes spread Chikungunya though 31.3% knew the type of mosquito that spreads it. 69% knew that the vector breeds in artificial collections of water. Although three fourths (73.6%) had good knowledge, only 39% had actually took control measures. Four of the six wards were high risk areas as per House Index and Breteau Index. All the larval samples collected were identified as Aedes albopictus. About 94.3%of the respondents used one or the other measure of personal protection against mosquito. An analysis of the high risk areas showed a significant association with education (p< .001) and information on control measures (p < .01). It therefore appears that integrated vector control is the key though converting vector control knowledge into practice by influencing human behavior is the challenge.
In India, annual rounds of mass drug administration (MDA) based on diethylcarbamazine and albendazole are used to control filariasis, which is a major public-health problem. In December 2007/January 2008, a few weeks after one such MDA, a household survey was conducted in the Ernakulam district of Kerala to evaluate coverage and compliance. After one member aged .14 years from each of 599 households was interviewed, coverage of the last MDA was estimated to be 77.0% and compliance only 39.6%. Most (67.4%) of the interviewees were not aware of the term ‘mass drug administration’ but 20.9% of the others thought that MDA prevented the occurrence of filariasis. Most (62.3%) of those interviewed said that they obtained information about MDA from television or radio programmes and/or newspapers and most (66.3%) considered MDA to be useful (only 5.0% said that MDA were not useful, the other interviewees saying that they did not know whether MDA were useful or not). Those who had not ingested the tablets given to them in the last MDA said that they were fearful of the drugs (39.4% of the non-compliers), were too ill to take the drugs (22.5%) or had misconceptions about the aims of the MDA (12.5%). Only 2.7% of the interviewees who had ingested the distributed tablets reported adverse effects and these were mild (fever, drowsiness, swelling/oedema and/or vomiting) and only occurred within 24 h of tablet ingestion. In a univariate analysis, individual compliance in the last MDA was found to be positively associated with perceived benefits to the individual (P, 0.001), the perceived usefulness of MDA (P50.001) and certain study wards within the panchayat (P50.032). It therefore appears that communication exercises targeted at the areas with relatively low compliance and designed to improve perceptions of the benefits and usefulness of MDA against Filariasis could be the key to a successful control programme.