Disease Burden Estimation of Lymphatic Filariasis in an Endemic Area.

Background: Anecdotal evidence collected by a community organization suggested high prevalence of lymphatic filariasis (LF) in Sitapur district, Uttar Pradesh. Village volunteers subsequently conducted a line listing in 13 villages of Pisawan block and recorded 261 cases of known LF complications, namely hydrocele and lymphedema. This being far higher than official projections, a block-wide cluster survey was conducted to estimate the disease burden more accurately. Methods: Cluster sampling techniques were applied, and 41 clusters selected within Pisawan block. Survey teams comprising one woman and man interviewed member of all households in the cluster, recording details of individuals suffering from hydrocele or lymphedema within them. Age and gender were noted, as well as duration of symptoms and details of any treatment availed. Results: A total of 1851 patients (1256 males and 595 females) were reported to have lymphedema, hydrocele, or both in the 6931 households surveyed. This equates to a prevalence rate of 4.95% (with 9.75% margin of error) in Pisawan block. With these calculations, an estimated 11,049 + 1077 patients with LF complications in Pisawan block, Sitapur, UP in 2016. Conclusions: The high prevalence rate of LF complications in Pisawan block is disconcerting, especially considering India's commitment to eliminate LF by 2020. Compliance with Mass Drug Administration (MDA) must be improved. Furthermore, the Morbidity Management and Disability Prevention (MMDP) component of the National Programme for Elimination of Lymphatic Filariasis (PELF) must be strengthened so that such patients can lead a productive life.

Reasons for obstetric referrals from community facilities to a tertiary obstetric facility: A study from Southern Karnataka.

CONTEXT: Pregnancy-related preventable morbidity and mortality remain high in India. Safe delivery services should focus on improving neonatal and maternal outcomes while also enabling a positive childbirth experience. However, high rates of intrapartum obstetric referrals are common. OBJECTIVE: To describe the timing and the reasons for obstetric referrals to a public tertiary care hospital in Bangalore and characteristics of the referring facilities. METHODS: We interviewed 320 women who delivered at the tertiary care hospital within a one-month time frame prior to the interview and who originally planned to deliver elsewhere. RESULTS: Ninety four percent of women in the study reported that the decision to transfer to the tertiary hospital was made after the onset of labour. Referrals were made for medical as well as non-medical reasons. About a third (35%) had to take loans to cover the expenses of childbirth. CONCLUSIONS: Referrals frequently occurred after the onset of labour. Our data imply that improving obstetric referral protocols will improve the birth experience and reduce the burden on tertiary care facilities and on the women themselves.