Combatting emerging infectious diseases from Nipah to COVID-19 in Kerala, India.

BACKGROUND: The state of Kerala, India, has experienced several unprecedented events in the past few years. The current study was an attempt to explore perceptions of stakeholders on how the decentralised system helped during the Nipah virus (NiV) outbreaks and COVID-19 pandemic in Kerala. METHODS: This study used a qualitative descriptive approach built on the advocacy paradigm. The stakeholders who were involved in decision-making and the representatives of local self-government who had real-time experience and had handled the challenges were identified using purposive sampling. Seven key informant interviews (KIIs) and nine in-depth interviews (IDIs) were conducted. RESULTS: Findings indicate that decentralisation had enabled the state to effectively deal with the outbreaks and the pandemic. The survey revealed four major themes: decision-making, engagement level, people-centric action, and difficulties. Two to four categories have emerged for each theme. CONCLUSION: The study results highlight the importance of human resources and service delivery as balancing factors during public health emergencies in any developing nation with limited resources. Given that very few nations have the healthcare infrastructure and resources necessary to cater to the healthcare needs of the whole population, decentralisation should be reinforced.

CONTEXTE: L'État du Kérala, Inde, a connu plusieurs évènements sans précèdent au cours des dernières années. Cette étude a cherché à analyser l'opinion des parties prenantes quant à l'aide apportée par le système décentralisé pendant les épidémies de virus Nipah (NiV) et la pandémie de COVID-19 au Kérala. MÉTHODES: Cette étude a eu recours à une méthode descriptive qualitative construite à partir du paradigme de mobilisation. Les parties prenantes impliquées dans la prise de décisions et les représentants des administrations locales autonomes, forts de leur expérience en temps réel et de leur expérience de gestion des défis, ont été identifiés par échantillonnage dirigé. Sept entretiens avec des informateurs clés (KII) et neuf entretiens approfondis (IDI) ont été réalisés. RÉSULTATS: Les résultats indiquent que la décentralisation a permis à l'État de gérer les épidémies et la pandémie de manière efficace. L'enquête a mis en évidence quatre thèmes majeurs : prise de décisions, niveau d'engagement, action centrée sur les personnes et difficultés. Chaque thème a pu être divisé en deux à quatre catégories. CONCLUSION: Les résultats de l'étude soulignent l'importance des ressources humaines et de la fourniture de services en tant que facteurs d'équilibre en période d'urgence de santé publique dans tous les pays en développement dotés de ressources limitées. Puisque très peu de pays disposent des infrastructures de santé et des ressources nécessaires pour répondre aux besoins sanitaires de l'ensemble de la population, la décentralisation devrait être renforcée.

Efficacy of 2% lignocaine medicated pad for pain alleviation during rabies immunoglobulin administration: A randomized controlled trial.

BACKGROUND: Rabies immunoglobulin (RIG) for animal bite victims is usually administered around the wound without the use of any anesthetic. Theoretically, the topical use of 2% lignocaine can reduce the pain during the procedure. OBJECTIVES: This study aimed to determine the efficacy of 2% lignocaine medicated pad (LMP) for reducing pain during administration of RIG. METHODS: A randomized triple-blind controlled trial was done in a tertiary care setting in Kerala, India. The proximal and distal wounds of the patient with minimum two, Category III animal bite wounds were randomized to intervention and placebo arms, based on a previously generated random number sequence. Sterile gauze pads soaked with 2% lignocaine and normal saline were the intervention and placebo, respectively. Pain was the primary outcome measure and was assessed using numeric rating scale (NRS) and sound, eye, and motor pain (SEM) scale. The patient, outcome assessor, and statistician were blinded. RESULTS: The wound sites and size of 100 intervention and 100 control wounds were comparable. The score of all elements of the SEM, total SEM, and NRS score were significantly lower in the wounds, which were given LMP compared to the control wounds. The number needed to treat for satisfactory pain relief and immediate pain relief was 25 and 14, respectively. No serious or minor adverse events were reported in the trial. CONCLUSIONS: The use of a proven drug in a topical route optimizes pain reduction from iatrogenic cause for millions of animal bite victims around the world with very little additional financial burden.

Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India.

BACKGROUND: Health insurance coverage ensures protection from catastrophic health-care expenditure, especially to the underprivileged sections of society. Health insurance schemes such as Ayushman Bharat are coming up in addition to the existing schemes such as Rashtriya Swasthya Bima Yojana in India. The objectives are to find the health insurance coverage and its impact on out-of-pocket (OOP) expenditure for public sector tertiary health-care hospitalization. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Kerala. Insurance coverage was assessed among patients seeking inpatient care in various medical and surgical departments. OOP expenses incurred for those receiving and not receiving insurance coverage were compared. In addition, factors influencing enrolment and availing of insurance schemes were determined. RESULTS: The coverage of health insurance was found to be 74%. Awareness campaigns and activities of local self-government (LSG) departments were the important reasons for enrolment and availing, respectively. Significantly lower OOP expenditures occurred in insured persons with regard to expenses incurred for treatment procedures (P = 0.019), investigations (P = 0.004), and medicines (P = 0.001). Among the enrolled patients, 45% expressed dissatisfaction regarding available services. CONCLUSION: A quarter of patients still remain out of insurance coverage. All patients are incurring OOP expenditures, though the insured patients have significantly lower OOP expenses. The role of primary care providers and LSG is pivotal in creating awareness and ensuring enrolment. Availing services depend on the availability of resources at the respective institution. Improvements in enrolment and use of health insurance should ultimately result in improved patient satisfaction.