Community knowledge on malaria among febrile patients in an endemic district of Orissa, India.

Background & objectives: Evidence on the community knowledge and perceptions on malaria are crucial to design appropriate health communication strategies for malaria control. Orissa, an Indian state with a large proportion of indigenous populations and hilly terrains contributes to the highest malaria burden in India. A study was undertaken to assess the knowledge on malaria among community members who had experienced fever and chills in the endemic district of Boudh in Orissa. Methods: A cross-sectional community-based survey was carried out with respondents (n=300) who had fever with chills within two weeks prior to data collection through a multi-stage sampling and interviewed them using a pre-tested, structured interview schedule. Results : About 90% of respondents recognized fever as a common symptom of malaria, 72.3% said mosquito bites cause malaria, 70.3% of respondents reported mosquito control and personal protection to be the method of malaria prevention, and 24.6% identified chloroquine as the drug used for treatment. Women and scheduled tribe (ST) respondents were found to have lower level of appropriate knowledge of causes, symptoms, and prevention methods of malaria than their counterparts. Interpretation & conclusion: The study population had a fair knowledge of malaria about the causes, symptoms, treatment, modes of prevention and outcomes of non-treatment compared to most of the studies conducted in similar settings. However, the relatively low awareness among women and tribal population calls for more context specific communication strategies. Such strategies should be based on information needs assessment of different population subgroups, especially of women and members of the ST community, using media that is accessible and clearly understood by different groups.

Household economic impact of an emerging disease in terms of catastrophic out-of-pocket health care expenditure and loss of productivity: investigation of an outbreak of chikungunya in Orissa, India.

BACKGROUND & OBJECTIVES: To examine the household economic impact of an outbreak of chikungunya in terms of out-of-pocket health care expenditure and income foregone due to loss of productive time in Orissa, India. METHODS: Structured interviews were conducted on 150 respondents, bread winners from the affected households of a village with maximum number of reported cases in the state, during August 2007. We looked at the economic profile, treatment history, and patient-side cost of care, loss of productivity and consequent income loss. RESULTS: The median out-of-pocket health care expenditure was US$ 84, of which the proportion of cost of diagnosis was the highest (US$ 77). One hundred and forty nine respondents incurred cost of care more than 10% of their monthly household income (catastrophic health expenditure). The median catastrophic health care expenditure was 37%. The respondents depended more on private health care providers (49%) and 31% of them accessed care from both public and private health care providers. The median work days lost was 35 with a consequent loss of income of US$ 75. INTERPRETATION & CONCLUSION: Outbreak of an emerging disease creates unforeseen catastrophic health care expenditure and reinforcing the poverty ill-health nexus. The priorities of tackling emerging diseases should include; discretionary public health spending, financial protection against the cost of illness and productivity with special emphasis on people living on daily wages with less financial reserves, and further research on therapeutic measures to reduce the duration of suffering and consequent economic loss.

Analysis of hospital-based stroke registry in a neurological centre in Kolkata.

This was a retrospective analysis of 7-year (January 1995-December 2001) hospital-based in-patient medical records of stroke cases (subarachnoid haemorrhage excluded) who arrived from various parts of West Bengal. The total number of cases was 801 out of whom 792 had neuro-imaging. There were 399 caes of intracerebral haemorrhage (ICH) and 393 cases of cerebral infarct (CI). The CI: ICH ratio was 0.98. Less than 25% patients reached hospital within 3 hours of stroke onset. Twenty-nine per cent of cases presented with mild stroke (Canadian stroke score > 8.5). Hypertension was observed in 77.3% of ICH cases. The striking finding of this study was a remarkably high number of ICH among the admitted patients. This indicates the need of population-based studies to be conducted at different parts of West Bengal to determine whether them is truly a high prevalence and incidence of ICH in this Indian state.