Assessment of knowledge about malaria and LLIN ownership and its use in Bankura, West Bengal, India.

BACKGROUND & OBJECTIVES: Community participation is one of the key factors for implementation and success of a public health programme which depends upon knowledge about that disease. Therefore, understanding the community knowledge about malaria is important for designing sustainable control programmes. This study was conducted to assess the knowledge about malaria, to evaluate long lasting insecticidal nets (LLINs) distribution and their use by LQAS method in endemic areas of Bankura district, West Bengal state, India Methods: It was a community based cross-sectional survey conducted in Bankura during December 2019-March 2020. Structured questionnaire under four categories: socio-demographic variables, knowledge of malaria, owner ship of LLINs and its use were used for the interview. Ownership of LLINs and its use were analysed by LQAS method. Data were analysed by binary logistic regression model and chi-squared test. RESULTS: Out of 456 respondents, 88.59% had good knowledge, 97.37% had good ownership of LLIN and 78.95% used LLINs properly. The knowledge about malaria was significantly associated with education level (p-value<0.0001). Out of 24 lots studied, 3, 2, 4 lots were underperforming with respect to knowledge, ownership of LLIN and its use, respectively. INTERPRETATION & CONCLUSION: The study population had a good knowledge about malaria. In spite of good coverage of LLIN distribution, the use of LLINs was not up to the mark. LQAS analysis showed underperformance in few lots about knowledge, ownership of LLIN and its use. The IEC and BCC activities about LLIN should be done to achieve the impact of this intervention at the community level.

Health care seeking behaviour and financial protection of patients with hypertension: A cross-sectional study in rural West Bengal, India.

BACKGROUND: Elevated blood pressure or hypertension is responsible for around 10 million annual deaths globally, and people residing in low and middle-income countries are disproportionately affected by it. India is no exception, where low rate of treatment seeking for hypertension coupled with widespread out-of-pocket payments (OOPs) have been a challenge. This study assessed the pattern of health care seeking behaviour and financial protection along with the associated factors among hypertensive individuals in rural West Bengal, India. METHOD AND FINDINGS: A cross-sectional study was conducted in Birbhum district of the state of West Bengal, India, during 2017-2018, where 300 individuals were recruited randomly from a list of hypertensives in a population cohort. Healthcare seeking for hypertension and related financial protection in terms of-OOPs and expenses relative to monthly per-capita family expenditure, were analysed. Findings indicated that 47% of hypertensives were not on treatment. Among those under treatment, 80% preferred non-public facilities, and 91% of them had wide-spread OOPs. Cost of medication was a major share of expenses followed by transportation cost to access public health care facility. Multivariable logistic regression analysis indicated longer duration of disease (adjusted odds ratio (aOR): 5.68, 95% Confidence Interval (CI) 1.24-25.99) and health care seeking from non-public establishment (aOR: 34.33, CI: 4.82-244.68) were associated with more incident of OOPs. Linear regression with generalized linear model revealed presence of co-morbidities (adjusted coefficient (aCoeff)10.28, CI: 4.96,15.61) and poorer economic groups (aCoeffpoorest 11.27, CI 3.82,18.71; aCoefflower-middle 7.83, CI 0.65,15.00 and aCoeffupper-middle 7.25, CI: 0.80,13.70) had higher relative expenditure. CONCLUSION: This study suggests that individuals with hypertension had poor health care seeking behaviour, preferred non-public health facilities and had suboptimal financial protection. Economically poorer individuals had higher burden of health expenditure for treatment of hypertension, which indicated gaps in equitable health care delivery for the control of hypertension.

The Status of Susceptibility of Japanese Encephalitis Vectors to Insecticides in Endemic Areas of Northern Districts of West Bengal, India.

Emergence and spread of resistance among vectors toward different insecticides is a serious problem for the Japanese encephalitis (JE) control program. Regularly monitoring the status of susceptibility of vector species to insecticides is important for formulating proper vector control measures. In this study, we studied the susceptibility status of major JE vectors from northern West Bengal, toward 4% DDT, 0.05% deltamethrin, and 5% malathion. Two- to three-day-old unfed female mosquitoes were subjected to a susceptibility bioassay using a World Health Organization kit. Corrected mortality (CM) and knockdown times were estimated. Culex tritaeniorhynchus, Cx. vishnui, Cx. pseudovishnui, and Cx. gelidus were the major JE vectors present in the study areas. All 4 vector species were highly tolerant to DDT with CM ＜ 90%. Cx. tritaeniorhynchus, Cx. vishnui, Cx. pseudovishnui, and Cx. gelidus were tolerant to deltamethrin with CM ＜ 90%, except for Cx. gelidus of Darjeeling and Malbazar. At most of the study sites, malathion was effective against Cx. vishnui, Cx. pseudovishnui, and Cx. gelidus with CM ≥ 98%. In contrast, Cx. tritaeniorhynchus was tolerant to malathion in all study areas. Predominant JE vector populations were highly tolerant to all 3 analyzed insecticides, except deltamethrin for Cx. gelidus and malathion for Cx. vishnui, Cx. pseudovishnui, and Cx. gelidus. The results of this study may be useful for better planning and implementing a JE control strategy.

Taking stocks of antimalarial activities: A study on knowledge and skill of health personnel at primary care setting in the state of West Bengal, India.

BACKGROUND: Early diagnosis and effective treatment are the key areas in malaria control in India. OBJECTIVE: The present study was carried out to assess the knowledge and skill of health personnel at primary care level and the logistic support related to the program at subcenter (SC) level. METHODS: A cross-sectional, descriptive study was conducted among medical and paramedical personnel working at primary health-care institutions in two districts of West Bengal. Knowledge was assessed using a structured questionnaire while diagnostic skill and logistic support were assessed with structured checklists. Clinical skill was assessed with case vignettes. RESULTS: Requisite knowledge on diagnostic procedure was found in two-third to three-fourth of health personnel while only 26.7% and 12.4%, respectively, knew the correct treatment of Plasmodium vivax and Plasmodium falciparum malaria. Median standardized score for knowledge was 50.0 while the scores for skill of preparing blood slide and for rapid diagnostic test were 70.0 and 57.1, respectively. Education and work experience were related to diagnostic skill but had little effect on knowledge. In clinical skill, medical personnel scored 50% or more in investigation and treatment aspects only. In another case vignette, health workers excelled over medical officers and other staff in all axes other than history taking and clinical examination although their performance was also suboptimal. Formal training on malaria did not show any bearing on median knowledge and skill score. Supply of diagnostics and drugs was insufficient in majority of SCs. CONCLUSION: Renewed efforts are needed to create competent workforce and ensure adequate logistic supply.

A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India.

BACKGROUND: India launched the Janani Suraksha Yojana (JSY) on the principles of conditional cash transfer providing monetary incentive to needy women to improve access to institutional childbirth. OBJECTIVES: This study was conducted among JSY-eligible women who delivered between April 2012 and June 2012 to assess the utilization of cash incentives toward institutional delivery, along with other associated factors influencing institutional delivery. METHODS: It was a cross-sectional, descriptive study conducted between July 2012 and May 2013 on 946 women selected through stratified random sampling of subcentres from better and worse performing districts of West Bengal. RESULTS: 74.7% of the study population was JSY-eligible. 90.2% of those who took three antenatal check-ups (ANCs) and 36.8% JSY-noneligible women received cash. Government institutions were preferred for childbirth among all groups irrespective of JSY eligibility, receipt of cash, and number of antenatal visits. Overall, 78.8% opted for institutional delivery if they had received cash, which was significantly more than those who did not (64.5%). JSY-eligible women were 1.5 times more likely to deliver in government institutions compared to JSY-noneligible women. With no incentive, the likelihood of institutional delivery was halved. The distance of a 24 Χ 7 delivery hub beyond 5 km (74.8% vs. 81.8%), the religion of Islam (62.7% vs. 83.2%), and multiparity (63.9% vs. 83.6%) were significant deterring factors. CONCLUSION: Despite some inclusion and exclusion errors, cash incentive under JSY was associated with increased institutional delivery, especially in government institutions though there were other factors influencing the decision as well.

Entomological investigations into an epidemic of Japanese encephalitis (JE) in northern districts of West Bengal, India (2011-2012).

BACKGROUND & OBJECTIVES: Japanese encephalitis (JE) is one of the most important arboviral diseases of human beings with outbreaks in many parts of Southeast Asia including India. We present the entomological findings of an outbreak occurred in northern part of West Bengal during 2011-2012 with special emphasis on the role of JE vectors in different seasons. METHODS: Adult mosquito collections were made with the help of mouth aspirators, aided by flash lights during day time resting inside human and animal habitations as indoor, and resting outside field grasses, bushes, underneath of culverts and bridges as outdoor, and in and around the pig enclosures and cattle sheds during dusk period in JE affected villages from Cooch Behar, Dakshin Dinajpur, Darjeeling and Jalpaiguri districts in North West Bengal. In all study villages, a long handled with enamel bowl dipper was used to obtain immature stages of mosquitoes from various breeding habitats. RESULTS: A total of 19 different types of mosquito breeding habitats were examined for vectors of JE. From these habitats, 23.7 per cent were positive for breeding during the study period. Overall, nine different species were recorded through emergence, but none was positive for JE virus when subjected for detection of virus. Adult mosquitoes of more than 50 per cent of the potential JE vector species obtained through dusk and the rest through indoor and outdoor collections in all seasons. Altogether, 27 different species were recorded. Most of these were JE vectors. INTERPRETATION & CONCLUSIONS: Our results showed that in addition to Cx. vishnui subgroup, detection of JE virus antigen in Cx. quinquefasciatus indicated the possible maintenance of JE virus in nature through poor vector mosquitoes throughout the year. Since, all potential vector species reported elsewhere in India were also found in this region and fluctuated in density in different seasons, a proper integrated vector control programme needs to be implemented to control JE transmission.

Goiter prevalence, urinary iodine, and salt iodization level in sub-Himalayan Darjeeling district of West Bengal, India.

National iodine deficiency disorders control program needs to be continuously monitored. Hence, a cross-sectional study was conducted during the period from April-May 2011 to assess the prevalence of goiter, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level in Darjeeling district, West Bengal. Study subjects were 2400 school children, aged 8-10 years selected through "30 cluster" sampling methodology. Goiter was assessed by standard palpation technique, UIE was estimated by wet digestion method and salt samples were tested by spot iodine testing kit. Overall goiter prevalence rate was 8.7% (95% confidence intervals = 7.6-9.8) and goiter prevalence was significantly different with respect to gender. Median UIE level was 15.6 mcg/dL (normal range: 10-20 mcg/dL). About 92.6% of the salt samples tested had adequate iodine content of ≥15 ppm. Findings of the present study indicate that the district is in a transition phase from iodine-deficiency to iodine sufficiency.