An acute gastroenteritis outbreak associated with a contaminated water supply system, Turkey, 2018.

Disruption of routine monitorization and chlorination of the water supply system during a week-long holiday led to a multi-organism gastroenteritis outbreak in a district with limited laboratory support. More than a 10-fold increase in patients with gastroenteritis was reported. Enteropathogenic Escherichia coli, Enteroaggregative E. coli, and norovirus were detected in human specimen samples. The main water tank and pipes were rusted; 13 out of the 19 water samples tested positive for total Coliform (1-920 colony-forming units (CFU)/100 ml) and E. coli (1-720 CFU/100 ml). Chlorine levels were below 0.2 ppm in seven of the nine samples. Information of 1,815 cases was obtained from the hospital records with a crude attack rate of 2.9%. Cases widespread in the district increased throughout the holiday, epidemic curve revealed a point-source outbreak. The case-control study revealed that consumption of drinking tap water and using it to clean vegetables/fruits were significantly associated with the illness. While drinking only bottled water had a protective effect against the illness. The culture technique showed that the water supply samples were positive for pathogenic bacteria. Upon decision in a multi-stakeholder meeting, the water tank was cleaned, and the Municipality initiated the renovation of the water supply system.

Innovative social protection mechanism for alleviating catastrophic expenses on multidrug-resistant tuberculosis patients in Chhattisgarh, India

Background: Patients with multidrug-resistant tuberculosis (MDR-TB) incur hugeexpenditures for diagnosis and treatment; these costs can be reduced through awell-designed and implemented social health insurance mechanism. The State ofChhattisgarh in India successfully established a partnership between the RevisedNational TB Control Programme (RNTCP) and the Health Insurance Programme,to form a universal health insurance scheme for all, by establishing RashtriyaSwasthya Bima Yojna (RSBY) and Mukhyamantri Swasthya Bima Yojana(MSBY) MDR-TB packages. The objective of this partnership was to absorbthe catastrophic expenses incurred by patients with MDR-TB, from diagnosis totreatment completion, in the public and private sector. This paper documents theinitial experience of a tailor-made health insurance programme, linked to coveringcatastrophic health expenditure for patients with MDR-TB.Methods: In this descriptive study, data on uptake of insurance claims throughinnovative MDR-TB packages from January 2013 to April 2014 were collected.A simple survey of costs for clinical investigation and inpatient care was conductedacross two major urban districts in Chhattisgarh. In these selected districts, threehealth facilities from the private sector and one medical college from the publicsector with a functional drug-resistant tuberculosis (DR-TB) centre were chosenby the RSBY and MSBY State Nodal Agency to complete a simple, structuredquestionnaire on existing market rates. The mean costs for clinical investigationsand hospital stay were calculated for an individual patient with MDR-TB who wouldseek services from the private or public sector.Results: A total of 207 insurance claims for RSBY and MSBY MDR-TB packageswere processed, of which 20 were from private and 187 from public healthestablishments, covered under the health insurance programme, free of charge.An estimated catastrophic expenditure, of approximately US$ 20 000, was savedthrough the RSBY and MSBY health insurance mechanism during the study period.Conclusion: The innovative RSBY and MSBY MDR-TB insurance package is astep towards reducing catastrophic expenses associated with treatment for MDRTB.