A comparative hospital-based observational study of mono- and co-infections of malaria, dengue virus and scrub typhus causing acute undifferentiated fever.

Positive serology for dengue and/or scrub typhus infection with/without positive malarial smear (designated as mixed or co-infection) is being increasingly observed during epidemics of acute undifferentiated febrile illnesses (AUFIs). We planned to study the clinical and biochemical spectrum of co-infections with Plasmodium sp., dengue virus and scrub typhus and compare these with mono-infection by the same organisms. During the period from December 2012 to December 2013, all cases presenting with AUFIs to a single medical unit of a referral centre in Garhwal region of the north Indian state of Uttarakhand were retrospectively selected and categorised aetiologically as co-infections, malaria, dengue or scrub typhus. The groups thus created were compared in terms of demographic, clinical, biochemical and outcome parameters. The co-infection group (n = 49) was associated with milder clinical manifestations, fewer, milder and non-progressive organ dysfunction, and lesser need for intensive care, mechanical ventilation and dialysis as compared to mono-infections. When co-infections were sub-grouped and compared with the relevant mono-infections, there were differences in certain haematological and biochemical parameters; however, this difference did not translate into differential outcomes. Scrub typhus mono-infection was associated with severe disease in terms of both morbidity and mortality. Malaria, dengue and scrub typhus should be routinely tested in all patients with AUFIs. Co-infections, whether true or due to serological cross-reactivity, appear to be a separate entity so far as presentation and morbidity is concerned. Further insight is needed into the mechanism and identification of the protective infection.

Healthcare policies and programmes for older persons: Exploring awareness among stakeholders.

BACKGROUND: Human rights are for all, regardless of age. The older adults are seen as vulnerable because biological, psychological and social ageing predispose the ageing person to frailty, infirmity, and in many cases dependency, setting the older person apart from the rest of the population in need of special protection and rights. Although the implementation of legislation, policies, and a package of integrated programmes and projects to cater to the needs of older persons had helped them to uplift their status, more has to be done to stem the increase of the reach of laws in a more fruitful manner. AIM: To develop a colloquial structured Healthcare Policies & Programmes Awareness Questionnaire and assess the awareness about the government healthcare provisions and benefits available for senior citizens among health professionals, older patients, and their caregivers. METHODS: This study was conducted in two phases, the development of the questionnaire consisting of relevant healthcare national policies and programmes followed by a cross sectional pilot study on 335 participants. RESULTS: The level of awareness was only 45.6% among health professionals followed by 26.4% & 22.2% of awareness among the caregivers and the older adults respectively. CONCLUSION: There is a huge gap between the healthcare providers and healthcare takers knowledge due to which the preventive and promotive care of older adults is poor in our country. There is a need to strengthen institutions and mechanism that can more systematically promote interaction between researchers, policymakers and other stakeholders who can influence the uptake of the research findings in a synergistic manner.