Morbidity among iron ore mine workers in Goa.

This study was carried out among workers from an open-cast iron ore mine in South Goa with an objective to assess morbidity among these workers. Investigations were carried out at the Occupational Health Service Clinic of the mining company. Nearly 0.6% workers had pneumoconiosis, 3.2% had abnormal spirometry findings, 38.16% had hearing loss and 27.7% had defective vision respectively. The prevalence of other chronic diseases were as follows: diabetes 5.1%, hypertension 8.3%, dyslipidemia 37.5% and polycythemia 12.7% respectively. Since the findings were not compared with the pre-placement records and as most of the workers are young with duration of exposures <10 years, relationship cannot be definitely determined. The study findings are suggesting an association between the occupation in mining with pneumoconiosis, compromised lung function and hearing loss. However for the other finding further analytical studies are required to see for any association. Airborne respirable dust survey and noise monitoring studies also need to be carried out.

Geospatial clustering, seasonal trend and forecasting of Kyasanur Forest Disease in the state of Goa, India, 2015-2018.

INTRODUCTION: Five states in India are reporting sporadic outbreaks of Kyasanur Forest Disease (KFD). Goa experienced an outbreak of KFD in 2015. It remains as an important differential diagnosis for tropical fever in the endemic regions. Few studies among neighboring two states (Karnataka and Kerala) have described the epidemiological characteristics of KFD. However, there is no study which describes the same among cases in the state of Goa. Hence, we planned to understand the epidemiology (time, place, and person distribution) of the disease including seasonal pattern with forecasting using zero-inflated negative binomial regression and time series models. We also explored geo-spatial clustering of KFD cases in Goa during 2015-2018 which would help design effective intervention to curb its transmission in Goa. RESULTS: Blood samples of all suspected cases of KFD during 2015 to 2018 were tested using reverse transcriptase-polymerase chain reaction technique. Reports of these results were periodically shared with the state surveillance unit. Records of 448 confirmed cases of KFD available at the State Integrated Disease Surveillance Programme were analyzed. The mean (SD) age of the patients was 41.6 (14.9) years. Of 143 cases with documented travel history, 135 (94.4%) had history of travel to forest for cashew plucking. Two thirds of cases (66.3%) did not receive KFD vaccine prior to the disease. Case fatality rate of 0.9% was reported. Seasonal peaks were observed during January to April, and forecasting demonstrated a peak in cases in the subsequent year also during January-April persisting till May. Around 40 villages located along the Western Ghats had reported KFD, and affected villages continued to report cases in the subsequent years also. Case density-based geographic maps show clustering of cases around the index village. CONCLUSION: Most of the confirmed cases did not receive any vaccination. KFD cases in Goa followed a specific seasonal pattern, and clustering of cases occurred in selected villages located in North Goa. Most of the patients who had suffered from the disease had visited the forest for cashew plucking. Planning for public health interventions such as health education and vaccination campaigns should consider these epidemiological features.

Kyasanur Forest Disease vaccination coverage and its perceived barriers in Goa, India-A mixed methods operational research.

BACKGROUND: Kyasanur Forest Disease (KFD) is a highly infectious viral illness transmitted by infected ticks through contact with monkeys and other forest animals. Till date there is no definite treatment available for KFD. Hence, vaccination is considered to be an important public health intervention to control KFD. This study aimed at estimating the vaccination coverage for primary and booster doses of KFD vaccine and exploring the perceived barriers to vaccination in the affected villages of Goa, India during 2015-18. METHODOLOGY & PRINCIPAL FINDINGS: In this explanatory mixed methods study, vaccine coverage was estimated bydata obtained from the KFD vaccination registers maintained at the health centers catering to the KFD affected villages. To understand the barriers to vaccination,key informant interviews were conducted among implementing health officers, medical officers and nurses involved in vaccination. Perceptions of vaccinees and community members were studied through in-depth interviews and focus group discussions. Out of the 35,500 targeted population (6-65 years)for KFD vaccination, 32% received one dose and 13.2% received two doses. The coverage for first booster and annual booster was 4.9% and 0.5% respectively. The drop out from first to second and third doses was 57% and 85% respectively. 69% of doses were delivered during community outreach programmes and remaining at health facilities. Inadequate vaccine stock, inappropriate timing of vaccination campaign, lack of awareness and misconceptions related to indications of vaccines, travel distance for follow up doses given at community health centre and pain due to injection were perceived as reasons for poor vaccination coverage. CONCLUSIONS: KFD vaccination coverage was poor in the villages affected by KFD in Goa. Both left-out and drop-out phenomena were observed in KFD vaccination. Vaccine implementation plan has to consider suitable time for the local people, maintain adequate vaccine stock and encourage community-based vaccination campaigns instead of facility-based to achieve optimal vaccine coverage.