Indigenous leprosy in Dera Ghazi Khan Division, Punjab, Pakistan.

OBJECTIVE: The study objective was to identify the main foci of leprosy in Southern Punjab and identify the problems precipitating prevalence of disease. METHODS: This was a retrospective study, from 2017 to 2012. A total number of sixty-five cases (n=65) were detected during this period. Snowball sampling technique was used. Every year contact survey was carried out for new case detection and compliance of medication. Family members of patients were examined for any anaesthetic patch or nerve involvement or any deformity. Grading of the deformity, if present, was also done according to WHO criteria. Data analysis was carried out by using SPSS version 18.0. Chi square test was applied and P-value calculated. Snow ball sampling procedure was applied to study the disease burden. RESULTS: In this study, the total number of new leprosy patients detected were sixty-five; female patients were 49 (75.38%) and male patients 16 (24.6%). Prevalence of Pauci- bacillary disease was 50.77%. Maximum number of cases were reported from rural area of Southern Punjab. Main foci of disease were concentrated in tribal areas of Dera Ghazi Khan and Rajan Pur. CONCLUSIONS: Leprosy is still evidenced in tribal areas of Dera Ghazi Khan and Rajan Pur.

Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT-PCR.

The objective of this study was to demonstrate the utility of dengue virus (DENV) non structural protein 1 (NS1) based rapid diagnostic test (RDT) for use in tribal and difficult to reach areas for early dengue (DEN) diagnosis in acute phase patients and evaluate its sensitivity and specificity against DENV NS1 enzyme linked immune sorbent assay (ELISA) and real time reverse transcriptase polymerase chain reaction (qRT-PCR). The DENV NS1 RDT was used for preliminary diagnosis during outbreaks in difficult to reach rural and tribal areas. The diagnosis was confirmed by DENV NS1 ELISA in the laboratory. The samples were also tested and serotyped by qRT-PCR. The results were evaluated using statistical tests. The DENV NS1 RDT showed 99.2% sensitivity and 96.0% specificity when analyzed using DENV NS1 ELISA as standard. The specificity and sensitivity of the RDT when compared with qRT-PCR was 93.6% and 91.1%, respectively. The serotype specific evaluation showed more than 90% sensitivity and specificity for DENV-1, 2, and 3. The RDT proved a good diagnostic tool in difficult to reach rural and tribal areas. Further evaluation studies with different commercially available RDTs in different field conditions are essential, that will help clinicians and patients for treatment and programme managers for timely intervention.

Teleophthalmology as a Model for Detecting Ocular Diseases in Tribal Areas of a North West State in India.

BACKGROUND: Lahaul and Spiti district of Himachal Pradesh, a high altitude tribal district, situated at altitudes varying from 10,000 to 15, 000 ft. above mean sea level is cut off from the rest of the country for nearly 6 months due to heavy snowfall in the mountain passes. In the absence of any ophthalmologist and ophthalmic technician, the provision of eye care is virtually absent. The current study (part of a research project funded by the Indian Council of Medical Research) was conducted with the aim to explore teleophthalmology as a model for detecting posterior segment eye diseases in tribal and inaccessible areas. MATERIALS AND METHODS: Fundus images (taken through fundus photography) of 1000 individuals above 5 years of age with no improvement in vision to 6/6 on refraction and individuals with known history of diabetes mellitus, systemic hypertension, or long standing headache with features of raised intracranial tension irrespective of whether their vision improved to 6/6 or not were sent to tertiary care center (base hospital) from regional hospital (field hospital). Transmitted images (through internet after attaching the details and patient particulars on the excel sheet) were analyzed by the ophthalmologists and the final diagnosis along with the line of management if any was transmitted back. RESULTS: Eighty-five percent of the images transmitted were of good quality. Retinal, vitreous, optic nerve head, and choroidal diseases could be detected. CONCLUSIONS: In the present situation, where trained workforce is unavailable in these areas, teleophthamology is an appropriate tool by which a number of eye diseases can be detected at early stages. Most of them can be treated in these early stages by lifestyle modification and medical management.

Experiences of junior public health nurses in delivery of maternal healthcare services to tribal women in kerala.

BACKGROUND: The maternal health care indicators are better in Kerala even in the tribal districts than the national averages. The tribal population scattered in hilly areas or other difficult terrains heavily constraints the MPHW female (Junior Public Health Nurse in Kerala) from providing services. The study was intended to describe the experiences of the Junior Public Health Nurses (JPHN) in delivery of maternal health care services to tribal women in Kerala. MATERIALS AND METHODS: JPHNs posted in Thariode panchayat under the sub centers of CHC Thariode in Wayanad district of Kerala. This is a Qualitative study with in-depth interview of the JPHNs using an interview guide. RESULTS AND INFERENCES: The various difficulties experienced by JPHNs in delivering the services in tribal areas were lack of sufficient time for field work, travel difficulties faced due to the hilly terrain and lack of public transport facilities, more time spent on travel than actual time spent for field work, cultural and language barriers and extra inputs put up in service delivery to tribal women. CONCLUSION AND RECOMMENDATIONS: The JPHNs serving in tribal areas overcame various constraints in service delivery like hilly terrain, limited public transport facilities, long hours spent in travelling, cultural and language barriers by putting in extra effort, time and personal money to fulfill their responsibilities. It is suggested that the JPHNs be given compensatory off to complete records and extra remuneration to cover their out of pocket expenditure on travelling to difficult areas.