Background
Dengue is major public health problem in India, especially in urban areas. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, Gujarat, India.
Methods
We reviewed the medical records of dengue patients hospitalized in five tertiary care facilities (private [n=2], semi-government [n=2] and government [n=1]) between April 2017 and March 2018. We used the World Health Organization 2009 classification to classify the severity of dengue. A resource utilization approach was used to estimate the cost of illness in US dollars (US$) (inflation adjusted to 2018) from a quasi-societal perspective (excluding non-medical cost) for dengue hospitalization.
Results
Of the 732 hospitalized dengue patients, 44.7% had no warning symptoms, 39.5% had warning signs and 15.8% had severe dengue. The mean cost of hospitalization was US$86.9±170.7. The cost of hospitalization was 28.8 times higher in private hospitals compared with government hospitals. Consultant charges in private hospitals, laboratory investigations in semi-government hospitals and registration with admission charges in government hospitals accounted for 27.3%, 39.4% and 53% of the direct cost in these facilities, respectively.
Conclusions
A better triage system for hospitalization, subsidizing costs in the public sector and cost capping in the private sector can help to reduce the cost of hospitalization due to dengue so as to ensure affordability for larger portion of the society for universal health coverage.
We estimated the incidence of laboratory-confirmed dengue patients for Surat city, India, using surveillance data from 2011 to 2016 and described the related entomological indices and climatic factors. There was a rise in incidence from 1.5 to 17.6 per 100,000 population, as the numbers of notified cases have increased because of better surveillance system. The case notification was 1.3 times higher for the public sector than the private sector. The larval indices were below the transmission level (House index, Breteau index < 1%). The median age of dengue patients was 20 years (IQR: 14-28), with a male to female ratio of 1.6:1. Five peripheral vector control units contributed to 1,013 (41.4%) confirmed cases with rising incidence in other units also. The number of dengue patients peaked during post-monsoon. Spearman's correlation of vector density with humidity (r s = 0.556), rainfall (r s = 0.644), and number of cases (r s = 0.708) suggested climate favorable for vector breeding. There is a good system of public-private coordination for dengue surveillance. However, there is a need to reassess the vector indices threshold for transmission in the city.
Background: During July 2017 to August 2017, five cases of laboratory-confirmed dengue cases were reported from Jothinagar village, Tamil Nadu, India. The episode was investigated to confirm the existence of an outbreak and formulate appropriate recommendations for containment.Methods: The monthly occurrence of dengue cases from 2014 to 2017 was compared to confirm the outbreak. Additional blood specimens from 22 patients were sent for laboratory confirmation. We conducted active case search, eco-entomological survey, and geo-mapping of cases and Aedes breeding spots.Results: The occurrence of 36 cases of dengue in the village, previously free from the disease for the past 3.5 years, confirmed the outbreak. Twelve were laboratory-confirmed while the remaining 24 were probable cases. The attack rate was highest amongst females in the age group 11-15 years (10.8/100 population). Case fatality was zero. The house index, Breteau index, container index (CI) and pupal index was 37.7% (23/61), 54.1% (33/61), 16.7% (33/198) and 32.8% (20/61) respectively. Discarded tyres were the key productive containers (CI=28.36%). Geo-analysis suggested clustering of cases within 70 m of the Aedes breeding spots particularly within the central part of the village.Conclusions: Based on high entomological indices, an intensive vector elimination campaign was implemented with a special focus on managing discarded tyres. Geo-analysis can be incorporated in surveillance to identify clusters early for control measures.
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