Dengue is one of the most serious and rapidly emerging tropical mosquito-borne diseases. The state of Kerala in India is hyperendemic for the disease and is one of the leading states in the reporting of deaths due to dengue. As primary prevention of dengue has had limited success, the prevention of mortality through the identification of risk factors and efficient patient management is of utmost importance. Hence, a record-based case control study was conducted in the Medical College Hospital in Thiruvananthapuram to identify the risk factors of mortality in patients admitted with dengue. Dengue patients over 40years of age were 9.3 times (95% CI; 1.9-44.4) more likely to die compared with younger patients. The clinical features associated with mortality from dengue were altered sensorium (odds ratio (OR) - 156, 95% CI; 12.575-1935.197), abnormal reflexes (OR - 8.5, 95% CI; 1.833-39.421) and edema (OR - 13.22, 95% CI; 2.651-65.951). Mortality was also higher in those patients with co-morbidities such as diabetes mellitus (OR - 26, 95% CI; 2.47-273.674) and hypertension (OR - 44, 95% CI; 6.23-315.499). The independent predictors of mortality were altered sensorium and hypertension. Dengue fever patients with these clinical features and those who are elderly should be more rigorously monitored and promptly referred from lower settings when required to reduce mortality.
Mass drug administration (MDA) for lymphatic filariasis elimination is a strategy of administering Diethylcarbamazine (DEC) tablets to all individuals above 2 years of age annually. It has been implemented in India and Kerala since 1997. A high coverage is essential for interruption of transmission in four to six years time, which is the average reproductive life span of the adult worm. The objectives of the study were to estimate the coverage and compliance of MDA for 2007 in Thiruvananthapuram district of Kerala, India; to explore the association of sociodemographic variables with compliance and to find the reasons for noncompliance to the drug. A cross-sectional survey was conducted using the probability proportionate to size cluster sampling technique. Three hundred households were selected for estimation of coverage and all individuals in these households, above two years of age, excluding pregnant and bedridden elderly patients were studied for determining compliance. Coverage was 52.3% (95% Cl 44.3, 60.3). Compliance was 39.5% (95% Cl 34.2, 45.0). Urban coverage was significantly lower than rural coverage. Compliance was not significantly related to any sociodemographic variables, but significantly associated with who the drug administrator was. Major reasons for noncompliance were fear of side effects (30.6%) and not perceiving the need (21.2%). Alternate drug delivery strategies need to be implemented to improve the coverage and compliance. Targeted Information Education and Communication (IEC) focusing on the safety of drugs and the requirement of MDA, is the need of the hour.
Mass Drug Administration (MDA) for Lymphatic Filariasis (LF) elimination has been implemented worldwide and in India with a goal of eliminating the disease by 2020 and 2015 respectively. Compliance to MDA is less than adequate to achieve the goal in the desired time. This study aims to identify the factors related to awareness, acceptability and attitude and the role of certain theoretical constructs of health belief model in determining the compliant behavior to MDA. Within a cross-sectional study done in Thiruvananthapuram district of Kerala, India, undertaken to determine coverage, a comparison was done between compliant and noncompliant individuals. 300 households were selected using cluster sampling technique, for estimation of coverage of MDA. From these households, 99 noncompliant and 70 compliant individuals were selected as cases and controls. The independent factors determining noncompliance were client attitude of not perceiving the need with an adjusted odds ratio (OR) of 2.52 (1.29-4.92), an unfavorable provider attitude with an adjusted OR of 2.14 (1.05-4.35) and low drug administrator acceptability with an adjusted OR of 2.01 (1.01-3.99). In MDA, the person giving the drug to the beneficiary is the most important person, whose attitude and acceptability determines compliance. More rigorous selection and training for capacity building of drug administrators are essential to enhance the compliance level. Alternate drug delivery strategies, besides house to house campaign by voluntary drug administers also needs to be implemented.
It is possible to improve the QOL of elderly women by providing financial security, ensuring care, and by enhancing social relationships of elderly women.
Background The primary objective of this study was to find the performance of the 2009 probable case definition of dengue and compare it with the definition given by the WHO-SEAR expert group in 2011. Methods A cross-sectional study was conducted in Thiruvananthapuram district of Kerala, which is hyperendemic for dengue. A consecutive series of 851 participants defined by the selection criteria were recruited from the primary, secondary, and tertiary health care settings. Sensitivity, specificity, predictive values, and likelihood ratios of the clinical case definitions were calculated using reverse transcriptasepolymerized chain reaction (RT-PCR) as gold standard in case of fever less than or equal to 5 days and serology (IgM positivity) for fever .5 days. Diagnostic odds ratio (DOR) was also calculated as a single indicator of performance of the case definition. Results The 2009 World Health Organization (WHO) case definition had a sensitivity of 76.4% (69.6-82.1) and negative predictive value of 87.5%. The 2011 WHO-SEAR expert group case definition had a higher sensitivity of 87.9% (82.2-91.9) but lower negative predictive value of 86.6%. The three independent criteria which were significantly associated with dengue were thrombocytopenia less than 150 000 (OR 2.80), leukopenia (OR 2.28), and absence of backache (OR 2.68). The performance of 2009 case definition was better (DOR 2.4) than the 2011 WHO-SEAR expert group case definition. This was further enhanced when thrombocytopenia was specified as platelet count less than 150 000 (DOR2.7). When 'no backahe' was added as an additional criteria, the performance of both definitions improved. Conclusions The 2009 WHO case definition has better discriminatory power than the 2011 WHO-SEAR expert group case definition. The performance of 2009 WHO case definition is enhanced by specifying thrombocytopenia as platelet count less than 150 000. The inclusion of 'no backache' further improves the discriminatory power. This may be more useful in primary care settings, to rule out dengue.
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