Quantifying the Impact of Chikungunya and Dengue on Tourism Revenues

<b>Background</b><br> Health economists have traditionally quantified the burden of vector-borne diseases (such as chikungunya and dengue) as the sum of the cost of illness and the cost of intervention programmes. The objective of this paper is to predict the order of magnitude of possible reduction in tourism revenues if a major epidemic of chikungunya or dengue were to discourage visits by international tourists, and to prove that even a conservative estimate can be comparable to or even greater than the cost of illness and intervention programmes combined, and therefore should not be ignored in the estimation of the overall burden. <b>Methods</b><br> We have chosen three Asian economies where the immediate costs of these diseases have been recently calculated: Gujarat (an economically important state of India), Malaysia, and Thailand. Only international tourists from non-endemic countries have been considered to be discouraged, and a 4% annual decline in their numbers has been assumed. Revenues from these tourists have been calculated assuming that tourists from non-endemic countries would spend, on average, the same amount as all international tourists. These assumptions are conservative and consistent with the recent experience of Mauritius and R�union islands. Non-Resident Indians (NRIs) have been considered half as likely to avoid travel to Gujarat compared to non-Indians. This paper reports inflation-adjusted expenditure figures as 2008 US$, assuming recent market exchange rates of 42.0 INR/US$, 3.22 MYR/US$, 0.68 EUR/US$, and 33.6 THB/US$. <b>Findings</b><br> A 4$ 8 million for Gujarat, US$65 million for Malaysia, and US$ 363 million for Thailand. The estimated immediate annual cost of chikungunya and dengue to these economies is US$90 million, US$ 133 million, and approximately US$127 million respectively, indicating that impact on tourism revenues should not be ignored when calculating the burden of infectious diseases. The impact on Gujarat is relatively less because its share of world tourism receipts is just 0.04$ 9.6 million loss in domestic tourism revenues to Gujarat. <b>Interpretation</b><br> This paper shows that potential loss of tourism revenues due to a severe epidemic outbreak could be substantial. In some cases, ignoring this component could seriously underestimate cost-benefit results, forestalling promising interventions that could benefit the society as a whole or leading to inadequate investment of resources in prevention and public-funded control programmes. This would be to the detriment of especially poorer sections of the society, who may not be able to afford treatment costs. At present data are insufficient for us to make more than a preliminary estimate of the magnitude of the potential loss of revenues from tourism due to a major outbreak of chikungunya or dengue.

Why Should 5000 Children Die in India Every Day? Major Causes and Managerial Challenges

Globally, more than 10 million children under 5 years of age, die every year (20 children per minute), most from preventable causes, and almost all in poor countries. Major causes of child death include neonatal disorders (death within 28 days of birth), diarrhea, pneumonia, and measles. Malnutrition accounts for almost 35 % of childhood diseases. India alone accounts for almost 5000 child deaths under 5 years old (U5) every day. India.s child heath indicators are poor even compared with our Asian neighbors, namely Malaysia, Sri Lanka, Thailand, Vietnam, China, Nepal and Bangladesh. Within India, the states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh account for almost 60 % of all child deaths India.s neonatal mortality, which accounts for almost 50 % of U5 deaths, is one of the highest in the world. India launched the Universal Immunization Program in 1985, but the status of full immunization in India has reached only 43.5 % by 2005-06. India started the Integrated Child Development Scheme (ICDS) in 1975 to provide supplementary nutrition to children, but 50 % of our children are still malnourished; nearly double that of Sub-Saharan Africa. The WHO/UNICEF training program on Integrated Management of Neonatal and Childhood Illnesses, known as IMNCI, started in India a few years ago, but the progress is very slow. What is unfortunate is the fact that most of these deaths are preventable through proven interventions: preventive interventions and/or treatment interventions, but the management of childhood illnesses is very poor. In this working paper, we bring out the nature and magnitude of child deaths in India (Chapter 1) and then share with you in Chapters 2, 3 and 4 our observations on the management of some of national programs of the government of India such as The Universal Immunization Program (UIP) The Integrated Child Development Scheme (ICDS) The Integrated Management of Neonatal and Child Illnesses (IMNCI) In the final chapter (Chapter 5), we highlight certain managerial challenges to satisfactorily address the child mortality and morbidity in our country.

Understanding Health-Seeking Behavior of People with Diabetes during COVID-19 Pandemic: A Facility Based Cross-Sectional Study Conducted in Ahmedabad, India

Objective: The study was conducted to understand health-seeking behavior (HSB) of people with diabetes during the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods: A hospital-based cross-sectional study was conducted at All India Institute of Diabetes and Research (AIIDR), Swasthya Diabetes Care in Ahmedabad, India. Data were collected with the help of a structured questionnaire. Response rate was 97%. One hundred thirty-eight participants who visited the hospital during the month of May 2022 were included and interviewed after obtaining informed consent.Results: Of the study participants (n = 138), 43.5% were female, while 56.5% were male. The mean age of study participants was 51.22. Out of 138 participants, 18.1% (n = 25) had type 1 diabetes mellitus (T1D) and 81.9% (n = 113) had type 2 diabetes mellitus (T2D). It was found that 55.7% faced delay in regular checkups, 39.8% used telemedicine to avoid travelling to hospital in fear of getting COVID infection, 7.8% faced delay in consuming medicines due to unavailability of medicines. Regular intake of medicines/insulin altered for 40.5% of study participants. 54.3% of our study participants felt fear while visiting the laboratory to measure their blood glucose level. Conclusions: Uncertainties created by COVID-19 pandemic have affected HSB of people with diabetes in terms of access to healthcare facilities, medicine adherence, laboratory testing, self-management habits. Knowledge shared here can help program planners to identify influencing factors and implement appropriate interventions. This understanding also helps in setting the stage for the formulation of effective diabetesrelated educational programs which might help for future pandemic

Why and where?—Delay in Tuberculosis care cascade: A cross-sectional assessment in two Indian states, Jharkhand, Gujarat

Tuberculosis (TB) is the second leading cause of death due to infectious diseases globally, and delay in the TB care cascade is reported as one of the major challenges in achieving the goals of the TB control programs. The main aim of this study was to investigate the delay and responsible factors for the delay in the various phases of care cascade among TB patients in two Indian states, Jharkhand and Gujarat. This cross-sectional study was conducted among 990 TB patients from the selected tuberculosis units (TUs) of two states. This study adopted a mixed-method approach for the data collection. The study targeted a diverse profile of TB patients, such as drug-sensitive TB (DSTB), drug resistance TB (DRTB), pediatric TB, and extra-pulmonary TB. It included both public and private sector patients. The study findings suggested that about 41% of pulmonary and 51% of extra-pulmonary patients reported total delay. Delay in initial formal consultation is most common, followed by a delay in diagnosis and treatment initiation in pulmonary patients. While in extra-pulmonary patients, delay in treatment initiation is most common, followed by the diagnosis and first formal consultation. DR-TB patients are more prone to total delay and delay in the treatment initiation among pulmonary patients. Addiction, co-morbidity and awareness regarding monetary benefits available for TB patients contribute significantly to the total delay among pulmonary TB patients. There were system-side factors like inadequacy in active case findings, poor infrastructure, improper adverse drug reaction management and follow-up, resulting in delays in the TB care cascade in different phases. Thus, the multi-disciplinary strategies covering the gambit of both system and demand side attributes are recommended to minimize the delays in the TB care cascade

A Record Based Study on Pediatric Tuberculosis in Ahmedabad City, India

Backdround: Good data on the burden of all forms of TB amongst children in India are scarce. There is an urgent need to study the available data. Methodology: This record based study was conducted in Ahmedabad city situated in western region of India. Five treatment units out of total ten units were selected by random sampling method. Records of Paediatric TB patients registered between February 2007 and January2008 were studied. Results: Out of total 382 records studied 193 (50.5%) were girls and 189 (49.5%) were boys with mean age of 8.3 years. Forty six percent of cases were in category III. Fifty four percent cases were of Extra- Pulmonary TB (EPTB). Total 123 patients who missed the doses, only one third were paid home visit. Eighty three percent of the children completed their treatment and 6% cases were declared as cured. Five children died during treatment. Conclusions: Analysis of records suggests high treatment completion rate amongst RNTCP paediatric TB patients in Ahmedabad city. It also suggests scope of improvement in home visits paid to patients who miss the doses during the treatment

Scenario of Newborn Care Practices in Private Healthcare Setting in India: An Insights From NFHS-5 Survey

Background: The private sector contributes significantly to health care service delivery in India. Study shows the prevalence of newborn care practices like early initiation of breastfeeding, kangaroo mother care, and hepatitis B birth dose practices in private sector hospitals across India. Methods: We conducted a basic analysis of unit-level data from the NFHS-5 survey; to understand the newborn care practices in private hospitals in India. Result: The place of the delivery has a significant impact on newborn care practices like kangaroo mother care, early breastfeeding within an hour of birth, and hepatitis-B vaccination at birth. The private sector accounts for 20.73 percent of deliveries wherein, 39.56 percent of private sector hospitals follow EIBF practice. Pre-lacteals were provided to 14.95 percent of the children within the first three days after birth. The better practice of kangaroo mother care was seen in the public sector. The prevalence of the hepatitis B vaccine at birth is very low with 3.25 percent in India