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

Are school-going adolescents mentally healthy? Case study from Sabarkantha, Gujarat, India

Background: Mental health issues becoming the global public health challenge, especially among the youth (12–24 years of age), although they are often detected later in life. In India, the adolescent population constitutes a quarter of the country's population and burden of disease varies from 9.5 to 102/1000 population. Most of the mental health disorders remain unidentified due to negligence and ignorance of multiple factors. Keeping this in mind and lack of population-based studies with good quality for guiding the mental health policies, this study aims to document the prevalence of emotional and behavioral difficulties among adolescents in Sabarkantha district of Gujarat, India. Methods: This is a school-based cross-sectional study conducted among 11–19 years of school-going adolescents during August–September 2016. About 477 adolescents who gave consent to participate were selected from 20 randomly primary and secondary schools. A prevalidated questionnaire for sociodemographic information including global validated standard questionnaire for mental health scoring known as Strengths and Difficulties Questionnaire (SDQ) were administered and self-reported responses were documented. Statistical analysis was conducted through SPSS version 20. Results: Mean age of the study population was 14.2 ± 1.4 years. About 14.6% boys and 12.6% of girls had abnormal total SDQ score, while 15.3% boys and 21.9% of girls had borderline SDQ score. Thus, 70.1% of boys compared to 65.6% girls had normal SDQ score. The difference between mean (higher mean score among girls) of total SDQ score of boys and girls was statically significant at the level of P < 0.05. Major risk factors for self-reported mental health issues were illiterate mother, occupation of parents, which make them away from family during daytime, nuclear family, severe addiction to alcohol in the family, financial problem in the family, and adolescent getting daily physical punishment. One-seventh adolescents are vulnerable for mental health problems found in this study. About one-fifth adolescents have internalizing (emotional) and about one-sixth have externalizing (conduct) manifestations. Conclusion: There is an urgent need to address the emotional and conduct manifestation among school-going adolescents. Rashtriya Kishor Swasthya Karyakram framework needs to address these issues on priority

Noncommunicable diseases among school-going adolescents: A case study on prevalence of risk factors from Sabarkantha District of Gujarat, India

Background: The increasing burden of noncommunicable diseases (NCDs) and large proportion of adolescent population in India; crafts the dynamics of NCD risk factors. Most of the NCD risk factors are behaviorally acquired which are due to change in lifestyle during adolescent age groups. Objective: This study aims to determine the prevalence of risk factors among school-going adolescents in one of district of Gujarat state, India. Subjects and Methods: This is a cross-sectional study conducted among sampled schools of Sabarkantha district of Gujarat, India, during September–December 2016. A total of 484 school-going adolescents were screened for body weight, height, blood pressure, and some information of sociodemographic, lifestyle habits, and family history were collected through a structured questionnaire in vernacular language. Data were managed with SPSS version 20. Results: This study documents that not having fruits and not doing physical activities daily are the major risk factors of NCDs among school-going adolescents of Sabarkantha district, Gujarat. In addition to this, also it has been documented that there are differential standards for body mass index (BMI) available for adolescents and have been used extensively in various studies. This study provides an insight to these three major BMI standards and their differences in measurement for the school-going adolescents. Conclusions: This study recommends promoting healthier practices for prevention of NCD lifestyle risk factors among school-going adolescents and it also recommends standardizing the BMI measurements for adolescents for India

Situational Analysis of Reporting and Recording of Maternal Deaths in Gandhinagar District, Gujarat State

A situational analysis of recording and reporting maternal deaths in Gandhinagar district, Gujarat, India and to suggest improvements in the system for reporting and recording maternal deaths based on the findings. This qualitative study was conducted during June-August 2008 and analyzed maternal deaths occurred during April 2007–March 2008. To understand the current reporting system of maternal deaths, semi-structured interviews were conducted with all the concerned officials and offices. Forms and formats relating to death registration and registers containing information on deaths in the villages and towns were studied. Deaths of women in reproductive age group (15-49), reported by the district for the same year were also analyzed. Analysis of 15 verbal autopsy forms filled by the Medical Officers and Block Health Officers was also carried out using Epi Info software. Verbal autopsy method was used for in-depth understanding the circumstances and issues relating to 2 maternal deaths occurred during the study period and its reporting. A group meeting was conducted with Anganwadi workers to understand the reporting of maternal deaths through ICDS.maternal deaths, autopsy, Mumbai, gujarat state, maternal mortality ratio, MMR, south asia, NFHS, births, MDGs, Anganwadi workers, ICDS,women, reproductive age group,

Knowledge of hepatitis B among healthy population: A community-based survey from two districts of Gujarat, India

Background: Hepatitis B is the world's most common blood-borne viral infection, accounting for 2 billion infections, 350 million carriers, and 6 lakh deaths annually. Country like India still harbors approximately 30–60 million hepatitis B virus (HBV) carriers. A modest estimate would put the number of deaths occurring due to HBV infection per year in India to around 100,000. To prevent transmission and progression of the disease, proper community awareness including prevention is necessary. Therefore, this study aims to study the knowledge awareness among the healthy population about hepatitis B including knowledge regarding vaccine. Methodology: A community-based cross-sectional study was undertaken in two districts of Gujarat. Cluster sampling (30 clusters) was used, and pretested questionnaire was administered to 600 (with a prevalence rate of 5% in Gujarat having design effect of 2 within 95% confidence interval and 10% nonrespondent) healthy individuals, who heard about hepatitis B. Data handled and analyzed in EpiData Analysis V2.2.2.183. Results: Majority of the participants knew about symptoms whereas only 41% knew about prevention methods and few 34% knew about the mode of transmission. Although 40% sample has knowledge about the availability of vaccination, only 20% were self-vaccinated. The common reason for nonvaccination was lack of awareness. Conclusions: Only one-third of the populations in study districts are aware about hepatitis B and its vaccine. Less than one-fifth of the populations are vaccinated for hepatitis B. Important knowledge deficits about the routes of hepatitis B transmission/prevention were identified. Continued efforts should be made to develop and implement hepatitis B educational campaigns/health promotion for these communities