Community knowledge on malaria among febrile patients in an endemic district of Orissa, India.

Background & objectives: Evidence on the community knowledge and perceptions on malaria are crucial to design appropriate health communication strategies for malaria control. Orissa, an Indian state with a large proportion of indigenous populations and hilly terrains contributes to the highest malaria burden in India. A study was undertaken to assess the knowledge on malaria among community members who had experienced fever and chills in the endemic district of Boudh in Orissa. Methods: A cross-sectional community-based survey was carried out with respondents (n=300) who had fever with chills within two weeks prior to data collection through a multi-stage sampling and interviewed them using a pre-tested, structured interview schedule. Results : About 90% of respondents recognized fever as a common symptom of malaria, 72.3% said mosquito bites cause malaria, 70.3% of respondents reported mosquito control and personal protection to be the method of malaria prevention, and 24.6% identified chloroquine as the drug used for treatment. Women and scheduled tribe (ST) respondents were found to have lower level of appropriate knowledge of causes, symptoms, and prevention methods of malaria than their counterparts. Interpretation & conclusion: The study population had a fair knowledge of malaria about the causes, symptoms, treatment, modes of prevention and outcomes of non-treatment compared to most of the studies conducted in similar settings. However, the relatively low awareness among women and tribal population calls for more context specific communication strategies. Such strategies should be based on information needs assessment of different population subgroups, especially of women and members of the ST community, using media that is accessible and clearly understood by different groups.

Rapid spread of Chikungunya virus infection in Orissa: India.

Background & objectives : A large number of cases of undiagnosed fever and joint pain were reported from different parts of the State of Orissa since February 2006. Epidemiological and laboratory investigation were carried out to confirm the cause of emerging illness, which was provisionally suspected as Chikungunya (CHIK) fever. Methods: Upon getting the reports of suspected CHIK like illness in different parts of the State, epidemic investigations were carried out in the outbreak affected villages. Case history was recorded, clinical examination undertaken and blood samples collected for seroconfirmation for CHIK IgM antibody using ELISA based kit. Simultaneously vector survey was also carried out. Results: With no previous record of CHIK infection in the State, the first outbreak was confirmed during February 2006. Subsequently, the infection spread to 13 of 30 districts in different episodes covering 79 villages till November 2007. Attack rate was 9-43 per cent in the different outbreaks with average seropositivity of 24 per cent to CHIK specific IgM. Morbidity was high though no deaths were recorded. Aedes aegypti and Ae. albopictus were identified as the possible vectors for transmission. Interpretation & conclusions : The report confirmed emergence of CHIK infection in the State of Orissa, India, and its spread to a larger geographic zone in a short period which warrants public health measures to control further spread.

Insecticide treated mosquito nets for malaria control in India-experience from a tribal area on operational feasibility and uptake

The study assessed the operational feasibility and acceptability of insecticide-treated mosquito nets (ITNs) in one Primary Health Centre (PHC) in a falciparum malaria endemic district in the state of Orissa, India, where 74 percent of the people are tribes and DDT indoor residual spraying had been withdrawn and ITNs introduced by the National Vector Borne Disease Control Programme. To a population of 63,920, 24,442 ITNs were distributed free of charge through 101 treatment centers during July-August 2002. Interview of 1,130, 1,012 and 126 respondents showed that the net use rates were 80 percent, 74 percent and 55 percent in the cold, rainy and summer seasons, respectively. Since using ITNs, 74.5-76.6 percent of the respondents observed reduction of mosquito bites and 7.2-32.1 percent reduction of malaria incidence; 37 percent expressed willingness to buy ITNs if the cost was lower and they were affordable. Up to ten months post-treatment, almost 100 percent mortality of vector mosquitoes was recorded on unwashed and washed nets (once or twice). Health workers re-treated the nets at the treatment centers eight months after distribution on a cost-recovery basis. The coverage reported by the PHC was only 4.2 percent, mainly because of unwillingness of the people to pay for re-treatment and to go to the treatment centers from their villages. When the re-treatment was continued at the villages involving personnel from several departments, the coverage improved to about 90 percent.Interview of 126 respondents showed that among those who got their nets re-treated, 81.4 percent paid cash for the re-treatment and the remainder were reluctant to pay. Majority of those who paid said that they did so due to the fear that if they did not do so they would lose benefits from other government welfare schemes. The 2nd re-treatment was therefore carried out free of charge nine months after the 1st re-treatment and thus achieved coverage of 70.4 percent. The study showed community...

A monozygotic twin pair with β-thalassemia carrier status in a Dudh Kharia tribal family of Orissa.

BACKGROUND: The β-thalassemia syndrome is a genetically inherited commonly encountered hematological disorder in the state of Orissa. It causes high degree of morbidity, mortality and fetal wastage in the poor vulnerable people. AIMS AND OBJECTIVES: There is an equal probability (50% chance) in every singleton pregnancy that a carrier parent of β-thalassemia major would either bear normal or carrier offspring, but not two offspring with carrier of β-thalassemia major genotype together. For the first time, a carrier parent of β-thalassemia major gene has born progeny (three daughters and a twin male offspring) with a carrier status of β-thalassemia major in Dudh Kharia tribal family studied from Sundargarh district of Orissa. MATERIALS AND METHODS: We screened randomly selected population of Dudh Kharia tribe from Sundargarh district of Orissa for hemoglobinopathies to assess the extent of the problem, design possible interventions and provide genetic counseling to them. A family with twin children was identified during screening in Lata Gaon in Bargaon block of Sundargarh district of Orissa for the above-mentioned study. Background information for this family such as name, age, sex, tribe, native place, reproductive history, family pedigree and clinical signs and symptoms were also recorded. Standardized genetic and hematological procedures and techniques were followed for analysis. RESULTS: Laboratory investigations for alkaline electrophoresis of blood lysate on cellulose acetate membrane showed raised hemoglobin A2 level in mother (Hb A2 = 5.3%), in three daughters (Hb A2 =6.5, 5.9, 5.5% in chronological and birth order), in two twin sons (Hb A2 =5.9% and 6.0%) and normal (Hb A2 = 3.3%) for father. Hence, all the children i.e., three daughters and two twin sons, including the mother were β-thalassemia carriers. Since all the hematological parameters i.e., red cell indices, G-6-PD enzyme activity, ABO and Rhesus blood groups and identical β-thalassemia (trait) genotypes with identical clinical manifestations and hematological profile of the twin sons under similar environmental conditions, hence they were labeled as identical monozygotic twins. CONCLUSIONS: It is a rare occasion when a single pregnancy carries either one or two abnormal genotypes at a time in a womb in human beings. Monozygotic twins are genetically alike and provide appraisal of the expression of identical genotype under the different environmental conditions.

Genetic heterogeneity of population structure in 15 major scheduled tribes in central-eastern India: A study of immuno-hematological disorders.

Background: The aboriginal tribes of India constitute an important segment of the society in the world. Though a large number of genetic studies have been carried out in India, the genetic data of the populations in the state of Orissa are very limited, especially pertaining to the indigenous tribal people. Most of the earlier studies were restricted to either a single tribe or a few genetic markers. Data on population structure of tribal communities of Orissa pertaining to common hemolytic disorders and genetic variations are still scanty. AIMS AND OBJECTIVES: In view of the limited data available on the tribes and the huge tribal population, a cross-section of ashram schools was investigated for immuno-hematological disorders in relation to geographical, linguistic and genetic variations. MATERIALS AND METHODS: A cross-section of 15 major scheduled tribes in ashram schools from eight districts of Orissa was randomly studied for five hereditary immuno-hematological markers, namely, the ABO and Rhesus (D) blood groups, sickle cell hemoglobinopathy, β -thalassemia syndrome and G-6-PD deficiency, following the standard hematological procedures and techniques. RESULTS: A preponderance of blood group B over A and low incidence of Rhesus-negative (D-) among Bathudi, Bhuyan, Kissan, Kolha, Kondh, Munda oraon, Paraja, Santal and Saora tribes was observed. The deficiency of G-6-PD enzyme was found to be quite high, varying from 5.1 to 15.9% among these scheduled tribes of Orissa. Both deficient female heterozygotes and homozygotes were encountered. Marked variation was seen in the prevalence of β -thalassemia trait, varying from 0 to 8.5%, in the aboriginal tribes. The frequency of sickle cell disorders was found to vary from 0 to 22.4% among the major tribes, but it was comparatively higher in Paraja (21.5%), Dhelki Kharia (13.7%), Gond (11.9%) and Bhatra (10.5%) tribes. CONCLUSIONS: The study showed genetic heterogeneity and diversity with respect to above immuno-hematological genetic markers and indicated not only the inter-tribal admixture but also diffusion with other racial groups of India. Further, the heterogeneous tribal populations from Orissa were found to harbor almost all major hemoglobinopathies. This is the first comprehensive study of immuno-hematological disorders among the scheduled tribes from the state of Orissa.