Measles Surveillance in Kashmir: A Mixed Methods Study

Background: Measles surveillance serves as the means of monitoring program success. The quintessential purpose of measles surveillance is to identify gaps and garner effective public health responses to achieve measles elimination. Objectives: There were two key objectives: (i) to conduct an in-depth review of the existing measles surveillance system in Kashmir and highlight its strengths and weaknesses and (ii) to assess the pattern of measles?containing vaccine (MCV1) coverage and MCV2 coverage among under?5 years children and describe the health-seeking patterns of suspected cases of measles. Methods: The mixed methods study was conducted in the Kashmir valley from March 2018 to March 2019. An explorative qualitative design was followed using individual face?to?face interviews with thirty-two (n = 32) different stakeholders from the state, district, medical block, and primary health center (PHC) levels. To complement the qualitative study, a quantitative survey was done in two districts, Srinagar and Ganderbal, which consist of 5 and 4 medical blocks, respectively. Results: Among the suspected cases of measles, 52% had visited PHCs. Sixty?four suspected cases of measles (64) were immunized with two doses of MCV. None of the clinically suspected cases of measles were further investigated. In the qualitative analysis, five themes were generated viz, “measles surveillance description of Kashmir valley;” “factors affecting measles surveillance, perceptions, and experiences of stakeholders;” “barriers to measles surveillance;” “measles surveillance activities need to be intensified;” and “respondent recommendations for building an effective and sensitive measles surveillance system.” Conclusion: The current measles surveillance system in Kashmir was not effectively functioning; case-based measles surveillance is not being done as per the WHO guidelines. There is a lack of planning, advocacy, awareness, and communication of measles surveillance among the stakeholders. The visible barriers in measles surveillance included lack of training, logistics, incentives, and monitoring by internal and external agencies.

The Lived-In Experience and Psychological Recount of Dog Bite VictimsVisiting the Anti-Rabies Clinic in Kashmir: A Qualitative Study

Introduction: There is a necessitated need for canvassing and prioritizing measures towards rabies elimination beyond existing statuesque post-exposure prophylaxis. Moreover, there is a need to characterize the psychological and intrusive experiences of dog-bite victims to portray a picture beyond the public health perspective. To get an expressive understanding of the psychological and lived-in experience ofObjective: dog bite victims' to complement existing concepts. The study was conducted at the anti-rabiesMethod: clinic(ARC) of SMHS hospital which receives animal bite cases from the whole of Kashmir valley. Participants were selected by purposive sampling based on the inclusion criteria, and data saturation was reached with eleven participant interviews. One to one in-depth interviews were conducted with eleven (11) dog bite victims, using a preformed interview guide. Data analysis was performed using Colaizzi's phenomenological method to describe the individualistic experiences faced in peculiar conditions with familiar phenomena embedded in them. Data analysis yielded three overarching themes and nine subthemes viz:-Results: 1.Spiritual and emotional ineffectualness. (Suffering and affliction, Spiritual sulkiness, Emotional emergence) 2. Flashbacks of being hindered and defenseless. (Lack of focus in one's work, lacking the courage to protect, Being shaky) 3. Social and economical implications. (Financial loss, group and peer detachment, preferring isolation) The results of this study showed that dog bite patients experience an unpleasantConclusion: phenomenon in the face of being bitten by the dogs and are subjected to severe psychological pressures that require attention and support of medical professionals, psychologists and government authorities.

Morbidity pattern in patients attending an OPD clinic at a health subcenter in Srinagar, Jammu and Kashmir

A retrospective descriptive study was carried out at subcenter Abidal, Srinagar to assess morbidity pattern among the population who visited this center. Secondary data was taken and analyzed using Microsoft excel. Results showed female population more often visited the center. Among the majority of recorded cases acute infections and fevers, hypertension, musculoskeletal disorders and anemia were a major contributing ailment.

Assessment of immunization coverage in district Srinagar of Kashmir

Background: Immunization is till now most safe, cost effective and powerful intervention that has decreased the burden of vaccine preventable infectious diseases all over the world. The aim of this study was to estimate the immunization coverage among children aged 12-23 months in district Srinagar of Jammu and Kashmir.Methods: The study sample included 30 clusters from district Srinagar selected as per the 30×7 cluster sampling method.Results: It was found that fully immunized children were 87.14% and 12.26% of children were partially immunized and none was unimmunized. Regarding the individual vaccine coverage, it was highest for OPV1 (99.52%) followed by BCG and OPV0 (99.05%) and lowest for Hepatitis birth dose (95.24%). The dropout was found highest (6.22%) for OPV1-OPV3 and lowest (1.47%) for LPV1 - measles/MCV (1.47%).Conclusions: The immunization of district Srinagar is above 85% and this gives a positive hope for better future to reach coverage of 100%.

Validity of pneumonia severity index and CURB-65 severity scoring systems in community acquired pneumonia in an indian setting.

Background. Little information is available from India regarding prognostic factors in patients with community acquired pneumonia (CAP). Methods. Hospital-based prospective study to test the validity of pneumonia severity index (PSI) and the confusion, urea, respiratory rate, blood pressure, age over 65 years (CURB-65) risk scoring systems in patients with CAP (n=150). Results. Although both CURB-65 class ³III and PSI class ³IV were 100% sensitive in predicting death, CURB-65 class ³III had a higher specificity (74.6%) than PSI class ³IV (52.2%) when used to predict death. In both PSI and CURB-65 risk scoring systems, mortality rate, need for intensive care unit (ICU) admission, prolonged need for intravenous (I.V.) antibiotics, prolonged duration of hospital stay and need for admission to ICU increased progressively with increasing scores. The PSI class ³IV was more sensitive in predicting ICU admission than CURB-65. The duration of hospital stay was found to have a weak but significant correlation with PSI and CURB-65 criteria. Defervescence time also had a very weak but significant correlation with PSI and CURB-65 criteria. Duration of I.V. antibiotics had a moderately strong correlation with CURB-65 criteria but a weak correlation with PSI criteria. Conclusions. Both PSI and CURB-65 were found to have equal sensitivity to predict death from CAP. Specificity of CURB- 65 was higher than that of PSI. However, PSI was more sensitive in predicting ICU admission than CURB-65.