A cutaneous Anthrax outbreak in Koraput District of Odisha-India 2015.

BACKGROUND: Cutaneous anthrax in humans is associated with exposure to infected animals or animal products and has a case fatality rate of up to 20% if untreated. During May to June 2015, an outbreak of cutaneous anthrax was reported in Koraput district of Odisha, India, an area endemic for anthrax. We investigated the outbreak to identify risk factors and recommend control measures. METHOD: We defined a cutaneous anthrax case as skin lesions (e.g., papule, vesicle or eschar) in a person residing in Koraput district with illness onset between February 1 and July 15, 2015. We established active surveillance through a house to house survey to ascertain additional cases and conducted a 1:2 unmatched case control study to identify modifiable risk factors. In case control study, we included cases with illness onset between May 1 and July 15, 2015. We defined controls as neighbours of case without skin lesions since last 3 months. Ulcer exudates and rolled over swabs from wounds were processed in Gram stain in the Koraput district headquarter hospital laboratory. RESULT: We identified 81 cases (89% male; median age 38 years [range 5-75 years]) including 3 deaths (case fatality rate = 4%). Among 37 cases and 74 controls, illness was significantly associated with eating meat of ill cattle (OR: 14.5, 95% CI: 1.4-85.7) and with close handling of carcasses of ill animals such as burying, skinning, or chopping (OR: 342, 95% CI: 40.5-1901.8). Among 20 wound specimens collected, seven showed spore-forming, gram positive bacilli, with bamboo stick appearance suggestive of Bacillus anthracis. CONCLUSION: Our investigation revealed significant associations between eating and handling of ill animals and presence of anthrax-like organisms in lesions. We immediately initiated livestock vaccination in the area, educated the community on safe handling practices and recommended continued regular anthrax animal vaccinations to prevent future outbreaks.

Primary healthcare services among a migrant indigenous population living in an eastern Indian city.

This paper reports the accessibility and utilization of the healthcare services among a migrant indigenous community inhabiting slums of an eastern Indian city. It is based on data collected through semi-structured interviews conducted with heads of the households. The results indicated that the services of health personnel by visiting households are rare and the service provision was very poor. For curative services, the people heavily depend on private practitioners, including unqualified practitioners, by spending large proportions of their earnings. Due to migration, this community becomes more vulnerable to low utilization of healthcare services. This study warrants evolving a system of healthcare to cater the needs of vulnerable migrant groups in urban areas of India.

Peripheral health workers' knowledge and practices related to filarial lymphedema care: a study in an endemic district of Orissa, India.

The Global Program to Eliminate Lymphatic Filariasis (GPELF), which includes alleviation of disability and suffering of patients, is run primarily in India by the primary health care system. The present study assessed the knowledge and practices related to lymphedema care among peripheral health workers of the primary health care system in a filarial-endemic district of Orissa, India. A total of 41 health workers sampled across the district were subjected to in-depth interviews. The results showed that many lymphedema patients visit the peripheral health institutions mostly for the treatment of acute episodes of lymphangitis. Many health workers do not know the concept of foot care and its importance in lymphedema management. However, a few health workers advised the patients to follow some components of foot care. The knowledge levels and practices of peripheral health workers are not at desirable levels. The medical and paramedical staff of the peripheral health institutions should be oriented about the management of lymphedema and peripheral health workers should promote the foot care practices. For the GPELF as a whole to prove successful, the patients who already have lymphedema need to be cared for and have their morbidity relieved as much as possible.