Prepared to react? Assessing the functional capacity of the primary health care system in rural Orissa, India to respond to the devastating flood of September 2008.

BACKGROUND: Early detection of an impending flood and the availability of countermeasures to deal with it can significantly reduce its health impacts. In developing countries like India, public primary health care facilities are frontline organizations that deal with disasters particularly in rural settings. For developing robust counter reacting systems evaluating preparedness capacities within existing systems becomes necessary. OBJECTIVE: The objective of the study is to assess the functional capacity of the primary health care system in Jagatsinghpur district of rural Orissa in India to respond to the devastating flood of September 2008. METHODS: An onsite survey was conducted in all 29 primary and secondary facilities in five rural blocks (administrative units) of Jagatsinghpur district in Orissa state. A pre-tested structured questionnaire was administered face to face in the facilities. The data was entered, processed and analyzed using STATA(®) 10. RESULTS: Data from our primary survey clearly shows that the healthcare facilities are ill prepared to handle the flood despite being faced by them annually. Basic utilities like electricity backup and essential medical supplies are lacking during floods. Lack of human resources along with missing standard operating procedures; pre-identified communication and incident command systems; effective leadership; and weak financial structures are the main hindering factors in mounting an adequate response to the floods. CONCLUSION: The 2008 flood challenged the primary curative and preventive health care services in Jagatsinghpur. Simple steps like developing facility specific preparedness plans which detail out standard operating procedures during floods and identify clear lines of command will go a long way in strengthening the response to future floods. Performance critiques provided by the grass roots workers, like this one, should be used for institutional learning and effective preparedness planning. Additionally each facility should maintain contingency funds for emergency response along with local vendor agreements to ensure stock supplies during floods. The facilities should ensure that baseline public health standards for health care delivery identified by the Government are met in non-flood periods in order to improve the response during floods. Building strong public primary health care systems is a development challenge. The recovery phases of disasters should be seen as an opportunity to expand and improve services and facilities.

Environmental health impact assessment of National Aluminum Company, Orissa.

Environmental Health Impact Assessment of industries is an important tool help decision-makers make choices about alternatives and improvements to prevent disease/injury and to actively promote health around industrial sites. A rapid environmental health hazard and vulnerability assessment of National Aluminum Company was undertaken in the villages in the vicinity plant in Angul region of Orissa. Aluminum smelter plant was known to discharge hundreds of tones of fluoride in to the environment contaminating the ecosystem around the plant. The present Environmental health impact assessment was carried out in 2005-06 at the request of officials from Government of Orissa. The findings showed adverse effects on human, veterinary and ecological health. Human health effects manifestations included dental and skeletal fluorosis. Veternary health effects were manifested through skeletal fluorosis. Ecological adverse effects were manifested by damage to paddy fields and crop yield.

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 ß-thalassemia carrier status in a Dudh Kharia tribal family of Orissa.

BACKGROUND: The ß-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 ß-thalassemia major would either bear normal or carrier offspring, but not two offspring with carrier of ß-thalassemia major genotype together. For the first time, a carrier parent of ß-thalassemia major gene has born progeny (three daughters and a twin male offspring) with a carrier status of ß-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 A(2) level in mother (Hb A(2) = 5.3%), in three daughters (Hb A(2) =6.5, 5.9, 5.5% in chronological and birth order), in two twin sons (Hb A(2) =5.9% and 6.0%) and normal (Hb A(2) = 3.3%) for father. Hence, all the children i.e., three daughters and two twin sons, including the mother were ß-thalassemia carriers. Since all the hematological parameters i.e., red cell indices, G-6-PD enzyme activity, ABO and Rhesus blood groups and identical ß-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.