Comparing community and hospital data of snakebite in North Bihar: a community incidence survey and a parallel hospital-based clinical study.

In Bihar, an estimated 4500 snakebite deaths occur per year, but community data are scarce. Using a multi-stage cluster design, 4159 households were interviewed across six Community Development (CD) blocks in North Bihar, identifying 206 snakebites and 254 deaths between the Chhaat festivals of 2014 and 2015. Concurrently, 357 snakebite victims presented to Duncan Hospital from this area. None of the 254 verbal autopsies were attributed to snakebite envenoming. The annual community snakebite incidence was 643/100,000 person-years (95% confidence interval [CI] = 556-730) with peak incidence in women aged 30-39 years at 1323/100,000 person-years (95% CI = 837-1809). Two-thirds of snakebite victims attended traditional healers first for help (95% CI = 59.9-73.2). The community envenomation rate was 24.9/100,000 person-years (95% CI = 7.6-42.2). The hospital envenomation rate was 4.6% (95% CI = 3.5-5.7). Of the hospital snakebite deaths, 91% (10/11) were aged <16 years. Only 4.6% (95% CI = 4.1-5.1) of snakebite victims from this area presented at the local hospital.

International classification of primary care: an Indian experience.

BACKGROUND: India is in the process of transition to universal health coverage for Indian citizens. The focus is to strengthen the primary and secondary level services. Coupled with this national scenario, the development of Family medicine as a distinct discipline is in a crucial stage. There is a nation-wide urge to build family medicine training units and service centers across the country to fulfill the unmet health needs of the population. OBJECTIVES: This study aimed to bring out reasons for encounter (RFE) and morbidity pattern of patients seen in a family physician run urban health center in South India. METHODS: The study was conducted in an urban health center of a tertiary care hospital. Clinicians entered the data using International Classification of Primary Care (ICPC) codes. Data included were demographics, 3 RFE, 3 diagnoses, 3 outcomes of care that include prescriptions, investigations, procedures, and referrals made. RESULTS: During 47,590 patient encounters, 59,647 RFE, 62,283 diagnoses and 68269 outcomes of care were recorded. The majority of RFEs and diagnoses are in the following ICPC chapters: Endocrinology (38.6%), cardiovascular (35.91%), respiratory (20.26%), digestive (7.68% and musculo-skeletal (6.8%). The most frequent outcome of care was prescriptions, followed by counseling and nebulization. CONCLUSION: This study is the first to report on the RFE in India. This study demonstrated the breadth of clinical conditions seen by family physicians across all ages and in both genders. This study attempts to highlight the need for family physician based services as a training ground for trainees.