chikungunya -KAP study introduction

CHAPTER I

INTRODUCTION

Disease surveillance ought to be an important component of public health programme in every country. It has two essential purposes. One is to monitor the progress of ongoing interventions for disease reduction. Second, disease surveillance is essential for early detection of outbreaks in order to initiate investigations and control measures.

Kerala's health indicators are often said to be at par with those of developed countries. The state has the lowest infant mortality rate of 14.1 per cent as against an all-India average of 70.5. The birth rate for Kerala is 15 per cent while for the rest of the country it is 23.8. Similarly, the death rate is 6.4 as against 7.60 for the country. With regards to life expectancy also Kerala leads the rest of the country with 70.9 for males and 76 for women as against 61.8 and 63.5 respectively in the country. The literacy rate of the state is 90.86 percent and the separate ratio of male and female is 94.24 and 87.72 respectively.

Ironically, Kerala’s status of having one of the best health care systems in India has received a severe blow in the past three year due to the outbreak of Chikungunya viral fever in the state. It is considered as due to the poor management of the environment and the failure of the people in the prevention of the mosquitoes.

In the year 2007, India's 12 states including Kerala were affected with Chikungunya epidemic. Alappuzha, Kottayam, Pathanamthitta, and Kollam are the districts of kerala which highly affected with the disease. The media reported state-wide fever outbreak with high mortality. The government denied it. According to the Kerala government’s estimates, around 31,000 people are down with viral fever in Pathanamthitta district and 77,000 in Kottayam district and State Health Minister

P K Sreemathy said that, in June 2007, the number of suspected chikungunya cases was very high, with Kottayam reporting the highest number of 6,021 patients followed by Pathanamthitta with 2,516.

She added that a total of 193 people died of the epidemic fever in Kerala in 2007, with Kottayam and Pathanamthitta districts together accounting for 161 lives lost. Government statistics cover only attendance at Public Health Clinics (PHC) and hospitals.

The economy of Kerala, especially of the worst-affected districts, has been severely stricken as recovering patients find it too weak to work for a long time. An acute shortage of work force faced in the plantation sector of Kerala.

The major weakness in this otherwise successful surveillance system was our inability to conduct epidemiological or aetiological investigations on many of the reported diseases. There are no personnel trained in field epidemiology in the public health system. In addition, there was lack of laboratory diagnostic support service. These are not the deficiencies of the disease surveillance per se, but those of the existing public health system infrastructure.

Knowledge, Attitude, Practice Study (KAP study) is a medical model study which usually conduct to assess the community level aspects of an epidemics. It serves as an educational diagnosis of the community. Usually the knowledge level influences people to frame their attitude towards a particular subject and this attitudes leads to the positive and negative practices related to that thing.

Here the Chikungunya epidemic is the focus of the study. This study reveals, the increase in knowledge level , make changes in attitudes towards the Chikungunya as well as changes in the practices regarding management of the Chikungunya and vector control.

see chap 2