Severity and costs associated with hospitalization for dengue in public and private hospitals of Surat city, Gujarat, India, 2017–2018

2019 ◽  
Vol 113 (11) ◽  
pp. 661-669 ◽  
Author(s):  
Viral R Bajwala ◽  
Denny John ◽  
T Daniel Rajasekar ◽  
Manoj V Murhekar
Keyword(s):  
Urban Areas ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Warning Signs ◽  
World Health ◽  
Severe Dengue ◽  
Major Public Health Problem ◽  
Private Hospitals ◽  
Government Hospitals ◽  
The Cost

Abstract Background Dengue is major public health problem in India, especially in urban areas. We conducted a study to estimate the severity and costs of treatment among hospitalized dengue patients in Surat city, Gujarat, India. Methods We reviewed the medical records of dengue patients hospitalized in five tertiary care facilities (private [n=2], semi-government [n=2] and government [n=1]) between April 2017 and March 2018. We used the World Health Organization 2009 classification to classify the severity of dengue. A resource utilization approach was used to estimate the cost of illness in US dollars (US$) (inflation adjusted to 2018) from a quasi-societal perspective (excluding non-medical cost) for dengue hospitalization. Results Of the 732 hospitalized dengue patients, 44.7% had no warning symptoms, 39.5% had warning signs and 15.8% had severe dengue. The mean cost of hospitalization was US$86.9±170.7. The cost of hospitalization was 28.8 times higher in private hospitals compared with government hospitals. Consultant charges in private hospitals, laboratory investigations in semi-government hospitals and registration with admission charges in government hospitals accounted for 27.3%, 39.4% and 53% of the direct cost in these facilities, respectively. Conclusions A better triage system for hospitalization, subsidizing costs in the public sector and cost capping in the private sector can help to reduce the cost of hospitalization due to dengue so as to ensure affordability for larger portion of the society for universal health coverage.

scholarly journals Prevalence and outcome of anaemia among pregnant women attending tertiary care hospital in Visakhapatnam

2017 ◽  
Vol 5 (1) ◽  
pp. 203
Author(s):  
Radha Kumari Paladugu ◽  
Srinivas Jagath Pentakota ◽  
Sushma N.
Keyword(s):  
Socioeconomic Status ◽  
Developing Countries ◽  
Pregnant Women ◽  
Urban Areas ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Developed Countries ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Study Population

Background: Anaemia in pregnancy is now considered as a major public health problem, caused by iron deficiency. WHO has estimated that prevalence of anaemia in developed and developing countries in pregnant women is 14% in developed countries and 51 percent in developing countries and 65-75% in India. Various programmes regarding anaemia prophylaxis and maternal health have been implemented but still the prevalence of anaemia related complications among pregnant women continues to be high. Hence the present study was conducted to study the prevalence and pregnancy outcome as a result of anaemia in a tertiary care center in Visakhapatnam. Methods: A cross sectional descriptive study was carried out from June 2016 to August 2016 in the Department of Obstetrics and Gynecology among postnatal women in King George hospital, Visakhapatnam. A semi-structured questionnaire was prepared and information regarding age, socioeconomic status, parity, gestational age interval between pregnancies and outcome and complication of pregnancy were collected. Results: Mean age of study population is 22.4 years. Out of 100 women involved in the study 65 are from urban areas 29 from rural areas and 6 from tribal areas. Majority of the study population 66% were having HB% between 8-11% i.e. mild anaemia. When Outcome of pregnancy was seen in relation to anaemia majority of the women had live births (90%) followed by 7% IUDs and 2% still births. Conclusions: Majority of the women are in the age group of 20-24 years. Socioeconomic status is directly related to anaemic status of the women. Majority of the women had complication of puerperal sepsis. 

Trend and Predictive Analytics of Dengue Prevalence in Administrative Region

2020 ◽  
pp. 236-262
Author(s):  
Kannimuthu Subramanian ◽  
Swathypriyadharsini P. ◽  
Gunavathi C. ◽  
Premalatha K.
Keyword(s):  
Machine Learning ◽  
Urban Areas ◽  
Goodness Of Fit ◽  
Predictive Analytics ◽  
Learning Algorithms ◽  
Public Health Problem ◽  
Viral Disease ◽  
Machine Learning Algorithms ◽  
Severe Dengue ◽  
Major Public Health Problem

Dengue is fast emerging pandemic-prone viral disease in many parts of the world. Dengue flourishes in urban areas, suburbs, and the countryside, but also affects more affluent neighborhoods in tropical and subtropical countries. Dengue is a mosquito-borne viral infection causing a severe flu-like illness and sometimes causing a potentially deadly complication called severe dengue. It is a major public health problem in India. Accurate and timely forecasts of dengue incidence in India are still lacking. In this chapter, the state-of-the-art machine learning algorithms are used to develop an accurate predictive model of dengue. Several machine learning algorithms are used as candidate models to predict dengue incidence. Performance and goodness of fit of the models were assessed, and it is found that the optimized SVR gives minimal RMSE 0.25. The classifiers are applied, and experiment results show that the extreme boost and random forest gives 93.65% accuracy.

scholarly journals Hematological and coagulation profile of dengue infection in age group 1 to 12 years children in a tertiary care hospital

2021 ◽  
Vol 11 (2) ◽  
pp. 341-353
Author(s):  
Suman Sarkar ◽  
Mamta Kumari ◽  
Amrita Roy ◽  
Anirban Chatterjee ◽  
Partha Pratim Pal
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Tertiary Care ◽  
Warning Signs ◽  
World Health ◽  
Infected Mosquito ◽  
Severe Dengue ◽  
Care Hospital ◽  
Coagulation Profile ◽  
D Dimer

Dengue is an arboviral infection of public health problems in tropical and sub-tropical countries transmitted to humans through the bite of an infected mosquito of the Stegomyia family. It varies in severity, ranging from influenza-like self-limiting illness to life- threatening, which if left untreated, are associated with mortality as high as 20%. Find out hematological and coagulation profile in dengue infected children aged 1 to 12 years and association of hematological and coagulation profile with dengue severity. It is an Observational Cross- sectional study done on 100 dengue patients aged 1 to 12 years during the study period from March 2019 –February 2020. Among 100 dengue fever, 85 (85%) were categorized as dengue fever (DF), 11(11%) DF with warning signs and 4 (4%) were cases of severe dengue (DHF/DSS) according to revised World Health Organisation 2009. The most common age of presentation was above 6 years and females were afflicted more with dengue fever.100% dengue patients presented with fever. Persisting vomiting, pain abdomen, hepatomegaly and hypotension indicate progression towards severe dengue. Raised Hb% and PCV, low to normal values of WBC as well as predominantly decrease in platelet was seen in severe dengue cases however, both ESR and CRP were normal. The Liver function test was deranged SGOT>SGPT in almost all of the dengue patients and it was 3 to 4 times maximally in DFW and SD. PT, APTT prolongation, increased D- dimer and hypofibrinogenemia associated with the severity of dengue fever. Dengue is a common viral infection that may have serious consequences especially in children. There is clear difference in pattern of change of both haematological and biochemical parameters in non-severe dengue fever and severe dengue fever. Rising trend of Hb%, PCV, decreasing value of platelet count, raised transaminases (SGOT>SGPT), elevated D- dimer, PT and APTT and hypofibrinogenemia can be used as predictor of entry into critical phase

scholarly journals Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

JMS SKIMS ◽  
2020 ◽  
Vol 23 (3) ◽  
Author(s):  
Sameer Anand ◽  
Owais Ahmed ◽  
Vijay Kundal
Keyword(s):  
Clinical Features ◽  
Rural Areas ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Snake Bite ◽  
World Health ◽  
Major Public Health Problem ◽  
Care Hospital ◽  
Female Ratio ◽  
Snake Bites

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’ Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite. Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite. Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients  were in the age group of 20-39 years  ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia  (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications  observed  were  acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and  ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%)  patients  recovered  and 13 (7.65%) patients  died and out of 130 neurotoxic snake bites, 124 (95.39%) patients  recovered and 6 (4.61%)  patients   died, overall mortality was 6.3%. In our study, bite to needle time  was less than 1 hour in 47 patients (15.66%), less than  6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%). Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.

scholarly journals DRUG UTILIZATION ANALYSIS OF ANTI-SNAKE VENOM AT A TERTIARY CARE CENTER IN CENTRAL MAHARASHTRA: A 3-YEAR RETROSPECTIVE STUDY

2018 ◽  
Vol 11 (8) ◽  
pp. 134
Author(s):  
Ketan Y Asawale ◽  
Mukesh C Mehta ◽  
Pravin S Uike
Keyword(s):  
Snake Venom ◽  
Care Center ◽  
Tertiary Care ◽  
Public Health Problem ◽  
World Health ◽  
Definitive Treatment ◽  
Major Public Health Problem ◽  
Prescribing Pattern ◽  
Bite Marks ◽  
The World

Objectives: In India, snakebite is a major public health problem. Anti-snake venom serum (ASVS) is the definitive treatment for poisonous snakebites. However, the non-availability of effective ASVS to treat the specific types of snakebite envenomation encountered in various regions of the world has become a critical health issue at global level. In the present observational descriptive study, we observed the prescribing pattern and rationality of ASVS and the dosage of ASVS at our hospital and compared them with the standard guidelines in the treatment of snakebite cases with the aim to observe optimum utilization of ASVS.Methods: Data collection of registered cases of snakebite of 3 years from January to December 2012, 2013, and 2014 was carried out between January 2015 and December 2015.Results: A total of 935 cases were studied. ASVS treatment was given to 774 cases of snakebite, out of which 161 had no bite marks and 613 patients had bite marks. Majority (615 [79.45%]) of cases were treated with 1–20 vials of ASVS during total stay at center. Overall, 899 cases were discharged, among them 606 cases were not followed the World Health Organization guidelines. 29 cases succumbed and seven were referred to other center. The mortality observed during the 3 years was 3.10%.Conclusion: We observed individualized treatment for treatment with ASVS, thereby reducing the use of ASVS. Thus, we conclude that individualized approach depending on locally predominant snakes for the treatment of snakebite based on the degree of envenomation is a way by which the scarce ASVS can be used optimally.

scholarly journals Clinical and laboratory profile of dengue fever in children from a tertiary care centre of Gandaki Province, Nepal

2020 ◽  
Vol 13 (2) ◽  
pp. 173-177
Author(s):  
Namrata K.C. ◽  
Krishna Bahadur Thapa ◽  
Nirmala Shrestha ◽  
Shankar Paudel ◽  
Chandra Bahadur Pun
Keyword(s):  
Dengue Fever ◽  
Tertiary Care ◽  
Stable Condition ◽  
Public Health Problem ◽  
Warning Signs ◽  
Severe Dengue ◽  
Warning Sign ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Laboratory Findings

Introduction: Dengue, the arthropod borne viral disease is serious public health problem in Nepal. The clinical diagnosis of dengue has become challenging in children as it is presented with nonspecific symptoms. The objective of present study was to assess different clinical presentations and outcomes of dengue fever in tertiary care centre. Methods: A record based observational cross-sectional study was carried out on all dengue positive patients of aged 11 months to 15 years presented in Gandaki Medical College from July to November 2019. Total 74 patients with history of fever with dengue seropositive were included in the study. All the clinical and haematological findings were recorded in semi-structured questionnaire form. Results: Of 74 patients 40 (54.1%) males and 34 (45.9%) were females. Fiftyone (68.9%) were cases of dengue without warning sign, 18 (24.3%) were dengue with warning signs and 5(6.8%) cases had severe dengue symptoms. Most of the patients (78.38%) were from Kaski district. Fever (100%) was the most common clinical presentation followed by headache (36.5%), vomiting (25.7%), and retro orbital pain (20.3%). Common laboratory findings included thrombocytopenia (59.4%) and leukopenia (35.1%). Among 74 cases, 68 were in stable condition and treated in OPD or in ward, and 6 were admitted in ICU of which one developed warning signs and other 5 had severe dengue. All the enrolled children recovered well and there was no mortality during this period. Conclusions: Fever, headache, vomiting, thrombocytopenia and leukopenia were most common presentation of dengue fever among children. Appropriate clinico-laboratory diagnosis and management is relatively simple, inexpensive and very effective in saving lives as long as correct and timely interventions are instituted.  

scholarly journals Global burden of depression: The intersection of culture and medicine

2003 ◽  
Vol 183 (2) ◽  
pp. 92-94 ◽  
Author(s):  
Jan Scott ◽  
Barbara Dickey
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Significant Proportion ◽  
Public Health Problem ◽  
Indirect Costs ◽  
Unipolar Depression ◽  
World Health ◽  
Major Public Health Problem ◽  
Major Depressive ◽  
The Cost

The statistics about depression clearly identify it as a major public health problem (Greenberg et al, 1993). About 6% of the population meet the criteria for major depressive disorder or dysthymia at any time, and 20% of those with major depressive disorder will have symptoms that persist beyond 2 years (Keller et al, 1992). The disorder is highly recurrent; 30% of individuals experience a relapse within 3 months of recovery and (in the absence of continuation or maintenance treatment) 50% experience a further episode within 2 years. The standardised mortality ratios for unipolar depression for accidental deaths, for deaths by natural causes and for suicide were 1.4, 1.7 and 19.7, respectively (Ustun, 1999). In the National Health Service the cost of treating depression ($887 million) exceeds the cost of treating both hypertension ($439 million) and diabetes ($300 million) (Department of Health, 1996). However, the direct health care costs are dwarfed by the indirect costs (Berndt et al, 2000). Days lost from work owing to depression exceed all other disorders and the economic burden on family members and society is considerable (Broadhead et al, 1990). This may account for 60–85% of the total cost of the illness and represents a significant proportion of the gross national product (Kind & Sorensen, 1993; World Health Organization, 2001).

scholarly journals Prevalence of anemia among pregnant women in rural Koppal: a study from teaching hospital, Koppal, India

2017 ◽  
Vol 6 (9) ◽  
pp. 3792 ◽  
Author(s):  
Seema B. N.
Keyword(s):  
Pregnant Women ◽  
Public Health Problem ◽  
Peripheral Blood Smear ◽  
Poverty Line ◽  
World Health ◽  
Major Public Health Problem ◽  
Severe Anemia ◽  
Mild Anemia ◽  
High Prevalence ◽  
Prevalence Of Anemia

Background: Anemia is the nutritional deficiency disorder and 56% of all women living in developing countries are anaemic according to World Health Organization. India has the highest prevalence of anaemia and 20% of total maternal deaths are due to anemia. To determine the prevalence of anemia and factors influencing its causation among pregnant women.           Methods: This is the study of 1769 pregnant women which was conducted in a rural population of Koppal district, Karnataka, India, from June 2016 to November 2016 i.e. a period of 6 months. This longitudinal prospective observational study was conducted in the district hospital of Koppal. Anemia was classified as per the Indian Council of Medical Research (ICMR) criteria. The diagnosis of anemia was undertaken by peripheral blood smear examination and standard hemoglobin estimation by shale’s method.Results: The average age of pregnant women was 23.5 years, ranging between 18 and 40 years. Most of the women belonged to below poverty line (BPL) families (84.6%) and Hindu religion (98%). Regarding education, 28.9% were illiterates. The mean haemoglobin level was found to be 8.95. Prevalence of anemia was 96.5% among the pregnant females in this region of rural Koppal. Out of these 22.47% had mild anemia, 56.30% had moderate anemia, 14.98% had severe anemia and 2.73% very severe anemia according to ICMR classification of anemia.Conclusions: High prevalence of anemia among pregnant women indicates anemia to be a major public health problem in the rural community and indicates strict implementation of National Nutrition Anemia prophylaxis programme. Factors such as socioeconomic status, education, birth interval, and gravida contribute to this high prevalence.

OP116 Cost-Effectiveness Of Sacubitril/Valsartan In Heart Failure

2017 ◽  
Vol 33 (S1) ◽  
pp. 52-53
Author(s):  
Liang Lin ◽  
Mohamed Ismail Abdul Aziz ◽  
David Bin-Chia Wu ◽  
Kwong Ng
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Public Health Problem ◽  
Cardiovascular Death ◽  
Sensitivity Analyses ◽  
Major Public Health Problem ◽  
Old Patients ◽  
Asian Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
The Cost

INTRODUCTION:Heart failure (HF) is a major public health problem worldwide and in Asia. Sacubitril/valsartan reduces cardiovascular death and hospitalizations for HF. However, decision makers need to determine whether its benefits are worth the additional costs, given the low-cost generic status of current standard of care.METHODS:Using a Markov model, we projected lifetime clinical and economic outcomes of sacubitril/valsartan versus enalapril for 66-year-old patients with HF in Singapore. Key health states included New York Heart Association (NYHA) classes; patients in each state incurred a monthly risk of hospitalization for HF and cardiovascular death. Probabilities of events were based on the PARADIGM-HF trial. The uncertain treatment effect of sacubtril/valsartan in Asian patients was modelled using a hazard ratio (HR) of 1 as upper limit in sensitivity analyses. Utilities were obtained from published literature. Local national epidemiological and cost data were applied. Analyses were conducted from the Singapore healthcare payer's perspective. Both one-way and Probabilistic Sensitivity Analyses (PSA) based on 10,000 Monte Carlo simulations were performed.RESULTS:Compared to enalapril, sacubitril/valsartan was associated with an incremental cost-effectiveness ratio (ICER) of SGD74k (USD52k) per quality-adjusted life year (QALY) gained. The cost-effectiveness of sacubitril/valsartan was highly dependent on its effectiveness in reducing the risk of cardiovascular death. However, this was uncertain, particularly in the Asian subgroup, where results were not statistically significant. In sensitivity analyses using results from Asian patients, the ICERs ranged from SGD41k (USD30k) to SGD1.3 million (USD 0.94 million) per QALY gained. PSA showed the probability of sacubitril/valsartan being cost-effective was below 1 percent, 12 percent and 71 percent at thresholds of SGD20k (USD14k), SGD50k (USD36k) and SGD100k (USD 72k) per QALY gained, respectively.CONCLUSIONS:Given the uncertain ICER, sacubtril/valsartan may not provide good value for money compared to enalapril in reducing cardiovascular morbidity and mortality in patients with HF at the current daily cost. Our study highlights the cost-benefit trade-off that healthcare professionals and patients face when considering HF therapy.

scholarly journals SEANUTS: the nutritional status and dietary intakes of 0.5–12-year-old Thai children

2013 ◽  
Vol 110 (S3) ◽  
pp. S36-S44 ◽  
Author(s):  
Nipa Rojroongwasinkul ◽  
Kallaya Kijboonchoo ◽  
Wanphen Wimonpeerapattana ◽  
Sasiumphai Purttiponthanee ◽  
Uruwan Yamborisut ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin A ◽  
Nutritional Status ◽  
Rural Areas ◽  
Urban Areas ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Rural Children ◽  
Major Public Health Problem ◽  
Serum Retinol

In the present study, we investigated nutritional status and health-related factors in a multistage cluster sample of 3119 Thai urban and rural children aged 0·5–12·9 years. In a subsample, blood samples were collected for the measurement of Hb, transferrin receptor, vitamin A and vitamin D concentrations. The prevalence of stunting and underweight was higher in rural children than in urban children, whereas the wasting rate was similar in both rural and urban areas. Among children aged 3·0–5·9 years, the prevalence of overweight was significantly higher in urban areas than in rural areas and so was the obesity rate in children aged 6·0–12·9 years. Protein intakes of all age groups were relatively high in both the areas. Intakes of Ca, Fe, Zn and vitamin C were significantly higher in urban areas than in rural areas. The prevalence of anaemia in rural areas was twice as high as that in urban areas, particularly in infants and young children. However, the prevalence of Fe-deficiency anaemia was similar in both urban and rural areas. While the prevalence of vitamin A deficiency (by serum retinol cut-off < 0·7 μmol/l) seemed to be very low, vitamin A insufficiency (by serum retinol cut-off < 1·05 μmol/l) was more prevalent (29·4–31·7 %) in both the areas. The prevalence of vitamin D insufficiency ranged between 27·7 and 45·6 % among the children. The present study indicates that the double burden of malnutrition is still a major public health problem in Thailand. Further studies need to explore the associated risk factors for these nutrient deficiencies. Effective strategies and actions are needed to tackle the nutritional problems in Thai children.

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