Browsing by Author "Joshi, DD"
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Publication An Epidemiological Study of Snake Bite Cases in Children of Nepal(Nepal Paediatric Society (JNPS), 2010) Joshi, DDAbstract: Introduction: Snakebite is common in the Terai region of Nepal. Injury and mortality of humans due to Snake envenomation is a serious pubic health problem in Southeast Asia and Nepal. It has been thought that at least 50,000 people in the region die of snake bites (this includes India, Bangladesh and Nepal and Pakistan) per year. There are abundant venomous snakes present in the region. Studies in Nepal have identified 4 species of snake responsible for the majority of fatal bites. These are the Indian cobra (Naja naja), common krait (Bungaris caeruleus) Russell's viper (Viper ressellii) and greenpit viper. The incidence of snakebite varies from 300-500 bites per 100,000 human populations in forested regions to 50-100 bites per 100,000 in Sahara. Objective: To study the epidemiology of snakebite in the endemic regions of the terai, to analyse the morbidity and mortality data of snakebite cases in children for the year 2008. Method: National Zoonoses and Food Hygiene Research Centre (NZFHRC) started collection of secondary and primary information on snakebite cases in children recorded and reported by different media and hospitals, health post in Nepal during the year 2008. The data had been compiled, tabulated and analysed. This is the regular surveillance study carried out on snakes in general and venomous snakebite human cases recorded in Nepal. The team visited in 6 mid, hill districts and 24 terai districts of Nepal. Results: Total snakebite cases in children were 540 during the year 2008. Of which 10 cases were from six mid hill districts and 530 were from 24 terai and inner terai districts of Nepal. Total morbidity was 406 (75.19%) and mortality 134 (24.81%). Seasonal incidence of snakebite cases recorded in Bheri zonal hospital and medical college Banke district. Highest morbidity were recorded during the month of Jestha (May) to Aswin (August). Morbidity 12 (25%) and mortality 3 (20%) were recorded in the month of May/June 2008. Conclusions: Snakebite cases in children and deaths were recorded and reported along with adult cases of snakebite. Total adult cases were 2190 of which children were 540 (24.66%) during the year 2008. This means that about 25% of all cases of snakebites were seen in children every year in the endemic areas of snakes. Mass awareness school education programme about snakebite especially in endemic area of terai and inner districts should be advocated regularly so that parents along with children will take necessary precautions.Publication Comparison of carcass and lingual examination for the diagnosis of porcine cysticercosis in Nepal(Institute of Medicine, 2008) Joshi, DD; Pandey, KR; Doray, P; Bista, PR; Vercruysse, JAbstract Abstract: With the increase in pig production and consumption by smallholder, there have been problems with zoonotic parasitic diseases especially porcine cysticercosis in Nepal. Materials and Methods: This study was conducted among 320 pigs from four different slaughter slabs of Chitwan and Kathmandu valley during June to November 2006. The objectives of this study were to determine prevalence by lingual examination, carcass examination and to identify predilection sites of T. solium cysticercosis in pigs as well as to compare the lingual examination, carcass examination. Result: The prevalence rate of cysticercosis for lingual and carcass examination was 0.63%, 0.94% respectively. The incidence of cysticercosis was not significantly different (P>0.05) between the Chitwan and Kathmandu valley and lingual (P>0.05) and carcass examination (P>0.05). Similarly the incidence of the disease was not significantly (P>0.05) different among the slaughter slabs by lingual (P>0.05) and carcass examination (P>0.05). The common predilection sites of the cysts were skeletal muscle, diaphragm, heart, oesophagus and tongue. The sensitivity, specificity, positive and negative predictive values of Lingual examination, taking carcass examination, as gold standard was 50, 100, 100, 98.99 and 100, 82.65 respectively. Conclusion: Among the animal factor under study breed was found significantly (P<0.05) associated with incidence of cysticercosis while the age and sex were not significant. Keywords: Lingual, porcine cysticercosis, carcass, neuroparasiticPublication Epidemiological Profile of Japanese Encephalitis in Nepal 1996 - 1997(Institute of Medicine, 2000) Joshi, DDAbstract In Nepal, during the past two decades, Japanese Encephalitis (JE) is known to occur mainly in southern terai districts of Nepal, but recently during 1996 and 1997, the Kathmandu valley particularly, the southern part of Lalitpur district first reported outbreak of JE, which was confirmed both serologically and virologically. Epidemiological surveillance study was carried out in all 18 JE endemic terai districts of Nepal during the months of November & December of 1996 and 1997 respectively. Results of epidemiological, entomological and serological investigation are presented, tabulated, analyzed and discussed. There was a total of 1687 cases with 353 deaths (21% Case fatality rate) in 1996 and a total of 1740 cases with 126 deaths (7% CFR) in 1997. All age & sex groups are infected with the disease, but below 15 years children were more prevalent with 21% & 7% CFR in male and 16% and 6% CFR in female children during 1996 and 1997 respectively. Whereas in adults, both male and female showed 23% and 25% CFR respectively. There is a seasonal difference in occuring diseases; the maximum number of cases appeared from June to October, and August was observed as a peak period during both years. It has long been recognised that the feeding behaviour of Culicin mosquitoes is of paramount importance in the epidemiology of mosquito-borne JE pathogens. Host feeding pattern of vector mosquitoes is crucial for the maintenance of the complex natural cycle of JE virus, which includes pigs and birds and sometimes large animals like buffaloes and cattle. The virus is transmitted from pig to pig and bird to pig by Culex species of mosquito. The human beings are only incidental hosts of JE. The role of pigs and ducks as amplifier hosts is well established in Nepal as well as in other southeast Asian countries. Except dog Cx. vishnui was found to feed on man, cattle, buffalo, pig, bird and goat, showing its wide range of feeding. Among them bovids were found to be preferred hosts after pigs and ducks. Pigs and ducks possess a high body temprerature and attract a large number of mosquitoes, thus maintaining the pig-mosquito-pig cycle, duck-mosquito-duck-mosquito-pig cycle. In Nepal, in recent outbreaks of 1996 and 1997, the feeding behaviour of mosquito on bovid in the endemic areas, where there are no pigs and ducks population, has been observed. This means the epidemiological pattern of the disease transmission could be buffalo-mosquito-buffalo and cattle-mosquito-cattle cycle with more contact with humans infection through vectors. JE virus isulation studies in the endemic areas from mosquitoes, animals and diseases human beings are needed to confirm this hypothesis. The prevention and control of JE has been a challenging problem in view of non-availability of effective chaemoprophylaxis against the virus and limitations of immuno-prophylaxis. There have been attempts for effective prevention and control of JE by malathion spraying, directing the control measures against the vectors-Culicine mosquitoes. However, this approach too has its own limitation because the known vectors of JE in Nepal namely Culex species mainly breed in large paddy fields and ponds limiting the effectiveness and feasibility of the larval control. JE virus transmission is from domestic animals and birds as reservoirs because the JE virus in nature is found in pigs, birds and large animals like water buffaloes and cattle. In Nepal pigs and ducks have been found as the main reservoirs of JE virus. In the present senario, the epidemiology of JE has undergone considerable changes over the last two decades. There are no reports of antibodies in 'sentinel' pigs from terai districts of the country. Therefore, seroconversion profile of sentinel pigs and birds with its relation to endemicity pattern of JE in Nepal must be carried out urgently. The human cases of JE have been known to occur between mid June to mid October with peaks in August and September. Therefore, the JE transmission period epidemiologically can be considered as July to October with a peak on September. The present study has revealed that the JE situation in Nepal from 1978 onward showed increasing trend in the incidence of JE from the human population point of view, coverage of geographical area, seasonal occurance, vector bionomics, animal reservoir hosts and environmental and climatic changing effects. Since it is a vector-borne viral zoonotic disease, so far Culicine mosquitoes species viz. Culex tritaeniorhynchus, Cx. vishnui, Cx. pseudovishnui, Cx. gelidus and Cx. fuscocephalus have been incriminated and identified as vectors of JE. The female mosquitoes are known to feed on a wide range of vertebrates including man. Whereas some Culicine species have a restricted host range and distinct feeding preferences. JE is a viral zoonotic disease transmitted by mosquito vector bite and caused by arbovirus (flavivirus) which affects the central nervous system. The virus is maintained in nature in animals reservoirs like pigs, cattle and birds. This disease was first recognised in Japan in 1924 and in the Indian adjoining border of southern terai districts of Nepal, Gorkhpur district of Uttar Pradesh in 1978. Since then the JE has become a major public health problem in all Terai districts of Nepal since 1978. The current epidemiological survey study has revealed that both the ricefields and the ponds situated in every endemic villages are chiefly contributing towards the population density of Culicine mosquitoes. In view of recurrent outbreaks in Terai districts and widespread breeding places of mosquitoes, there is an urgent need to asses the feasibility of suitable vector control measures including antilarval operations and ultra-low volume application of insecticides in all the affected endemic districts. Keywords: amplifier host, chemoprophylaxis, immuno-prophylaxisPublication Epidemiological Survey of the Snakebite Problem in Human in the Terai Region of Nepal, 1996/97(Institute of Medicine, 2000) Joshi, DD; Chapman, David R; Joshi, Yuba RajAbstract In this survey the team visited 13 zonal or district hospitals, veterinary hospitals, and municipalities across the Terai and gathered a variety of informations. Epidemiological data on snakebite incidence was collected for 1996 & 1997 from all these hospitals. Information on treatment protocols for snakebite by medical staff, availability and cost to the patient of ASV, and awareness of the rural populations about first aid treatment for snakebite was gathered. Age & sexwise venomous snakebite cases were recorded in Nepal for the year 1996/1997. The case fatility rate is higher in children: 8% in 1996 and 3% in 1997, than adults: male 3% & female 4%. The 1994 study demonstrated a total of 1917 bites by venomous snakes in the Terai area and a total of 151 deaths, the mortality rate being 8% over a period of 6 years. Morbidity was highest in Mechi, Koshi, Sagarmatha, Bharatpur and Lumbini hospitals respectively. The peak season for snakebite was from June to September, during and following the monsoon, when snakes are most abundant. It has been shown that a breakdown of snakebite morbidity by age and sex for 10 years (1985/86 - 1994/95) from Bharatpur hospital, Chitwan. The case fatality rate exceeded 20% in this district. Mortality and injury to both humans and livestock due to the bites of venomous snakes is a serious public health problem in much of the developing world, and particularly in Southeast Asia where there are abundant venomous snakes (Navy, 1965a). It has been estimated that there are on average 3000 reported human deaths per year from snakebites (Sawai, 1993), and this figure is probably underestimated. Several prior epidemiological studies (Joshi 1982, 1983, 1994) have demonstrated that mortality and morbidity caused by snakebite is a significant problem in the Terai region of Nepal. Studies in neighbouring India have identified 4 species of snake responsible for the majority of fatal bites: the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell's viper (Vipera russellii), and saw-scaled viper (Echis carinatus) (Gaitonde, 1979). The polyvalent anti-snake-venin (ASV) produced in India by the Haffkine Institute and Serum Institute of India, and currently purchased by His Majesty's Government for use in Nepal, is directed against the venom of these four snakes. Recent studies (Joshi et al., 1996) in Nepal suggest that the Indian cobra and common krait are the problem snakes in the Terai region, whilst Russell's viper and the green pit viper (Trimeresurus albolabris) constitute a threat in the hill and mountain forest areas of Nepal. Fear and dislike of snakes often leads to indiscriminate killing of snakes on sight, even though the great majority of snakes are non-venomous. In addition to the ecological impact of decimating snake populations, there are economic impacts to farmers of such actions. It has been suggested that 20 - 50% of India's grain crop is destroyed by rodents (Whitaker, 1975), and snakes constitute one of the most effective natural controls over rodent populations, often multiplying in response to increasing rodent populations. Unfortunately, indiscriminate killing of snakes removes this natural control leading to expanding rodent populations and increased loss or grain and crops. Keywords: Snakebite, NepalPublication Evidence of Visceral Leishmaniasis (Kala-azar) in Nepal 1996 - 1997(Institute of Medicine, 2000) Joshi, DD; Sharma, Minu; Bista, PRAbstract Visceral leishmaniasis (Indian Kala-azar) first appeared in the Eastern Terai parts of Nepal during 1982. Dhanusha and Siraha districts were mostly affected. The present study reviewed epidemic situation with regards to Kala-azar in all 18 endemic districts of Terai for collection of morbidity and mortality statistics from different hospitals, health posts and health centres during 1996 and 1997. The kala-azar cases were tabulated age and sexwise. It has been found that children are more affected than adults, because the CFR in male child was 13% and 11% compared to female, 8% and 13%, during 1996 and 1997 respectively. Whereas CFR in male adults was 4% and in female only 3%. These cases were seen more from April to August. Kathmandu, the capital city of Nepal, which is non-endemic for Kala-azar, has shown signs of sand flies (Phlebotomus sps.). About 100-150 imported cases have been admitted and treated in Infectious Disease Hospital, Teku, Kathmandu during 1996 and 1997. They were infected in endemic districts of Terai before coming to Kathmandu. Sarlahi, Udayapur, Bara, Lahan and Siraha districts recorded 696 cases of Kala-azar with 11% CFR, 1160 cases with 7% CFR and 766 cases with 5% CFR during the year 1995, 1996 and 1997 respectively. At present Aldehyde screening serology test is practised. A sensitive and specific serologic test for accurate diagnosis of leishmania should be made necessary and also for the detection of amastigotes in stained smears of aspirate from enlarged superficial lymph nodes, bone marrow or enlarged spleen. Leishmeniasis, both cutaneous and visceral, are endemic in the Terai districts. All these Terai districts are bordered with the northern districts of Bihar and West Bengal, India. Presumably, its simultaneous resurgence indicated long standing presence of visceral leishmaniasis (Kala-azar) in these areas and became source of infection to Nepal. It is a vector borne parasitic disease and the vectors responsible are Phlebotomus species. Their population density increases in the month of July to September. At present no insecticide spraying is being practised for reducing vector population and controlling Kala-azar in Nepal. P. argentipes, fed on men, dogs, large animals and rodents, is an opportunistic feeder and shows both zoophilic and anthropophlic behaviour. Keywords: Kala-azar, visceral leishmaniasis, Nepal