An analysis was undertaken of 3623 post-mortems conducted in the Civil Hospital, Delhi, during 1991, covering 75 per cent of civil police stations and all three railway police stations. The study showed that the death rate was highest in the age group of 30-39 years (29.6%), road traffic accidents being the most common cause (33.9%). In general four times more deaths occurred in males than in females. However, in deaths by burning it was three times higher in females. The attention of all concerned should be drawn to this huge, untimely and tragic loss of lives.

Using senior health professionals as interviewers, a 30-cluster sampling survey was carried out to investigate community perceptions of pilia (the local word for jaundice) in east Delhi (India). Of 416 persons (mostly mothers of children aged < 2 years) interviewed, 339 (81%) were aware of pilia as an illness. Only 322 (77%), 164 (39%), 73 (18%) and 71 (17%) people knew about correct symptoms, dangers, causes and prevention of pilia. Most of the correct responses were related to the faeco-orally transmitted viral hepatitis. Literate respondents were significantly more aware of pilia (chi 2 52.81, P < 0.0001), its symptoms (chi 2 48.88, P < 0.0001), causes (chi 2 39.34, P < 0.0001), dangers (chi 2 19.3, P = 0.0007), and prevention (chi 2 60.8, P < 0.0001). However, age of the respondents had no significant bearing (P > or = 0.05) on the correctness of responses. About 293 (70%) subjects considered pilia as a treatable illness; of them, 193 (66%) and 77 (26%) respectively expressed their preference for the 'modern' and indigenous systems of medicine for its treatment. In contrast, 110 (38%) respondents said that they would prefer faith healers for the treatment of pilia. Although only 31 (7%) persons were aware of a vaccine against pilia (hepatitis B vaccine), virtually all agreed to have their children immunized if such a vaccine were made available. The study underscores the usefulness of pilia in lay-reporting of viral hepatitis and epidemiological studies on jaundice-associated illnesses and the need for educating the community about its causes and prevention to increase people's participation in controlling viral hepatitis and other diseases that mainly manifest as jaundice.

In Rajahmundry town in India, 234 community cases of jaundice were interviewed for risk factors of viral hepatitis B and tested for markers of hepatitis A-E. About 41% and 1.7% of them were positive for anti-HBc and anti-HCV respectively. Of 83 cases who were tested within 3 months of onset of jaundice, 5 (6%), 11 (13.3%), 1 (1.2%), 5 (6%) and 16 (19.3%) were found to have acute viral hepatitis A-E, respectively. The aetiology of the remaining 60% (50/83) of cases of jaundice could not be established. Thirty-one percent (26/83) were already positive for anti-HBc before they developed jaundice. History of therapeutic injections before the onset of jaundice was significantly higher in cases of hepatitis B (P = 0.01) or B-D (P = 0.04) than in cases of hepatitis A and E together. Other potential risk factors of hepatitis B transmission were equally prevalent in two groups. Subsequent studies showed that the majority of injections given were unnecessary (74%, 95% CI 66-82%) and were administered by both qualified and unqualified doctors.

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Cholera is endemic in Delhi and is a highly seasonal disease. Suspected cholera cases are referred to Infectious Diseases Hospital, Delhi. Rectal swabs from 2783 cases were bacteriologically examined during 1992, out of which 1075 were found to be positive for Vibrio cholerae O1 biotype El Tor. First isolation was made on 3 April and the last on 14 December. About 87 per cent isolations were made between May and September, which are summer and monsoon months in Delhi. Detailed epidemiological information was collected for about 198 cases of diarrhoea out of which 103 were confirmed cases of cholera. Half of these cases occurred in children below 10 years of age. The other major group affected was adult females, especially housewives. All the cholera cases occurred in those who were illiterate or educated up to primary level. Important risk factors were: contact with person having similar illness, storage of water in wide-mouthed containers, use of glass or mug to draw water from containers, absence of sanitary latrines and habit of washing hands with water alone after defecation, before cooking and eating food. About 30 percent cases had access to piped water supply which was found safe in Delhi during 1992. The findings suggest that the hygienic practices were more important than contaminated water sources for transmission of cholera in Delhi during the year 1992.