Introduction: As part of coronavirus disease 2019 (COVID-19) control strategies, entry screening was established at International airports. An assessment of the screening system will inform decision-making for improving entry screening for infectious diseases. Methods: Assessment of entry screening at Thiruvananthapuram international airport done during pre and post-lockdown phases. Observation, interviews, and secondary data analysis were the methods employed. The number of passengers screened, their symptom profile, the yield of screening, actions taken, staff pattern, perceptions, training, and infection control practices assessed. Chi-square test and t test were used for testing significance. Results: Out of the 46139 passengers screened pre-lockdown, 297 (0.64%) had symptoms, 23 (0.05%) were positive in thermal screening. Six (2%) among them tested positive for COVID-19. Out of the 44263 passengers screened post lockdown, from May to July 2020, 671 (1.5%) were symptomatic, and 12 (0.03%) were positive in thermal screening. COVID-19 was confirmed in 45 (6.7 %) patients identified through the screening. With the surge in cases, the proportion of passengers opting for institutional quarantine increased significantly (P<0.001). None of the staff contracted the disease. Infection control practices followed by them were optimal. Conclusion: Though the yield of thermal and symptom screening is low, entry screening is an opportunity to identify travelers at risk of COVID-19 infection. In addition, it helps in raising awareness to ensure quarantine and guides public health authorities in preventing disease spread to the community.

BACKGROUND Dengue fever is a major public health problem in Kerala. Vector control measures practiced at household level is the most cost-effective way of controlling dengue. This study aims to assess environmental measures of vector control practised among households of suspected or confirmed dengue patients in Thiruvananthapuram district of Kerala. METHODS A cross sectional study was done among households of patients diagnosed with dengue fever and reported in Integrated Disease Surveillance Programme (IDSP) in Thiruvananthapuram district from June to December 2018. Investigators interviewed the household members and made direct observations to collect data on vector control practices using a structured questionnaire. RESULTS A total of 108 houses were surveyed. Potential breeding habitats were found in 58 (53.7 %) houses. Aedes larva was found in containers from four (3.7 %) houses. Dry day observance was not regular with only 5 (4.6 %) houses practicing it weekly. Waste management practiced was proper in 47 (43.5 %) houses. Community level pre monsoon preparedness for epidemics was done in the vicinity of 53 (49.1 %) houses and it was found to be a protective factor against presence of breeding habitats in and around houses (p = 0.013). Low education (p = 0.012) and low occupational status (p = 0.017) were found to be significant risk factors. CONCLUSIONS Even during an epidemic, with occurrence of infections in the family, only half of the households are practising adequate vector control methods. Community level interventions and targeted information education campaign will help improve practice of environmental methods of vector control in dengue. KEYWORDS Dengue, Vector Control, Aedes Control, Environmental Methods, Community Interventions

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Background and Objectives: The morbidity and mortality spectrum of the south Indian state of Kerala is dominated by chronic non-communicable diseases, yet febrile illnesses because of neglected tropical diseases and emerging viral infections are often reported. As fever deaths are mostly avoidable, understanding the determinants of mortality is essential for implementing preventive measures. Methods: A case-control study was done during an ongoing dengue outbreak in Thiruvananthapuram district, Kerala during 2017–18. Cases included all fever deaths from the line list of Integrated Disease Surveillance Program (IDSP). Data were obtained from hospital case records and by interviewing patients or care givers. The theoretical model for determinants of mortality was constructed at three levels namely sociodemographic factors, access to health care and health seeking behavior, and clinical determinants. Results: This study confirmed association of mortality with age above 40 years ( P = 0.010, OR = 3.48), being heavy built ( P = 0.029, OR = 13.25), clinical symptoms of breathlessness ( P < 0.001, OR = 24.89), restlessness ( P < 0.001, OR = 97.26), clinical signs of drowsiness ( P = 0.024, OR = 7.97), hypotension ( P < 0.001, OR = 42.22), complications such as ARDS ( P = 0.047, OR = 171.56), and myocarditis ( P = 0.012, OR = 16.59). A low occupation status of semiskilled work or less ( P = 0.012, OR = 0.30), choosing a nearby hospital for treatment ( P = 0.018, OR = 0.48) and shortening the time gap between onset of symptom and final diagnosis ( P = 0.044, OR = 0.72) was found to be protective. Conclusion: Along with biological and clinical factors, distal determinants like social factors, health seeking behavior, and health system factors are associated with fever mortality.

BACKGROUND Dengue Fever is a major contributor to morbidity and mortality among all communicable diseases in Kerala. Delay in seeking care is significantly associated with complications. Understanding health seeking behaviour of persons with risk of infection, helps in improving health care delivery. METHODS A cross sectional study was done among 100 dengue fever patients listed under Integrated Disease Surveillance Programme (IDSP) of Thiruvananthapuram district, Kerala state. Data regarding their health seeking behaviour during the course of the disease was collected using a structured questionnaire. RESULTS Inappropriate health seeking behaviour indicated by delay in seeking care and self medication was found in 22 % (95 % CI; 13.9 - 30.1) of subjects. Mean (SD) of delay in seeking health care was 3.01 (1.3) days. Treatment was initiated from government health facility by 63 % of patients. Primary level health care facility was sought by 61 % patients whereas 30 % opted for a secondary level facility. Proximity of the location of health facility to the patient’s dwelling was the factor influencing choice of treatment facility in 70 % of patients, followed by perceived quality of facility (15 %) and patient perceived competency of the physician (9 %). Male gender (p = 0.03) and educational status less than secondary level (p = 0.008) were significant risk factors for self-medication and delay in seeking health care. CONCLUSIONS Inappropriate health seeking behaviour in patients with suspected Dengue Fever is comparatively less in Kerala. Majority are seeking care from Government facilities and access to health care is influencing health seeking behaviour. Awareness generation in general and specific interventions targeting those with lower education status can further improve health seeking behaviour and reduce complications of dengue. KEYWORDS Health Seeking Behaviour, Dengue Fever, Self-Medication, Delay in Seeking Care, Healthcare Access, Kerala