Community cases management of malaria in Tripura, India- MSF intervention in response to malaria epidemic

Abstract

Background: Epidemics of hand, foot and mouth disease(HFMD) are elevated every year globally, especially in mainland China. And there is no safe and effective vaccine or antiviral medications available worldwide at present. The disease now deeply affects children's health and presents as an increasing threat to public health.Methods & Materials: A case control study was designed to examine the effect of hospital visit behavior on the outcome of severe hand, foot and mouth disease from January 2011 to December 2014 in Hunan, China. A total of 576 HFMD cases (276 death cases as the case group and 300 survival cases as the control group) were collected from the National Surveillance System. Multi-factorial logistic regression was used to analyze independent associations between hospital visit behavior and death from severe HFMD.Results: The male-to-female ratio was 1.51 : 1 in the death cases and 1.78 : 1 in the survival cases. Over 90.0% of cases are children under 3 years of age. 214(77.5%) and 98(32.7%) of death and survival cases first visited a village level clinic(OR= 9.548, 95% CI: 3.22-35.37). rates of confirmed diagnosis at first visit to hospital among death and survival cases were 22.8% and 68.6% (OR= 0.44, 95% CI: 0.17-0.89). 67(24.3%) of death cases died in village level hospital. Only 6(2.0%) of survival cases discharged from village level hospital (OR= 11.92,. 201(72.9%) and 187(62.4%) of death and survival cases consulted the doctor within three days of symptoms developing(OR= 2.43, 95% CI: 1.06-5.59). 13.5% of death cases didn't have any medical insurance, the rate among survival cases was only 1.7% (OR= 8.36,. Conclusion:Changing some hospital visit behavior of patients may help reduce the mortality from severe HFMD. And health administrative departments should focus on rational allocation of health resources, optimization of health service systems and increase input into village level health institutions.