a report on epidemiological and laboratory investigations of outbreaks of diarrhoea in madhubani district, bihar: implications for control

Research Article
Ragini Mishra*, Navin Mishra and Isha Narang
Acute Diarrhoea, Outbreak,Public health interventions, Epidemiological Survey, Environmental Investigations, Phyline cyclone, Disaster

Acute diarrhoeal illness is very common worldwide and estimated to account for 1.8 million childhood deaths annually, predominantly in developing countries (World Health Organization, 2005). Conservative estimates place the global death toll from diarrhoeal diseases at about two million deaths per year (1.7 - 2.5 million deaths), ranking third among all cases of infectious disease death world-wide. Most of these deaths occur in children under five years of age. Diarrhoea continues to be an important contributor to childhood deaths in India. About 10% of infants and 14% of 1-4 year children die every year due to diarrhoea in India. In Bihar, Acute Diarrhoeal Disease (including Gastroenteritis) constituted 28% of total outbreaks reported & responded in the last two years i.e. 2011& 2012. Around 302 and 272 cases of Acute Diarrhoea were reported in village Arer (PHC:Benipatti) and village Kharra (PHC:Rahika) of Madhubani district in Oct 2013.The objective of the research was to find out the causes of the outbreak, the social and the environmental factors contributing to the outbreak and to suggest remedial measures to control the outbreak. To find out the reasons of the outbreak, discussion with the district authorities, medical and paramedical staffs and physicians who treated the cases was done to know about the clinical presentation of cases, results of laboratory investigations and outcome of cases, interview and clinical examination of some of the cases was done, rapid epidemiological survey by house to house visit and collection of stool, blood and water samples from cases as well as controls who suffered from Acute Diarrhoea for microbiological tests in order to trace the aetiological agent behind the outbreak was also done. In addition, examination of water storage practices, environmental investigation, knowledge, attitude and practices of the community were also analyzed as per pre-planned questionnaire. With all the available evidences, it was concluded that the present outbreaks of diarrhoea were food borne in nature and was a point source outbreak that was caused due to consumption of stale meat consumed during Bakrid in Muslim community and due to consumption of stale food cooked in Durga Puja mela in Hindu community in village Arer. In Kharra village, majority of the Muslim community were affected due to consumption of stale meat. Majority of the affected population belonged to low socio-economic strata (agricultural labour class). As majority of the affected population were illiterates/less educated/aware, they also had poor awareness regarding personal hygiene. Public health interventions to prevent disease outbreaks should focus on sanitation measures for safe water supply, food hygiene, proper sewage systems/disposal of excreta, public health education.