Editorial 1: Understanding leptospirosis, a disease that surges during the monsoon
Context
Leptospirosis has emerged as an important infectious disease in the world today. It is a potentially fatal zoonotic bacterial disease that tends to have large outbreaks after heavy rain or flooding.
About
- The disease is more prevalent in warm, humid countries and in both urban and rural areas.
- It affects an estimated 1.03 million people every year, killing around 60,000.
- In India, thousands of people are affected by leptospirosis every year.
- However, the numbers at the global and regional levels are not exact because of misdiagnosis (its symptoms mimic those of dengue, malaria, and hepatitis), limited access to reliable diagnostics, lack of awareness among treating physicians, and lack of environmental surveillance.
- Within India, studies have found that leptospirosis is more common in the south, although this could be due to the region’s better healthcare and thus better disease detection.
Causes
- The disease is caused by a bacterium called Leptospira interrogans, or leptospira.
- It is a contagious disease in animals but is occasionally transmitted to humans in certain environmental conditions.
- The carriers of the disease can be either wild or domestic animals, including rodents, cattle, pigs, and dogs.
- The cycle of disease transmission begins with the shedding of leptospira, usually in the urine of infected animals.
Peoples at risk
- Humans become part of the cycle when they come in direct contact with this urine or indirectly, through soil and water that contain leptospira bacteria.
- A person is more likely to contract leptospirosis if they have cuts or abrasions on their skin.
- The disease is also considered an occupational hazard for people working in agricultural settings, with animals, or in sanitary services that bring them into contact with contaminated water.
- Recreational activities in contaminated lakes and rivers are also reported to increase the risk of leptospirosis.
The symptoms
- The severity of a leptospirosis infection ranges from a mild flu-like illness to being life-threatening.
- The infection can affect many organs, reflecting the systemic nature of the disease. This is also why the signs and symptoms of leptospirosis are often mistaken for other diseases.
- In milder cases, patients could experience a sudden onset of fever, chills, and headache – or no symptoms at all.
- But in severe cases, the disease can be characterised by the dysfunction of multiple organs, including the liver, kidneys, lungs, and the brain.
- Animals exhibit a variety of clinical symptoms and indications. In cattle and pigs, the disease can potentially cause reproductive failure, stillbirths, and weak calves or piglets.
The Misconceptions
- The disease has been called “ili jwara” in Kannada and “eli pani” in Malayalam, both meaning “rat fever”.
- This usage has fed the common belief that rats are the sole cause of the disease, which is not true as Leptospirosis has a spectrum of reservoir hosts, including pigs, cattle, water buffaloes, goats, dogs, horses, and sheep.
- Further, seasonal patterns such as the onset of the monsoon can also potentially facilitate the disease’s incidence and transmission.
- Ambient air that is more humid can help the pathogenic leptospira survive longer in the environment, thus increasing the risk of disease exposure in the community.
- The incidence of the disease is also linked to extreme weather events like floods and hurricanes, when people are exposed to contaminated water.
- Similarly, poor waste management, a high density of stray animals, faulty drainage systems, and unhygienic sanitation facilities are major drivers of the disease in urban areas.
- In rural parts, these are contaminated paddy fields, dirty livestock shelters, and poor water-quality and sanitation.
Preventing leptospirosis
- Leptospirosis control can benefit from a ‘One Health’ approach.
- ‘One Health’ is an interdisciplinary approach that recognises the interconnections between the health of humans, animals, plants, and their shared environment.
- People who frequently interact with animals or their urine should exercise particular caution, such as by wearing personal protective equipment like gloves and boots.
- Preventing animals from getting infected is also important to reduce the risk of leptospirosis spreading and to limit farmers’ economic losses.
- This in turn requires sanitary animal-keeping conditions, which is also desirable to improve the animals’ health and to prevent the spread of many diseases.
- Given the spike in leptospirosis during the monsoons, it is best to take precautions, including washing one’s arms and legs with an antiseptic liquid after handling animal waste and after working in water.
Way forward
In sum, with ‘One Health’ in mind, public health professionals must work closely with the animal husbandry department to familiarise people about the dangers of leptospirosis, and create countermeasures that work for the health of both people and animals.
Editoroial 2 : The irrevocable connection between anaemia and maternal health
Context
A study conducted on anaemic pregnant women of low-and middle-income countries has found that there is a strong link between anaemia and postpartum haemorrhage, with the risk of death or near miss very high.
Anaemia and Pregnancy
- Of late anaemia has been in the news in India, what with the government proposing to remove a question on it from the National Family Health Survey (NFHS) and instead do a more elaborate test to determine haemoglobin levels in the blood as part of the Diet and Biomarker (DAB) survey.
- Anaemia has a very strong link with postpartum haemorrhage (excessive vaginal bleeding after delivery), and the risk of death or near miss is very high.
- As per the study, by the WOMAN (World Maternal Antifibrinolytic )-2 trial collaborators, worldwide, more than half a billion women of reproductive age are anaemic.
- Each year, about 70,000 women who give birth die from postpartum haemorrhage, almost all of them in low-and middle-income countries.
Blood loss and shock
- There was clear evidence from the study that lower haemoglobin values had a direct relationship with volume blood loss, and clinical postpartum haemorrhage.
- Anaemia reportedly reduces the oxygen-carrying capacity of blood, and therefore, women with anaemia cannot tolerate the same volume of bleeding as healthy women, and become shocked after a smaller volume blood loss.
- The study also eventually found that a clinical diagnosis of postpartum haemorrhage was highly specific for clinical signs of shock and irrevocably associated with worse maternal function.
Preventing anaemia- Government initiatives
- Health is a State subject and the primary responsibility for strengthening health care services including implementation of national programs lies with the respective State/UT government.
- The Ministry of Health and Family Welfare provides financial and technical support to States/UTs under the National Health Mission.
- In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) strategy with the target to reduce anaemia in the vulnerable age groups such as women, children and adolescents.
- Weekly Iron and Folic Acid Supplementation (WIFS): This Programme is being implemented to meet the challenge of high prevalence and incidence of anaemia amongst adolescent girls and boys.
- Health Management Information System & Mother Child Tracking System: It is being implemented for reporting and tracking the cases of anaemic and severely anaemic pregnant women.
- Universal Screening of Pregnant Women for Anaemia: It is a part of Ante-Natal Care (ANC) and all pregnant women are provided iron and folic acid tablets during their ante-natal visits through the existing network of sub-centres and primary health centres and other health facilities as well as through outreach activities at Village Health & Nutrition Days (VHNDs).
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): It has been launched to focus on conducting special ANC check up on 9th of every month with the help of Medical officers to detect and treat cases of anaemia.
Conclusion
- However, the rising levels of anaemia in the country is a source of concern and mandates that any project to bring down anaemia in the country must be on mission mode.
- Any public outreach programme must be mindful of the cultural, social realities and have a sense of the attitudes of the people they are targeting.
- If these factors are not sewn into a public health programme, the outcomes may be far from what was sought or planned.
