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In India as per the National vector borne disease control program NVBDCP Essay

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In India, as per the National vector borne disease control program (NVBDCP), nearly 75000 AES cases were reported from 22 states and union territories between 2007 and 2016, with a case fatality ratio of 15% (NVBDCP 2017). The most commonly identified cause of AES in Asia especially in Uttar Pradesh is Japanese encephalitis (JE) virus which accounts for around one quarter to one third of cases. The State of Uttar Pradesh (UP) is highly endemic; since the first report of a JE epidemic in 1978 (Mathur et al.

1982, Rathi et al. 1993) extensive and recurrent outbreaks have been reported from the eastern parts of the State. Climatically State experiences tropical monsoons, weather conditions change significantly as per the location and onset of the season. UP has three broad seasons ” winter from October to February (minimum temperatures of 3″4 °C), summer from March to mid-June (temperatures up to 45 °C), and the rainy season from June to September (85% of average annual rainfall of 99cm and temperatures of 30″45 °C) (www.moef.gov.in). Due to its topography the entire region is prone to annual flooding. Five districts in Eastern UP (Gorakhpur, Kushinagar, Maharajganj, Sant Kabir Nagar and Siddarth Nagar), a region surrounded by embankments and drainage structures, are the most affected by floods. Regular flooding is devastating for the crops, life and property of the farming community, and to a large extent determines their socioeconomic and political lives. (Kumar et. al 2016). Both JE and AES exhibit a higher case frequency among children compared with adults characterized by high case fatality of 20-30% (Kakkar et al. 2013, Mittal and Kushwaha 2014, Ranjan et al. 2014). Approx. 36 % children are thought to die from JE annually (2017 unpublished data), and many more suffer neurological impairment. JE affects the central nervous system and can cause the serious complications and death. The case fatality rate is high and those who survive may suffer from neurological sequelae such as convulsions, episodic headache, autonomic disturbance, abnormal behaviour, mood disorder, Intellectual deficit, paresis, incoordination of movements, limbic hypertonia, speech disorder, cranial nerve palsy, gaze palsy, parkinsoanian features, impaired hearing, etc.( Baruah et al. 2002). The acute case fatality rate is €ј30%, and up to 50% of the survivors develop neurological sequelae that are physical and mental impairment (NVBDCP 2014).Studies of outcome among JE patients report widely varying results, with death in 30-35% and long term neurological impairment in 22″94% (Solomon T, 2008). Children with disabilities can have limited participation in everyday life and social activities. Participation is affected by motor and cognitive function, communication skills, age, gender and environmental factors. Reduced participation has been shown to have a negative impact on quality of life in disabled children. Improving inclusion and participation for people with disabilities is the ultimate aim of the World Health Organization’s Community Based Rehabilitation’ programme.(Le VT et al.2013). Due to 2005 JE outbreak in Gorakhpur and adjoining districts, its vaccination is a priority in eastern UP. In 2006, the Government of India launched a JE vaccination campaign for children from 1 to 15 years of age (Kumari and Joshi 2012). This was followed by immunization of new cohorts as an integral component of the Universal Immunization Programme with single dose of live attenuated JE vaccine (SA”14-14-2) in 11 highly endemic districts of four states (Assam, Karnataka, Uttar Pradesh and West Bengal). Of the 11 districts, 7 (Deoria, Gorakhpur, Kheri, Kushinagar, Maharajganj, Sant Kabir Nagar and Siddharth Nagar) reported coverage of above 70 % of the estimated target (Murhekar et al 2017). This success led to the JE vaccination programme being extended in a phased manner to the other endemic districts. During 2007, an additional seven endemic districts (Bahraich, Balrampur, Basti, Gonda, Raebareli, Saharanpur and Shravasti) were covered. A further 16 districts were included in 2008 and 2009. Sustained high coverage of JE vaccination is clearly required to bring down the disease burden.. Several studies have examined the neurological outcome of JE survivors soon after hospital discharge, but there are few data on long-term outcome in this region. A study done in Lucknow and nearby areas including Basti had shown that JE-AES patients have worst functional outcome as compared to non JE- AES and JE have severe socio-economic impact on poor families (Verma et al 2017). A study was done by P shrivastava et al. 2016 in Gorakhpur to know the status of neurological sequelae and other complications in JE and non JE- AES in the year 2008-2010 by randomly selecting patients from three blocks out of 19 blocks. They concluded that Mental and behavioural problems were more frequently encountered sequel in patients with JE and Non JE- AES.The aim of this study is to provide an overview of the functional and neurological impairment, and reduced social participation experienced by children following JE in the year 2017 in eastern Uttar Pradesh. We also identified a large spectrum of behavioural disturbances and impaired school performance following JE. We co-related the clinical profile of Patients having poor outcome due to JE in comparison to those who get fully recovered post infection. Child and adolescent scale of participation (CASP) was assessed of the children with disabling condition and psychological abnormality. We assessed the outcome of children with JE with the Liverpool outcome score (LOS)( least 6 months after hospital discharge.The main objective of this study is to investigate the outcome of children with Japanese encephalitis and to examine the predictors of outcome by reviewing their medical records and by assessing them with Liverpool outcome score after hospital discharge. In this endemic area of eastern UP this kind of study is required to identify the risk factors associated with a poor outcome among children with JE. Vaccination status of the patients was also recorded to highlights the success of JE vaccination programmes. Almost patients from all the blocks were covered that admitted in the BRD medical college in the year 2017.

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