KERALA

Typhoid endemic in West Kochi

KOCHI MARCH 30. Sayeeda Abdul Rehman of Eeraveli is in the Fort Kochi Government Hospital nursing her grandson Amjad who has contracted typhoid. Amjad's mother is also a victim of the disease. Earlier, another grandchild of Sayeeda was hospitalised with typhoid. There is at least one person or the other in the locality who is down with typhoid throughout the year.

Typhoid has become endemic to West Kochi. At any particular time of the year, there are a few cases of typhoid in the area. Such has been the situation for the last 6-7 years. With the disease continuing to cause some real problems for the health authorities and an irritant to Kochi Corporation and the Kerala Water Authority, many feel that it is likely that very soon businesses will also get affected.

Fish exports from the area and tourism are the major businesses here and both face a threat from the endemic typhoid here. If the authorities do not wake up, there is every possibility that the place may face an embargo on fish exports and tourism to the area be curtailed by international agencies, say observers.

In 1995, there were a total of 450 cases, in 1996 there were only 98. But it increased to 275 cases in 1997 and 446 in 1998 taking the form of an epidemic in 1999 with 1,030 cases. The number of cases came down to 795 in 2000 and in 2001 there were 810 cases.

After campaigns and a drive against the disease, not just by the District Medical Officer, but by various other organisations in the area like a business chamber and medical professionals' association the cases did come down drastically in 2002 to 142. This year till now a total of 60 cases have been reported with 30 in January, 14 in February and 15 cases in March till today.

Water shortage, lack of hygiene and awareness regarding the spread of the bacteria are the basic reasons for this disease becoming endemic to the region. "It is not as if the people do not understand what has to be done, the awareness campaign is simply not being done properly,'' says B. Rajendran, Medical Director of West Side Hospital, where quite a few cases of tyhoid are treated throughout the year.

There are instances in which campaigns taken up by `ayalkootams' have become successful, he adds. It is not enough to just distribute notices. "Women who are more practical about daily routines have to be told personally what should be done and what should be avoided,'' explained Dr. Rajendran.

Suneeta Jalal and Manaf are neighbours who have a severely blocked drain right behind their house. Nobody cleans up this drain, they say. People come and distribute chlorine tablets here but this place is never cleaned up, they add.

Says the District Medical Officer, K.T. Remani, "we make house visits, take awareness classes which have made people more informed.''

Local residents say that there are some activities by Government agencies at times but there is no continuation of any programme. There is no follow up.

The disease transmits through the oral-faecal route and one gets its by taking contaminated food or water.

Another lacuna lies in the treatment of the disease. Points out the former DMO and paediatrician, K. Sivadas, the disease spreads through food handlers - mostly women at home. The bacteria Salmonella typhi resides in the gall bladder of the carriers.

Since the carriers do not show any symptoms of the disease they will continue to transmit the disease even if it is controlled in its epidemic form, said Dr. Sivadas. After a gap of 4-5 years it may again take the form of an epidemic, he added.

According to Dr. Sivadas, the vaccine prescribed today is not just expensive costing Rs. 280 but provides only 80 per cent protection. It also cannot be given to children below 2 years.

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