Affiliations: National Expert Committee on Acute Encephalitis
Syndrome, National Vector Borne Disease Control Program, Government of India,
New Delhi, India | Automatic Forecasting Systems, Hatboro, PA, USA
Abstract: Preliminary analysis in 1995 suggested that > 80% deaths (n=1,500) and > 88% (n=1,500) of the complications/sequel of acute
encephalitis syndrome that have no specific treatment (AESn) could have been
prevented by reducing the transport time of patients and providing timely basic
care by improving rural health services. In order to investigate the effect of
preferential strengthening of primary and secondary care hospitals (PSCH)
versus preferential strengthening of tertiary care hospitals (TCH) on case
fatality rate (CFR) of AESn, a record based study of AESn from 1994 to 2011
from Uttar Pradesh state of India (UP) (34,841 cases with 6,962 deaths) and
Nepal (30,670 cases with 3,436 deaths) was done. PSCH were strengthened since
1996, in both cohorts. Recurrent AESn epidemics with high CFR in UP led to
preferential improvement of TCH since 2004. Outcome measure was survival or
death within 6 mo. Time series analysis followed by Chow test showed that there
was a statistically significant increase in CFR of UP at 99.9% confidence
level. Odds ratio of CFR in UP was about 1 until 2003 and then progressively
increased to 26.37 in 2011 at a P value of 0.000. Confounding variables were
excluded. Clinical significance was confirmed. Though strengthening of either
PSCH or TCH decreased the CFR, the former reduced it a greater extent (96.41%)
and the latter to a lesser extent (20.07%). The risk of death decreased with
preferential improvement of PSCH and increased with preferential improvement of
TCH. This study can guide policy decisions of governments.
Keywords: Incidence rate, health policy, primary care, rural health services, tertiary care, Chandipura encephalitis, stroke, epidemic brain attack
