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| Last Updated:: 01/02/2024

Health

Major Health Problems in Kerala

 

Communicable Diseases:

 

               Kerala is witnessing an increasing burden of communicable and non-communicable diseases. Although the State has been successful in controlling a number of communicable diseases earlier, the prevalence of Dengue, Leptospirosis, Malaria, Hepatitis, H1N1, Scrub Typhus and COVID-19 in recent years has led to considerable morbidity and mortality. Instances of vector borne diseases such as dengue, malaria and scrub typhus incidents have been seen in many districts. Water borne infections such as different kinds of diarrhoeal diseases, typhoid and hepatitis are also reported in many districts.

 

Prevalence of Major Communicable Diseases:  A comparative analysis of the prevalence of major communicable diseases is given below:

 

Dengue:

 

                   Dengue fever, which surfaced in Kerala as early as 1998, has now become the single largest vector borne disease in the State. Till 2015, this disease was more prevalent in Thiruvananthapuram, Kollam, Kottayam, Pathanamthitta, Kozhikode and Malappuram. But in 2017, all districts reported dengue and that too in large numbers. Districts located at higher altitudes were having low prevalence, but all others showed high incidence of the disease. These mosquitoes, which in the earlier days were seen more in rural settings, now spread to urban areas also. Details of cases and death from 2018 to 2022 (till August 2022) are given in the table below:

 

Name of Diseases Case

2018

2019

2020

2021

2022 (Aug 31)

Case

Death

Case

Death

Case

Death

Case

Death

Case

Death

Dengue Fever

4090

32

4651

14

2722

22

3251

27

2655

19

Source: Directorate of Health Services

 

 

Leptospirosis:

 

                 Leptospirosis is another public health challenge faced by the State. Considered as a rare disease in early 1980, later spread to all districts. The disease was seen initially as a rodent borne infection, spread through urine of the infected rodents and the consequent contamination of the environment. Over the years, the disease has been reported in many domestic animals such as cows, dogs and pigs and thus has become an occupational risk for those engaged in agriculture. People, who have been involved in cleaning of stagnant canals and drains, were reported to have contracted the disease. More recently the mortality due to leptospirosis is also on the rise and joint efforts of veterinary and animal husbandry departments is essential for effective control of this disease. District-wise number of patients treated and death reported affecting Leptospirosis in 2021-22 and 2022-23 (upto August 2022) and number of cases and death reported from 2018 to 2022 (upto August 31, 2022) are given below:

 

Name of Diseases Case

2018

2019

2020

2021

2022 (Aug 31)

Case

Death

Case

Death

Case

Death

Case

Death

Case

Death

Leptospirosis

2079

99

1211

57

1039

48

1745

97

1522

55

Source: Directorate of Health Services

 

District wise number of Patients treated and death reported –

Leptospirosis 2021 and 2022  (up to August 31)

Sl. No.

District

Leptospirosis

2021

2022

Patients Treated

Death Reported

Patients Treated

Death Reported

1

2

3

4

5

6

1

Thiruvananthapuram

251

9

225

6

2

Kollam

63

5

86

0

3

Pathanamthitta

87

3

132

4

4

Idukki

20

8

23

0

5

Kottayam

202

7

81

1

6

Alappuzha

235

10

210

7

7

Ernakulam

231

16

190

6

8

Thrissur

53

7

85

 

9

9

Palakkad

78

5

51

10

10

Malappuram

124

9

89

4

11

Kozhikode

174

10

67

 

4

12

Wayanad

111

4

203

3

13

Kannur

38

4

34

1

14

Kasaragod

78

0

48

0

STATE

1745

97

1524

55

Source: Directorate of Health Services

 

 

Chikungunya:

 

           Chikungunya is a newcomer among the vector borne infections. This disease is believed to have originated in the remote islands in Arabian Sea in 2005-06 and spread rapidly over whole of Kerala within the next two years, affecting more than 80 per cent of our population. This has resulted in lifelong immunity for the affected population. The past five years have seen no deaths due to chikungunya. But in 2021, 334 cases were reported in Kerala. Here again the vector responsible for disease transmission is the Aedes mosquitoes. Since both dengue and chikungunya are transmitted by the same mosquito and as the same mosquitoes are responsible for transmission of the potential threat of Zika virus disease and Yellow fever, the health system should be vigilant. In 2021, 334 cases were reported in which 315 cases were from Thiruvananthapuram District. In 2022 (upto August 31), 46 cases reported, of which 43 were from Thiruvananthapuram only. The details of District-wise patients treated for chikungunya and death reported in 2021 and 2022 (upto August 31) and number of cases and death reported from 2018 to 2022 (upto August 31) are given in below:

 

Name of Diseases Case

2018

2019

2020

2021

2022 (Aug 31)

Case

Death

Case

Death

Case

Death

Case

Death

Case

Death

Chikungunya

76

0

109

0

558

0

334

0

46

0

Source: Directorate of Health Services

  

District wise Patients treated for Chikungunia during 2021 and 2022

(up to August 31) (Nos.)

Sl. No.

District

Chickungunia

2021

2022 (upto August 31)

Patients Treated

Death Reported

Patients Treated

Death Reported

1

Thiruvananthapuram

315

0

43

0

2

Kollam

0

0

0

0

3

Pathanamthitta

0

0

0

0

4

Alappuzha

0

0

0

0

5

Kottayam

4

0

2

0

6

Idukki

0

0

0

0

7

Ernakulam

3

0

0

0

8

Thrissur

4

0

1

0

9

Palakkad

0

0

0

0

10

Malappuram

0

0

0

0

11

Kozhikode

0

0

0

0

12

Wayanad

0

0

0

0

13

Kannur

1

0

0

0

14

Kasaragod

7

0

0

0

Kerala

334

0

46

0

Source: Directorate of Health Services

 

 

Fever:

 

                Fever is a body temperature that is higher than normal. A number of infections can affect humans. A fever may be a symptom of many infections. A viral fever is a fever caused by an underlying viral illness. Some viral infections may cause a fever like dengue. A total of 1,46,3517 viral fever cases were reported in Kerala in 2021. In 2022 (up to August 31), the number of reported cases were 20, 40,180. The details of District-wise patients treated for viral fever and death reported in 2021 and 2022 (up to August 31)  and number of cases and death reported from 2018 to 2022 (up to August) are summarized in table below:

 

 

District wise Patients treated for Fever during 2021 and 2022 (up to August 31) (Nos.)

Sl. No.

District

Fever

2021

2022 (upto August 31)

Patients Treated

Death reported

Patients Treated

Death Reported

1

Thiruvananthapuram

124136

0

174594

 

2

Kollam

79253

0

97066

1

3

Pathanamthitta

47174

0

46410

1

4

Alappuzha

66754

0

108969

0

5

Kottayam

68897

0

114181

0

6

Idukki

34087

0

53050

0

7

Ernakulam

162264

0

190666

2

8

Thrissur

85773

0

115940

1

9

Palakkad

92435

0

135380

1

10

Malappuram

206645

0

284804

2

11

Kozhikode

150082

0

252874

0

12

Wayanad

59455

0

102455

2

13

Kannur

168058

0

210436

0

14

Kasaragod

118504

0

153355

0

Kerala

1463517

0

2040180

10

Source: Directorate of Health Services

 

Malaria:

 

                 Malaria, a vector borne disease transmitted by Anopheles mosquitoes, has been a major public health challenge for our country for the past many decades. Various national programmes targeting its elimination have met with limited success. Though Kerala had eliminated the disease in early 1970s, Malaria incidents still exist as a public health challenge. The problem has recently aggravated because of the presence of large scale population movement from malaria endemic States. Proportion of falciparum malaria, the more severe form of the disease also exists in Kerala. Though elimination of indigenous form of Malaria has been included in the SDG targets by the State, the issues in its fulfillment are many. Rapid urbanisation, extensive infrastructure development in many districts, uncontrolled construction works in urban area and climate related changes in life cycle of mosquitoes are all big hurdles in the attainment of the SDG goals. Annual cases of malaria in Kerala are less than 500 and the number of deaths reported is also very low. Kasaragod District is persistently having high number of malaria cases, over many years, because of its proximity to the highly endemic districts of Karnataka. Movement of fishermen along the western coast of our State is a potential threat for spread of malaria along the coastal districts. In 2021 number of cases reported was 309 and one death was reported. In 2022, upto August, 208 cases and no death were reported. Number of cases and death from 2018 to 2022 (August 31) is given in the table below. There is a declining trend in number of malaria cases in the State.

 

Name of Diseases

Case

2018

2019

2020

2021

2022(Aug 31)

Case

Death

Case

Death

Case

Death

Case

Death

Case

Death

Malaria

908

0

656

1

267

1

309

1

208

0

Source: Directorate of Health Services

 

Japanese Encephalitis (JE):

 

                 This is a form of encephalitis, an inflammatory disease of brain and its coverings, and is also a mosquito borne infection. Kerala is more prone to this disease because of the presence of large paddy fields as the virus responsible for the disease is spread by Culex mosquitos, which breed abundantly in water logged areas of paddy fields. The peculiar nature of the Culex mosquito to breed in contaminated water increases the potential threat in other areas as well. Role of migratory birds in transmission of JE is an extra risk for Kerala, because our State has many sanctuaries for migratory birds. But since there is an effective vaccine against JE, we can be optimistic in its control programme, by strengthening the JE vaccination. In 2021, no cases and death reported. One case has been reported in 2022 (up to August 31). Details of cases and death from 2018 to August 31, 2022 are given below:

 

Name of Diseases

Case

2018

2019

2020

2021

2022(Aug 31)

Case

Death

Case

Death

Case

Death

Case

Death

Case

Death

Japanese Encephalitis (JE)

5

2

11

2

0

0

0

0

1

0

Source: Directorate of Health Services

 

Water Borne Diseases:

 

                     The main reason for waterborne diseases is attributed to the unavailability of safe drinking water in many parts of the District especially in tribal and coastal areas. Unhygienic drinking water sources such as wells, pump houses, water supplied through tanker lorry, leaks in public water supply pipes and the consequent mixing of foul water with drinking water, dumping of waste including sewage in water sources, use of commercial ice in preparation of cool drinks and using unsafe water in preparation of welcome drinks are some reasons for spread of water borne diseases. Health Department is implementing a programme called “Jagratha” from November 2017 for prevention and control of communicable diseases. There has been a considerable decrease in incidents of typhoid in Kerala since 2015. Details of cases and death due to water borne diseases of Acute Diarrhoeal Diseases (ADD), typhoid and Hepatitis from 2018 to 2022 August 31 are below:

 

 

Prevalence of water borne diseases in Kerala

Name of Diseases

Case

2018

2019

2020

2021

2022(Aug 31)

Case

Death

Case

Death

Case

Death

Case

Death

Case

Death

Hepatitis-A

1369

5

1620

7

464

2

114

0

95

1

Cholera

9

0

9

0

2

0

1

0

0

0

Typhoid

109

0

27

0

16

0

30

0

45

0

ADD (Diarrhoea)

540814

12

544027

6

250788

1

240860

3

318372

0

Source: Directorate of Health Services

 

 

HIV/AIDS:

 

                        Kerala State Aids Control Society is the pioneer organisation in the State working with the objective of controlling the spread of HIV as well as strengthening the State’s capacity to respond to HIV/AIDS. The society was formed to implement National Aids Control Programme in the State. The prevalence rate in the State has declined from 0.21 per cent in 2008-09 to 0.13 in 2010-11 and 0.06 per cent in 2021. The prevalence rate in India in 2021 is 0.21 per cent. In Kerala, the prevalence of HIV/AIDS is 0.41 per cent (4.95 per cent in 2011) among injecting drug users (IDU) which is 6.26 per cent at the National-level. It is 0.23 per cent (0.36 per cent in 2011) among men having sex with men (MSM) which is 2.69 per cent at the National-level and 0.10 per cent (0.73 per cent in 2011) among Female Sex Workers (FSW) which is 1.56 per cent in India in 2017. Among transgender persons, HIV prevalence rate in Kerala is 0.16 per cent which is 3.14 per cent at the National-level. HIV prevalence among migrants in India is 0.51 per cent.

 

(Source: Kerala State Aids Control Society)

 

Coronavirus Disease (COVID-19):


                            The first case of COVID-19 in India was reported in Kerala on January 30, 2020. Kerala adopted a multi-pronged strategy in dealing with the pandemic even before the first COVID-19 confirmed case was reported. In fact, Kerala’s response to COVID-19 started much earlier than March 11, 2020, when the Director General of the World Health Organisation (WHO) characterised COVID-19 as a pandemic. The containment strategies were well in place when the first case was reported.

 

                 The Health Department activated its emergency response mechanism. From the beginning of COVID control activities, the private hospital engagement team was working in close liaison with the District private hospital engagement nodal officers, private hospital managements and Indian Medical Association. Kerala Medical Services Corporation Limited has played the most critical role in the ambulance services by managing the Kaniv-108 ambulances to mobilise the COVID-19 suspects/patients from their houses/exit points to the isolation facilities. During the corona virus outbreak in Kerala, it was decided to provide psycho social support ‘Ottakkalla Oppamundu’ to the persons in quarantine/isolation and their family members. State-level training was conducted exhaustively and elaborately covering all staff working in the health sector. Ward-level teams were active in all Panchayats and are ensuring daily calls and visits to the homes of the elderly. A series of mass media campaigns were conducted for COVID-19 awareness from the beginning of 2020 itself. Health Department launched e-Sanjeevani telemedicine services in Kerala on June 10, 2020. They provided services in a centralised manner and DISHA is the State hub managing the telemedicine activities for the State. The COVID-19 data were made available to public via the GoK dashboard available in the web address www.dashboard.kerala.gov.in. Major highlights of the COVID-19 disease are given below:

 

Major highlights of the COVID-19 disease*

 

Total number of cases confirmed

65,34,596

Total number of cases recovered

64,63,499

Total number of active cases

2351

Total number of death reported

69,782

Source: www.dashboard.kerala.gov.in

*Data from January 1, 2020 to April 8, 2022

  

Non-Communicable Diseases (NCD):

 

                    Common non-communicable diseases causing great threat to a healthy life are diabetes, hypertension, cardio vascular diseases, cancer and lung diseases. Unless interventions are made to prevent and control non-communicable diseases, their burden is likely to increase substantially in future because of ageing population and changes in life style. Considering the high cost of medicines and longer duration of treatment, this constitutes a greater financial burden for low income groups. Rapid urbanisation, drastic lifestyle changes, heavy dependency on alcohol and tobacco, affinity for white collar jobs, unhealthy eating patterns, low priority for physical exertion, high levels of stress in all strata of population are some of the reasons contributing to the prevalence of non-communicable diseases in the State.

 

               Incidents of obesity, hyper lipedemia, heart attack and stroke are also high. Cancer mortality is extremely high among males in Kerala compared to national average. A survey conducted by Achutha Menon Centre for Health Science Studies, Thiruvananthapuram reveals one out of three has hypertension and one out of five has diabetes. The study also revealed that the level of normalcy attained for blood sugar and blood pressure even after early detection and management is significantly low compared to the standards.

 

                   Even though the State has witnessed a steep decrease in the use of tobacco in the Global Adult Tobacco Survey 2016 with the prevalence dipping to 12 per cent from 21 per cent, the increasing consumption of alcohol is affecting the health sector with prevalence rate as high as 44 per cent and age of starting coming down every year. The unhealthy dietary practices and lack of physical exercise in all sections of the population irrespective of the age and economic status has contributed to the rise in lifestyle diseases resulting in 52 per cent of total deaths in the productive age group between 30 and 70 being due to one or other cause of NCD.  
 

Prevalence of Anaemia:

 

             The findings of the NFHS-5 (2019-2021) reveal that there has been an increase in the prevalence of anaemia among women and children compared to NFHS-4, 2015-16. Kerala is the only State to have recorded a prevalence of less than 40 per cent in all targeted age groups. Anaemia Mukt Bharat (AMB) strategy was launched in 2018 with the objective of reducing anaemia prevalence among children, adolescents and women in reproductive age group. Anemia Free Kerala aims to strengthen the existing mechanisms imparted as part of Anemia Mukth Bharth and foster State specific newer strategies for tackling anaemia. Details of Anaemia prevalence in Kerala as per NFHS-5 compared to NFHS-4 is given below:

 

Anaemia prevalence in Kerala as per NFHS-5 compared to NFHS-4

Indicator

NFHS-4

NFHS-5

Children age 6-59 months who are anaemic (<11.0 g/dl) 22 (%) percentage of children in the said age group with a haemoglobin concentration less than 11 g/dL

35.7

39.4

Non-pregnant women age 15-49 years who are anaemic (<12.0 g/dl) 22 (%)

34.7

36.5

Pregnant women age 15-49 years who are anaemic (<11.0 g/dl) (%) percentage of women with a haemoglobin concentration less than 11 g/dL

22.6

31.4

All women age 15-49 years who are anaemic (%)percentage of women with a haemoglobin concentration less than 12 grams per decilitre (g/dL)

34.3

36.3

All women age 15-19 years who are anaemic 22 (%)

37.8

32.5

Men age 15-49 years who are anaemic (<13.0 g/dl) 22 (%)

11.8

17.8

Men age 15-19 years who are anaemic (<13.0 g/dl) 22 (%)

14.3

27.4

Source: National Family Health Survey


Cancer :

 

                   Cancer is a major non communicable disease in Kerala. Apart from Medical Colleges, Regional Cancer Centre, Malabar Cancer Centre and Cochin Cancer Research Centre are the major hospitals in Government sector which offer treatment for cancer patients. Apart from these institutions all the major Government hospitals provide cancer treatment. Delay in early detection, huge treatment cost, minimal treatment centres and lack of awareness contribute to high mortality of the disease.
 

Health Care Institutions:

 

              In  Kerala modern medical services are offered by the Directorate of Health Services (DHS) and the concerned education sector is dealt by the Directorate of Medical Education (DME).

 

Health Care Institutions under DHS:

 

           At present there are 1,286 health institutions with 38,525 beds, 6,550 doctors, 14,373 nursing staff and 7,304 paramedical staff under Health Services Department consisting of 159 (24x7) PHCs, 688 PHC/FHCs, 227 CHCs/Block FHCs, 87 taluk headquarters hospitals, 18 District hospitals, 18 general hospitals, 3 mental health hospitals, 11 women and children hospitals, 3 leprosy hospitals, 18 TB hospitals/clinics, 6 other specialty hospitals and 48 other hospitals. PHCs/FHCs are institutions providing comprehensive primary care services including preventive care and curative care. CHCs/Block FHCs and taluk-level institutions form the basic secondary care institutions. District hospitals, general hospitals and maternity hospitals provide specialty services and some super speciality services. Category-wise major medical institutions and beds in Kerala, details of IP and OP cases, major and minor surgeries conducted DHS during 2021-22 and 2022-23 and medical and paramedical personnel under DHS are given here. Table 1, Table 2 & Table 3.

 

District-wise Distribution of Hospital Beds in Kerala:

 

                District-wise distribution of hospital beds in Kerala is shown below. Thiruvananthapuram and Ernakulam districts have higher number of beds as compared to other districts while Kasaragod, Idukki and Wayanad districts have lesser number of beds. The bed population ratio in Kerala is 1:604 which is 1:668 for modern medicine alone. The average doctor bed ratio in Kerala is 1:4 and 1:5 for modern medicine. Doctor population ratio in Kerala is 1:2634. Population here is estimated population of 2021. The figures are reflecting the status of Government sector only and the figures will be much better if private sector is also included.

 

District-wise Distribution of Hospital Beds in Kerala, 2022

 

 

       Comparative Analysis of Major Communicable Diseases 2009-21

 

 

 

NOROVIRUS INFECTION

 

Health Indicators Definitions  

 Prevalence of principal communicable diseases during 2013-2017(up to October)

⇒ 100 Core Health Indicators 2015

⇒ 100 Core Health Indicators 2018

                                

Source: Economic Review 2011-2022