EIACP PC Hub: Kerala
State of Environment and Related Issues

                    Health status is generally measured in terms of mortality indicators like Death rate, Infant mortality rate and expectation of life at birth among others. Mortality indicators shows that health status of Kerala is far advanced and higher than the all India average and is even comparable with developed countries. This outstanding progress of health status is achieved through widespread growth of the three systems of medicine in public, private, co-operative sectors combined with people's health awareness. The basic health indicators of Kerala and India are given in below. Though Kerala has attained better health care indicators, the people are now facing the problem of high morbidity both from communicable and non- communicable diseases.Kerala is having the highest number of health care institutions as per the 1991 census. About 26% of total health care institutions in India are located in Kerala.Basic Health Indicators  2009 , 2011 and 2013. 

                  Kerala has made significant gains in health indices such as high life expectancy, low infant mortality rate, birth rate, and death rate. The State must ensure that these gains are sustained. Besides, the State also needs to address problems of life style diseases (Non Communicable Diseases) like diabetes, hypertension, coronary heart disease, cancer and geriatric problems. Increasing incidences of communicable diseases like chikungunya, dengue, leptospirosis, swine flu are also a major cause of concern. Besides, there are new threats to the health scenario of the State, like mental health problems, suicide, substance abuse and alcoholism, adolescent health issues and rising number of road traffic accidents. The health status of the marginalised communities like adivasis and fishing workers is also poor compared to that of the general population. To tackle these, concerted and committed efforts with proper inter sectoral co-ordination is essential.

• District wise details of health care institution, beds and waste generation are given here         

• The district wise distribution of health care institutions in the state is given here                                                  

                 Health Indicators of Kerala: Comparative figures of major health and demographic indicators at the State and National level are given below:

Nipah Virus Disease Outbreak in Kerala 2018

            The disease surveillance system has been functioning extremely well in Kerala, with a robust mechanism for early recognition of any communicable disease of epidemic potential, with quickest response to control and prevent its spread. This aspect has been proved once again with the recent incident of detection in the Districts of Kozhikode and Malappuram and prompt response to the first ever Nipah virus disease outbreak in the State which started in May 2018. This has been appreciated by various experts in the field of communicable disease surveillance and control, including GoI and World Health Organisation (WHO).

              All contacts of the confirmed/probable cases including the health care providers of various health facilities were listed out, monitored for their health status daily, samples were tested in probable cases, and continuously monitored till they came out of the maximum incubation period. Central surveillance unit and Ministry of Health (MoH) were informed on a daily basis the sequence of events. Expert teams from Delhi, Chennai, Pune and Manipal reached the District for onsite assistance and evaluation of activities. The observations to identify the possible source of infection were on par with the experience on Nipah outbreaks in Malaysia and Bangladesh, as well as north eastern parts of West Bengal, where the prominent reservoir hosts were fruit eating bats.

           The disease was previously reported from Asian countries like Malaysia and Bangladesh from 1998 onwards and also recurrent outbreaks have been reported from parts of West Bengal in India from 2001 onwards. But in South India, this was the first instance, and Kerala’s disease surveillance system could detect the outbreak in shortest possible time. The outbreak response activities undertaken by Kerala’s health system contained the outbreak in a shortest time of 10 days, though we lost 16 very precious lives during the period. The administrative leadership, the political commitment, community’s cooperation and the health systems resilience have contributed to this remarkable outbreak response.

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 emergence of dengue, chikungunya, leptospirosis, malaria, hepatitis, H1N1, in recent years has led to considerable morbidity and mortality. Instances of vector borne diseases like dengue, malaria, Japanese encephalitis, scrub typhus etc. have seen a marked increase in many Districts. Water borne infections like different kinds of diarrhoeal diseases, typhoid and hepatitis are showing persistence in many Districts. Cholera has surfaced in many Districts after few years of relative low incidence. Vaccine preventable diseases like diphtheria and whooping cough are yet to be eliminated despite years of effort.

Dengue:

                   Dengue fever, which surfaced in Kerala as early as 1998, has now become the single largest vector borne disease. Till 2015, the disease was more prevalent in Districts like Thiruvananthapuram, Kollam, Kottayam, Pathanamthitta, Kozhikode and Malappuram. But in 2017, all the Districts reported Dengue in large numbers. Districts located at higher altitudes were having low prevalence, but all others showed high incidence. The main reason for this wide spread distribution is believed to be due to the changes in the environmental factors causing proliferation of the dengue vector-Aedes mosquitoes. These mosquitoes, which in the earlier days seen more in rural settings have now spread to urban areas also.

Leptospirosis:

                 Leptospirosis is another emerging public health challenge faced by the State. Considered as a rare disease in the early 1980’s, it has now spread to all Districts. In 2012-13 a major epidemic of the disease occurred, affecting most of the northern Districts, following which the disease has become endemic in Kerala. The disease is initially a rodent borne infection, spread through urine of the infected rodents, and the consequent contamination of the environment is the factor responsible for the disease. Over the years, the disease has been reported in many domestic animals like cows, dogs, pigs etc. and thus has become an occupational risk for those engaged in agriculture works. 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 are essential for effective control of this disease. Out of the 1098 leptospirosis cases reported in 2015, 43 deaths were reported. The number of cases increased to 1,710 with 35 deaths in 2016. In 2017, a total of 1,408 cases were confirmed resulting in 80 deaths. In 2018, there were 625 cases and 30 deaths reported upto September 2018.

Chikungunya:

Chikungunya is a newcomer among the vector borne infections. This disease believed to have originated in the remote islands in Arabian Sea in 2005-06 spread rapidly over whole of Kerala within the next two years, affecting more than 80 per cent of our population. Fortunately, the disease is fading out, and has resulted in life long immunity for the affected population, a blessing in disguise. The past two years have seen only sporadic cases in Kerala, annual total being less than 200 cases and no deaths. Here again the vector responsible for disease transmission is the Aedes mosquitoes. Since both dengue and chikungunya are transmitted by same mosquito, and also since the same mosquitoes are responsible for transmission of the potential threat of Zika virus disease and Yellow fever, the State should be vigilant in future. In 2014, out of the 139 cases of chikungunya reported, 106 were from Thiruvananthapuram. In 2015, 104 cases were reported and 99 were from Thiruvananthapuram District alone, while it was 90 and 67 respectively in 2016-17. It was 54 and 41 respectively in 2017-18. In 2018-19 (upto September) 37 cases reported in which 33 from Thrissur District. A total of 20,46,455 viral fever cases were reported in Kerala during 2014 and in 2015 it was 19,25,690 cases. It was15,41,441 cases in 2016-17 and rose to 34,17,698 in 2017-18. In 2018-19 (upto September), the number of reported cases are 17,86,250. The details of District-wise patients treated for chikungunya and viral fever during 2017-18 and 2018-19 (upto September) is given below: