Sheela Prasad
It is well known that some diseases are endemic in specific regions due to unfavorable physical and social environments. An attempt is made to map the incidence of a few major diseases in AP to highlight the high prevalence vulnerable zones. It needs to be admitted that this map is largely indicative based on piecemeal district level morbidity and mortality data collected from different sources from 1995 to 2005. Minimal changes may have occurred since then.
The spatial pattern of disease incidence in AP shows some disturbing trends (see map). Most of the diseases mapped are communicable diseases as district level data for other diseases is not easy to collect. Also, the data available is only from government health sources and hence does not fully represent the magnitude of disease prevalence in the state. One needs to keep some of these limitations in mind in reading this map.
Malaria followed by TB affects the largest number of people in the state. While malaria is found across the state, endemic malaria zones are associated with the hilly, forested tracts covering Srikakulam, Vizianagaram, Vishakapatnam, Khammam, and Adilabad. These five districts are also endemic to plasmodium falciparum (PF) malaria (brain fever), a more virulent type of malaria with high death rate. These districts including the northern parts of the Godavari districts are characterized by high Adivasi populations and poor health facilities in the ‘Agency’ areas.
Of the other diseases shown on the map, filaria is endemic to the coastal districts with East and West Godavari, Srikakulam, Vizianagaram and Khammam reporting most cases. The earlier pattern of vector borne diseases prevalent in regions of higher rainfall and dense vegetation is changing. Japanese encephalitis and dengue cases in AP are today also found in large numbers in urban pockets (Hyderabad) and the Rayalseema and Telangana districts. Tuberculosis does not reveal any marked spatial preference, is reported across the state, though Prakasam, Adilabad, Anantapur, Khammam and Vizianagaram have a higher incidence. HIV prevalence which is linked to high TB incidence is noted in the coastal districts of Prakasam, East and West Godavari and Guntur. Incidence of leprosy is higher in the interior districts compared to coastal Andhra, with Kurnool, Mahbubnagar, Adilabad, Srikakulam and Vizianagaram reporting most cases.
Water related diseases are a serious health problem in AP through the year and particularly, during the rainy season. Diarrhoea cases are high and reported from all districts, both urban and rural. Gastroenteritis epidemics are common during the monsoon months in Adilabad, Srikakulam, Vizianagaram, Nizamabad, Anantpur and Mahbubnagar. Fluorosis is a major health issue in large parts of the state, with Nalgonda and Mahbubnagar the worst affected. Viral hepatitis/jaundice cases are on the rise with Hyderabad and Ranga Reddy districts showing the largest number.
To summarise, some thoughts:
Communicable diseases continue to pose a major threat to better health in the state.
The spatial pattern of highest communicable disease incidence in AP coincides with the Adivasi /Agency belts which are areas of poor health facilities.
A number of studies on AP inform us that the victims of epidemics and illness are mostly the poor in both urban and rural AP.
Disease burden from diarrhea is high, particularly for children, with AP accounting for about 14% of the diarrhea deaths and 21% of cases in the country.
From the map a tentative listing of districts with highest disease burden: Srikakulam, Adilabad, Vizianagaram, Khammam, Vishakhapatnam.
In AP high disease burden is clearly correlated with districts/regions that are least developed and have poor health care availability.
If the non-communicable diseases are included the disease picture gets further aggravated.
News reports mention high rates of cardiovascular diseases, diabetes and cancers for the state as a whole.
A recent study projects 10% of population in AP as being diabetic.
AP also has 22.6% of the total snake bite cases of the country.
A recent study on Burden of Disease in AP concluded the six major causes of death in both rural and urban AP were: lower respiratory infection; diarrhea; low birth weight; heart disease; accidents; TB.
Most of these causes were linked to lack of nutrition, safe drinking water and sanitation facilities.
The map is based on data from 2005/6. The broad findings suggest a high disease burden from communicable diseases. These diseases account for the highest morbidity rates in the state. Most of them are seasonal and preventable. Their continued high prevalence speaks of the collapse of the public health system in the state. The above findings and the disease map force us to conclude that the disease picture of AP has not changed much in 2013.
The question is,
If communicable diseases continue to contribute to the burden of disease in AP, why are they not covered under Aarogyasri, either when it began in 2006 or even today?
