Rapid assessment of coverage of chemoprophylaxis against Leptospirosis in Post flood situation in Kozhikode District, Kerala, India, 2018

  • Water or foodborne
  • Zoonotic
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Background:
In August 2018, severe floods affected 12 districts of Kerala, displacing more than 800,000 people and exposing a large proportion to contaminated flood water. Considering the threat of leptospirosis outbreaks, health authorities initiated chemo-prophylaxis with doxycycline/azithromycin, targeting individuals exposed to flood or stagnated water. We conducted a rapid assessment to estimate the coverage of doxycycline/azithromycin chemoprophylaxis among flood affected areas of Kozhikode district.

Methods:
We conducted a cross-sectional survey 3 weeks following the floods covering all the 55 flood affected panchayats of Kozhikode district of Kerala state. From each panchayat, thirty points with latitude and longitude were randomly selected using grid sampling and seven households nearest to these points were included in the survey. All the household members were interviewed to collect information about their exposure to flood/stagnant water, receipt of doxycycline/azithromycin chemoprophylaxis and its consumption. The data was collected in the field using a mobile-based application.

Results:
We interviewed 1573 individuals from 396 households (number of households per random point is 56). Of the 1573 individuals interviewed, 152 (9.7%) were exposed to flood/stagnant water and among them 119 were eligible to receive chemoprophylaxis; 58 (51.8%, 95% CI: 29-73.9) of whom consumed doxycycline/azithromycin. Most of the flood affected individuals received chemotherapeutic drug from the district hospital (n=24, 16%) or health workers at the community/ sub-center n=85, 56%) and remaining from community health worker (n=10, 8%). Four (12.1%) of the 33 individuals who developed febrile illness in the post-flood period with history of exposure to flood/stagnant water, were prescribed doxycycline/azithromycin.

Conclusion:
The coverage of doxycycline/azithromycin chemoprophylaxis in Kozhikode was low. We recommended to intensify the chemoprophylaxis coverage of doxycycline/azithromycin and to increase the awareness among health professionals to prescribe doxycycline/azithromycin to patients with febrile illness who had exposure to flood/stagnant water.

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