Health GIS - Enabling Health Spatially

increased urbanization are leading to an explosion of dengue hazards) (El Morjani Zel A et al., 2007). The AHP method has cases in Thailand in what health officials are calling a near- also been used to establish and optimise health case waste crisis situation. At least 14,000 people have been diagnosed management (HCWM) systems (Brent et al., 2007). A map- with DF/DHF in the year 2008 alone and mostly since April based, interactive AHP implementation, which provides a link when the rains started early. DF/DHF is a tropical, mosquito- between a well-understood decision support method and borne viral disease found mostly in the urban areas. In 2007, exploratory geographic visualization (Rinner and Taranu, Chachoengsao province, Thailand alone reported alarming 2006). number of 792 DF/DHF cases. The goal of this paper was to develop a model for DF/DHF risk zonation in Chachoengsao province, Thailand. The Geographers and epidemiologists explain some of the ways essential parameters adopted were location of DF/DHF how the Geographical Information System (GIS) can be affected villages, rainfall (1999-2007), land use, elevation, applied for the prevention and control of this infection. and population density. Dengue, a vector-borne viral disease, generally emerges in certain seasons; therefore, the climate seems to be an 2. STUDY AREA AND METHODS important factor. Another important factor could be the physical setting of the locations where these diseases 2.1 Study area: Chachoengsao province, Thailand frequently occur. Spatial statistics are the most useful tools for describing and analyzing how various geographical events Chachoengsao province is located in central Thailand and was occur (Nakhapakorn and Tripathi, 2005). Spatial analysis has among top most provinces in Thailand in morbidity rate with been employed to evaluate the relationships between 39.68 per 100,000 populations as per Ministry of Public geographical locations and DF/DHF incidences (Lee and Health Thailand in 2005 (Table 1). Therefore, it was selected Wong, 2001). as the study area (Figure 1). It also had reported high incidence rate for last several years. The province has a The integration of an Analytical Hierarchy Process (AHP) population of about 637,665 in 2007 consisting of 11 districts, method with a GIS for solving spatial planning problems has which are Mueang Chachoengsao, Bang Khla, Bang Nam received considerable attention among multidisciplinary Prieo, Bang Pakong, Ban Pho, Khlong Khuean, Phanom planners. The ability of GIS to integrate with AHP has been Sarakham, Plaeng Yao, Ratchasan, Sanam Chai Khet, and Tha demonstrated in several studies related to natural and Takiap. The province is 80 km away from eastern part of environmental management (Pawattana and Tripathi, 2008). Bangkok and covers an area of 5,093.94 km2. The average The decision making process can benefit from the use of temperature is around 34°C in the summer season, 16°C in the Multi-criteria decision-making (MCDM) techniques that can cold season and 26°C in the rainy season (Thai Meteorological be used to facilitate the decision making process by making Department). the process more explicit, rational and efficient. For multi- criteria evaluation, AHP is used to determine the weights of Table 1. Top ten morbidity rate of DF/DHF incidence by each individual criterion. Determination of weights in AHP depends on the pair-wise rank matrix which is developed province in year 2007. based on the experts’ opinion (Tseng et al., 2008). Systematic decision-making analysis can help decision maker to Morbidity rate summarize and judge all information effectively and to define right question and to find out optimum and the most Rank Province (per 100,000 appropriate solution (Thirumalaivasan et al., 2005). An AHP method was applied to derive the weights of parameters populations) because of its simple hierarchical structure, sound mathematical basis, widespread usage, and its ability to 1. Ranong 55.63 measure inconsistency in judgments (Thirumalaivasan et al., 2005 Pawattana and Tripathi, 2008). 2. Chachoengsao 39.68 The potential of GIS to integrate with AHP and other method 3. Saraburi 32.78 has been confirmed in several studies related to site suitability disease outbreaks and natural disasters (Pawattana and 4. Phetburi 31.78 Tripathi, 2008;Vansarochana et al., 2008). A GIS based methodology is proposed to explore the influence of physical- 5. Prachinburi 30.15 environmental factors on dengue incidence in Sukhothai province, Thailand. Information value (IV) method was 6. Ratchaburi 27.51 utilized. The highest IV was obtained for the built up area. This indicated that built up area has the maximum influence 7. Rayong 23.93 on the incidence of dengue (Nakhapakorn and Tripathi, 2005). Multi-criteria evaluation method of weighted linear 8. Bangkok 23.42 combination technique along with GIS is used to determine zones at risk from malaria epidemic in the Central highlands 9. Nakhonphato 23.12 of Madagascar (Rakotomanana et al., 2007). The pair-wise comparison method developed in the context of the AHP with m GIS based methods, has been used to create the first volume of the Atlas which looks at the spatial distribution of 5 natural 10. Lopburi 22.87 hazards (flood, landslide, wine speed, heat, and seismic Source: Ministry of Public Health, Thailand

Figure 1. Factors considered towards DF/DHF analysis in 2.2.1 Model evaluation factors Chachoengsao Province, Thailand 2.2 Methods Many researches has used several factors to analyze the Main objective of the study was to develop a model based on influence of DF/DHF incidence like physical-environmental, Analytical Hierarchy Process (AHP) and multi-criteria land cover types (agricultural, forest, urban, and water approach. A flow chart of the methodology for modeling bodies), location of DF/DHF affected villages, climate factors dengue risk zones is shown in Figure 2. Criteria and indicators (Nakhapakorn and Tripathi, 2005), and population data (Tran were evaluated on GIS using remote sensing data coupled with and Raffy, 2005). Satellite image, environmental and the physical-environment, climate, and demographic factors in epidemiological data were also frequently used (Rotela et al., association with DF/DHF incidence locations. 2007). Therefore, in this research following factors were used to determine dengue risk zones (Figure 1): Figure 2. Flow chart of the methodology Location of DF/DHF affected villages; This data was collected from the Chachoengsao Provincial Public Health Office. The data of DF/DHF cases village wise was obtained for nine years (1999-2007). Buffers were created at a specified distance from the points of disease i.e. village locations to identify the geographic environmental conditions such as land use, water bodies, surrounding village affected by DF/DHF. The buffer distance was considered owing to two factors: flight distance covered during the life span and average distance travelled per day by the Aedes Aegypti mosquito (Nakhapakorn and Tripathi, 2005). The average lifespan of female is about 8-15 days and the female mosquito can fly about 30 to 50 m per day on an average. This indicates that in general female mosquito would move around 240 to 600 m range in their lifetime (Nakhapakorn and Tripathi, 2005; Bohra, 2001). The adults of peri-domestic strains of Aedes Albopictus are both zoophilic and anthropophillic and feed outdoors during the day. Their longevity is comparable with that of Aedes Aegypti, or a little longer. The active maximum dispersal range of Aedes Albopictus females appears to be 400 to 600 m (Gubler and Kuno, 1999). These buffer zones were combined in one group corresponding to the distance from life span, and average distance travelled per day by the Aedes Aegypti mosquito. Therefore, the buffer zones of 600 m interval in five categories were created, which covered 815 villages. Rainfall; Average yearly data of rainfall for the years from 1999 to 2007 were collected from the Department of Meteorology, Thailand. The climate office has reported that it has observed that dengue incidence outbreak coincided with El Nino years. El Nino events in Thailand are actually related with high temperature and also low rainfall (Nakhapakorn and Tripathi, 2005). Thailand experiences rains from May to September and remaining part of the year remains mostly dry. Seasonal fluctuations of dengue were driven by rainfall increases from May to November (Jury, 1999). In all, the temperature in Chachoengsao province was between 26.63°C to 29.98°C in 9 years (1999-2007). Temperature higher than 20°C is the favourable temperature for Aedes Aegypti mosquitoes (WHO, 1997). The average monthly humidity in 9 years (1999-2007) was found to be 72.68%. Land use; Land use layer of 2007 were collected from Land Development Department (LDD) of Thailand. They were classified into many types of crops, forest, rice field, urban/village areas, water bodies and so forth. These were grouped into agricultural, forest, built up, and water bodies areas.

Elevation; Elevation data was collected from Royal Thai assigned to each attribute. The weights of main-criteria are Survey Department. Digital Elevation Model was generated multiplied by the weights of sub-criteria within the same from contour lines with 20 m intervals derived from hierarchical level and summing of the products over all topographic maps (L7018 series). attributes to obtain total scores (Ri) by the following formula; Population density; Total number of population for each Ri  k wk rik districts in year 2007 was collected from Department of Administration, Thailand. Population density data for whole (1) province was found to be of high density at Muaeng Chachoengsao, Bang Khla and Bang Pakong districts Where, wk and rik are vectors of priorities of the main and sub- respectively. criteria, respectively. 2.2.2 The Analytic Hierarchy Process (AHP) Figure 3. Decision tree for determining the main and sub- criteria for DF/DHF risk zonation. The Analytic Hierarchy Process (AHP) is a theory of measurement concerned with deriving dominance priorities 3. RESULTS AND DISCUSSION (relative importance or relative weights) from paired comparisons of homogeneous or clustered heterogeneous 3.1 Model development: Analytical Hierarchy Process decision elements with respect to a common attribute (Saaty, 1980). The AHP, which follows an approach of pair-wise The pair-wise comparison matrices for all criteria along with comparison, provides a way for calibrating a numerical scale, weights were calculated. The pair-wise comparison elements particularly in new areas where measurements and were decided in consultation with an expert and field realities. quantitative comparisons do not exit (Brent et al., 2007). The The advised scores for each element in Saaty’s scale of AHP is based on the empirical findings that the human mind importance were applied in the matrix. The pair-wise has certain difficulties in dealing with many (seven plus or comparison was determined for consistency ratios less than minus two) decision criteria or alternatives simultaneously 0.1. The pair-wise comparison for the main criteria, sub- but, humans are well capable of evaluating two elements at a criteria and weights are depicted in Table 2 for main criteria time. Thus, the pair-wise comparison approach coupled with a and Figure 3 for sub-criteria along with the value of ratio scaling method has been used to uncover the relative consistency index (CI) and consistency ratio (CR). importance among all decision elements in a multiple attribute decision-making environment. This is because of its The first part was a summation of all values in each column of simplicity, accuracy, theoretical robustness, ability to handle the pair-wise comparison matrix. All the values in each both intangible and tangible criteria, ability to account for column were derived by the summation value. In the second group decision-making problems, and capability to directly part, derived by using the normalized pair-wise comparison measure the inconsistency of respondent’s judgements (Saaty, matrix and in the third part, the weights were computed by 1980). The AHP was based on; summing all the values in each row and dividing by the number of main criteria factors. The weights derived from Decomposition; A complex problem is decomposed into a AHP were summed up to one for any main and sub-criteria. hierarchy of interrelated decision elements. A hierarchical They were fractional numbers (Figure 3) and normalized by structure is established to interrelate and chain all decision dividing the lowest weight into one another in the same level, elements of the hierarchy from the top level down (Pawattana so that the lowest weight became one (Table 2). In addition, and Tripathi, 2008). The global objective (DF/DHF risk the weights of criteria were obtained by comparing the criteria zones) was placed at the top of the hierarchical structure. The themselves against one another. lower level of the hierarchical structure consisted of more detailed elements, which interrelated to the criteria in the next Table 2. Pair-wise comparison elements and weights of main higher level. The hierarchical structure for this study is criteriaa. presented in Figure 3. Prioritization; After the hierarchical structure was established, the relative importance of all decision elements was captured and revealed through pair-wise comparison. This method involves pair-wise comparisons to create a ratio matrix. Pair- wise comparisons of the main and sub-criteria within the same hierarchical level are established. The numerical scales as proposed by Saaty ranging from 1 to 9 were used in the pair- wise comparison matrices (Saaty, 1980). Synthesis; To identify DF/DHF risk zonation, a weighted linear combination (WLC) method, which is one of the most often used techniques for tracking spatial multi-attribute decision-making (MADM), was used (Malczewski, 1999; Thirumalaivasan et al., 2005). The method of WLC was use to assess the weightings for factors, and to map the risks in the various zone (Rakotomanana et al., 2007). It is based on the concept of a weighted average. The relative weights are

VB R LU E PD W NW found to be in the buffer zones 600 m around affected village. VB 1 1 2 2 1 0.251 2.00 Regarding climatic factor (rainfall data), the results R 1 1 1 2 1/2 0.194 1.54 established that the amount of rainfall between 1400 to 1700 LU 1/2 1 1 1/2 1/2 0.144 1.15 mm has the highest risk influence and the amount of rainfall E 1/2 1/2 2 1 1/2 0.125 1.00 100 to 400 mm offered lower risk influence. Analysis of land PD 1 2 2 2 1 0.287 2.29 cover types has shown that the highest risk is in built up area. Besides these, the rest of risk influences were in water bodies, aCI = 0.034, CR = 0.031, λmax = 5.137 forest and agriculture areas respectively. Concerning elevation (Remark; W is weights, NW is Normalized weights) data were derived by using spatial analysis tools so as to The degree of inconsistency in the square matrix A was create elevation area for 11 districts. The highest DF/DHF risk needed to determine the acceptability of the weights. The area was found within elevation area less than 100 m interval. processes were described successively. The weighted sum From the DF/DHF risk zones map (Figure 4), it is found that vector was derived by multiplying the weight of the first the very high DF/DHF risk areas were in Mueang criteria by the first column of the original pair-wise Chachoengsao district. Most of the areas of the province fall comparison matrix, and then multiplied by the second weight into low risk zone. As mentioned in the Table 3 summarized by the second column for n criteria. These values were then the DF/DHF incidence. It can be concluded that highest summed over the rows. The column of the consistency vector DF/DHF risk zone of 460 villages (25.10% of the whole was determined by dividing the weighted sum vector by the province) consisted of 825.75 km2 of DF/DHF affected. The weights as derived previously. The average value of the moderately high DF/DHF risk zone of 330 villages (35.96% of the whole province) comprised of DF/DHF area of 413.46  consistency vector was the Lambda max value. The km2. The low DF/DHF risk zone covering 14 villages (0.22% of the whole province) was found to cover 2924.45 km2. The calculation of CI was based on max and n it is noted that high DF/DHF risk zone covered 7 villages (16.56% of the max  n is always true (Saaty, 1980). The values of CI and whole province) comprising of 19.04 km2 area. The very high risk zone covered 8.13 km2 areas with 4 villages (22.17% of CR of the main criteria were 0.034 and 0.031, respectively. The value of CR for the sub-criteria of location of DF/DHF the whole province). affected villages (village buffer), rainfall, land use, elevation, and population density were 0.011, 0.015, 0.012, 0.026, and Accuracy was determined by calculating the intensity of cases 0.008, in that order so all the weights were acceptable. in the areas falling in the predicted influence of DF/DHF. The The normalized weights of the main criteria were multiplied results obtained are summarised in the Table 3. For risk zone, with the normalized weights of the sub-criteria. These values the intensity of DF/DHF incidence (case*1000/area affected were then used in the calculation process by applying the by DF/DHF) in each risk zone was calculated and grouped by attributes of the sub-criteria. All features of the sub-criteria risk zone classes. Largest area related to case density related were combined linearly using Equation 2, which was modified to moderately high risk zone (Table 3). Therefore, moderately form Equation 1, using the spatial analysis tool of ArcGIS to low risk zone had 557.07, the very high was 492.00, the high calculate DF/DHF Risk Zonation Index (DRZI): 367.65, and the low risk was 4.79 km2. But very low risk was fm/oouunndWtaini1ntsheaenadst part of the study area, which is covered with    DRZI  low population (Table 3). Approximately, FVB Ci  FRCi  FLU Ci  FE Ci  FPD Ci (2) 74.69% people lived in very high, high, and moderate high risk classes’ level. The most of the risk zone was found in the Where F is factor weight of village buffer (VB), rainfall (R), district Mueang Chachoengsao comprising of 142,485 or land use (LU), elevation (E), and population density (PD). Ci 22.34% of total population (Department of Administration, is class weight of sub-criteria. The value of DRZI had no 2007). quantitative meaning other than to describe in relative terms the study area. The natural break method (Thirumalaivasan et al., 2005; Pawattana and Tripathi, 2008) in ArcGIS was used to classify the suitable dengue risk zonation of DRZI at each Table 3. AHP-Intensity of DF/DHF incidence range of 6.72 were used as the cut-off levels into very high (43.08 to 49.80), high (36.36 to 43.08), moderate high (29.64 DRZI Affected No. of Case % to 36.36), moderate low (22.92 to 29.64), low (16.20 to cases density 22.92), very low (9.48 to 16.20) as show in Figure 4 and DF/DHF Table 3. area (km2) Furthermore, each multi-factors evaluation in relation to DF/ VH 43.1–49.8 8.13 4 492.00 22.17 DHF cases was analyzed including physical-environment 19.04 7 367.65 16.56 (land cover types and elevation), climatic (rainfall), and H 36.4–43.1 413.46 330 798.14 35.96 MH 29.6–36.4 460 557.07 25.10 825.75 demographic (population density) factors. The results ML 22.9–29.6 demonstrate that the weight of main criteria was shown in L 16.2–22.9 2924.45 14 4.79 0.22 Table 2. It can be concluded that the significant factors were VL 9.5 – 16.2 903.11 000 population density, location of DF/DHF affected village, 5093.94 815 2219.65 100.00 rainfall, land cover types, and elevation respectively. The Total highest DF/DHF incidence was covered under areas population density greater than 2050 per km2 as found in Mueang Chachoengsao. The highest level of DF/DHF was

Figure 4. DF/DHF risks zones, Chachoengsao Province, higher than average (Nakhapakorn and Tripathi, 2005). High Thailand. population density related to highest risk zone as shown in district Mueang Chachoengsao. The risk maps developed by 4. CONCLUSIONS AHP and multi-criteria method can be used by the Ministry of Public Health as a preventive measure to plan and control the Recently the planning for monitoring and controlling dengue DF/DHF outbreak. epidemics has become critical issue. The mixture of AHP method with GIS is a new trend in public health problem and The relationship between DF/DHF incidence and physical- an influential combination to apply for public health monitor environment factors such as land cover types (agriculture, and control. The AHP has been introduced and applied in forest, built up, and water bodies) and elevation, climatic assessing the risk of DF/DHF. AHP has gained wide factor (rainfall), and demographic factor (population density) popularity and acceptance in GIS analysis for its robustness in were of high accuracy. The use of GIS has helped in precise allocating the stable weights. It has been considered that AHP determination of risk areas and in decision-making and a is one of the powerful tools to help individual as well as group preparedness plan can be developed to reduce the incidence in decision makers to convert linguistic assessment to risk zone. Further research needs to be centred on more in quantitative ranks. This can be used as a means of aiding socio-economic factors such as gender, age, income and life multi-criteria choice and is widely used in different types of style. The AHP based approach was used to investigate all problems, such as landslide, environmental impact, and potential location for dengue epidemic. This methodology is decision-making. This investigation has offered some useful general and can also be applied in other applications field such information related to the DF/DHF incidence. The consistency as disease outbreak during natural disasters. The application ratio (CR) was 0.031, which was < 0.1 and found to be of the methodology shows that it works efficiently for acceptable. The AHP approach provided suitable weights, investigating of risk zonation. Moreover, the methodology is which were later used in a weighted linear combination highly flexible regarding the number, types, and expert (WLC) method to created DF/DHF risk zonation in decision criteria to rank all factors. However, the development Chachoengsao province. The zonation map of DF/DHF using of the criteria is based on expert preferences. AHP method was derived. Influence of demographic and spatial factors were synthesized using the total weights of ACKNOWLEDGEMENTS each data and situation of DF/DHF in the whole area was visualized. This method facilitated to find the quantitative We would like to express our sincere gratitude to Naresuan value of DF/DHF indicator in the area clearly. Figure 4 shows University, Thailand for providing financial support to this the map that has been developing in GIS environment and research. We are also extremely grateful to Chachoengsao which represents the result of the AHP and multi-criterion Provincial Public Health Office, Department of approach. Administration, Department of Meteorology, and Ministry of Public Health, Thailand for data and for their support. Analysis of the physical-environment factors such as land cover types (agriculture, forest, built up, and water bodies) REFERNCES and elevation with the DF/DHF incidences could bring out the information that built up areas have highest influence and Bohra, A., 2001. Prediction modeling of dengue risk comprise the highest level of risk zones. 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GEOGRAPHICAL INFORMATION SYSTEM: UNDERSTANDING THE EPIDEMIOLOGY OF JAPANESE ENCEPHALITIS Amarjeet Singh and Dinesh Kumar School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh. E mail :[email protected] 1. INTRODUCTION Shift to alternative crop (e.g., Rice) By common form of viral encephalitis that appears in the form of frequent epidemics of Desire for profit Ecological brain fever throughout Southeast Asia. It affects Crop failure; Imbalance/ disturbance around 50,000 people in Asia annually and is debts regarded as the leading global cause of viral Diminishing encephalitis. Approximately 3 billion people live returns of other in JE endemic regions, with 70 million children crops born in affected countries each year. JE is an arboviral zoonotic disease for which man is an JE vector accidental (dead end) host. Pigs, cattle and birds facilitated as amplifying hosts are involved in its transmission cycle. The principal vector of JE is Farmers Affects Disease Culex tritaeniorhynchus mosquito. Thus, a (Japanese Encephalitis) peculiar set of favorable environmental conditions are required for maintenance of JE Figure 1: Influence of rice cultivation on vector and infection in community e.g., linkage incidence of Japanese Encephalitis disease. of rice cultivation with JE incidence. (Reuban and Gajanana,1997;PATH,2004;WHO ,2006; As rice irrigation requires stagnant water for its Dhillon and Raina,2008, Govt of Indias,2008) growth in initial stages, a good environment is thus created for breeding of mosquitoes vectors Rice cultivation and disease: of JE. Presence of amplifying host (pigs, cattle, Rice is grown under varying eco-systems on a fowl etc.), in the locality creates conditions variety of soils under varying climatic and favorable for JE to become an emerging disease hydrological conditions. It is mainly of four in such areas. types viz., irrigated, rainfed, costal saline, and cold/hills. Irrigated rice provides conducive In Pakistan, the rice area grew until 1993, but environment for mosquito growth because of remained stable over the past 10 years. JE cases stagnant water in rice fields. In rain fed rice there in Pakistan are limited to central deltaic areas. is no standing water in the field after few hours Rice cultivation and incidence of JE has already of cessation of rain. High humidity in coastal shown a significant positive association in areas and low temperature in hills rice do not various countries where an increase (22.0%) in provide a conducive environment for mosquito the rice harvesting area over 40 years was linked breeding. Countries like India, Bhutan, with increase JE problem. Similarly, in Haryana Bangladesh, Sri Lanka, Bangladesh, have having 1,083,00000 hectares of rice harvesting reported substantial increase in the rice-irrigated area, had reported 275 JE cases from year 2003 area in recent past. Shifting by farmers to to 20076. In contrast, rice-irrigated area has cultivation of alternative crop (rice) is influenced decreased in Japan, Australia, and Singapore. by important factors like economy (Fig 1 ) as There have been rare sporadic cases of JE from was seen in states like Haryana and Punjab in Japan in all islands except Hokkaido and rare north India, where rice is not a staple food. case of JE have been reported from Singapore. 1

It has been reported that in many areas of acute encephalitis syndrome (AES) as some Haryana, the farmers have stopped growing cases may be due to bacterial etiology.(Fig 2) sugarcane and have shifted to rice cultivation The reporting units are advised to collect the with desire to earn more profit8. This led to sera/CSF samples for testing and based upon the increase in sugar prices as well as JE cases. laboratory analysis, the positivity of JE is Indian soil is suitably fertile for rice cultivation. declared. Haryana experienced its first outbreak The area occupied under rice in West Bengal is in 1990 and Kerala as recently as 1996. The the highest followed by Uttar Pradesh, Madhya worst ever recorded JE outbreak in India Pradesh, Bihar, Orissa, Andhra Pradesh, Assam, reported from Uttar Pradesh in 1998 and 2005, Punjab, Tamil Nadu, Maharashtra and when 4485 cases with 1413 deaths (CFR 31.5%) Karnataka. These states put together accounts for and 6061 cases and 1500 deaths (CFR 24.7%) about 92 per cent of the total area under rice in respectively recorded from 11 districts of the the country. A positive association between rice state. irrigation area and reported JE cases from these states .Thus, apparently, the problems of In Haryana, the JE problem has now become a increasing incidence of JE is linked with ecology matter of concern for the state health services. and local environment. The factors favorable for First time it gained public health attention when JE sustenance are economy driven as due to the an epidemic of encephalitis occurred in the pricing policy for crops like rice. However, the eastern, paddy growing districts of Haryana state solution to this problem of non-medical origin is between July and November 1990. One hundred sought to be found in health sector. and eighty-two patients with encephalitis were admitted to different hospitals in Haryana and Figure 2: Map of reported JE cases from 330 118 with case (88.0% were children) fatality rate million population of 135 districts of 15 states of of 64.8%. (Prasad etal,1993).Since then regularly India in year 2007. serologically proven cases of JE are being reported from this region. Again, 140 cases were Directorate of National Vector Borne Disease reported in year 2003 from Haryana. There has Control Program (NVBDCP) has been been an increasing trend of case fatality rate in monitoring JE incidence in the country since the state .In view of this, the JE vaccination 1978, and reported 103389 cases and 33729 campaign was started here in 2007.(Puri etal, deaths (Case fatality rate 32.62%) from 1978 to 2007) December 2007 across the country. The annual reported incidence ranges from 1243 to 7500. GIS and Disease control Until 2005, JE cases in the country were reported under suspected JE category. However, after The geographical distribution type of soil and 2006 all suspected JE cases are being recorded as rice cultivating areas will play important role in JE disease prevention and control. The soil study of, atmosphere, and subsurface can be examined by feeding satellite data into a Geographical Inforamtion System (GIS) .It gives researchers the ability to examine the distribution and variation of cultivating areas over period of time. The study carried out in Nadiad taluka, Kheda district, Gujarat for the application of Remote Sensing and GIS in a village-wise analysis of receptivity and vulnerability to malaria found that malaria annual parasite incidence (API) relationship with water table followed by soil type, irrigation and water quality (Sharma and Srivastava 1997). Based on GIS analysis location specific malaria control strategy was suggested to achieve cost effective control of malaria on a sustainable basis. As in malaria control mosquito density can be studied and mapping of Culex mosquito will 2

help in describing the JE outbreak prone areas. linked to computer-aided analysis of remotely Working with two variables over time will allow sensed data to map potential ephemeral researchers to detect regional differences in the freshwater breeding sites of Culex annulirostris. lag between a usage of land for rice cultivation Also the use of color infrared aerial photography and its effect on JE disease distribution. Together is used to identify the specific parts of the salt with cartography, remote sensing, global marsh in which larvae and eggs of Aedes vigilax positioning systems, and geography, the GIS are found. Mapping was done to identify the have evolved into a discipline with its own mosquito breeding sites and as an aid to planning research base which can be utilized by the modification (Dale etal 1998) . The technique is epidemiologists. being used for other diseases as a survey strategy to provide key data on the population dynamics A study from Kenya aimed to determine whether of Anopheles arabiensis in Sudan. Quantitative Remotely Sensed (RS) data could be used to estimates of the contributions of various habitat identify rice-related Culex quinquefasciatus types and their proximity to settlements provide breeding habitats in three rice-villages within the a basis for planning a strategy for reducing Mwea Rice Scheme. It was concluded that the malaria risk by elimination of the vector optical RS can identify rice cultivation population. (Ageep etal 2009 ) associated with high Culex oviposition. The regions of higher Culex abundance based on Data and analysis results can be displayed using oviposition surveillance sites reflect underlying a novel visualization environment, which differences in abundance of larval habitats which supports multiple views including GIS, timeline, is where limited control resources could be and periodical patterns. BioPortal as a web-based concentrated to reduce vector larval abundance system for real-time information sharing helps to (Jacob etal,1996). make available a set of advanced space-time cluster analysis techniques, including scan Geographical Inforamtion System (GIS) as statistic-based methods and machine learning- technology will help analyze large datasets, based clustering methods. These techniques are allowing a better understanding of terrestrial aimed at identifying local clusters of disease processes and human activities to improve cases in relation to the background risk. economic vitality and environmental quality Environmental studies, geography, geology, Another study from India showed that the GIS public health planning for disease control and based information management system using management. GIS and Remote Sensing (RS) district and block wise malaria data for quick technologies are being used increasingly to study retrieval of information and dynamic generation the spatial and temporal patterns of diseases. of maps to highlight hot spots of malaria for They can be used to complement conventional formulating prompt and focused malaria control ecological monitoring and modeling techniques, strategy. Data showed out of total 48 districts and provide a means to portray complex consisting of 313 blocks, based on certain relationships in the ecology of diseases with criteria GIS identified 58 blocks falling in 25 strong environmental determinants. In particular, districts as Hot Spots. It was further suggested to satellite technology has been extraordinarily and implemented by state health authorities that improved during recent years, providing new focused malaria control in these hot pockets may parameters useful to understand the be taken up on priority during next year epidemiology of parasites, such as vegetation (Srivastava etal 2009). GIS as a technology also indices, land surface temperatures, soil moisture helped in other diseases like Hepatitis A, and rainfall indices. HIV/AIDS, and conditions like water and sanitation metals in soil in order to develop data A study from Australia showed that the vectors set and based upon that develop specific strategy Aedes vigilax and Culex annulirostris, are as a control measure. For JE control the mapping vectors of human arbovirus diseases such as of rice cultivating areas can be done by using Ross River and Barmah Forest virus disease. GIS based system (Cheng etal 2009). Vector Culex annulirostris is also implicated in the mapping in rice cultivated areas for the risk transmission of Japanese Encephalitis. Simple mapping for epidemic forecasting and planning risk model was applied to data for the city of of JE control activities. Brisbane in southeast Queensland. This is then 3

2. CONCLUSION serological evidence of Japanese encephalitis in a few patients. Indian Vaccination should not be looked as an only Pediatr;30(7):905-10. strategy for disease prevention and control. 8. Puri S, Bhatia V, Singh AJ, Swami HM, Other cost effective strategies like GIS and RS Kaur A. 2007,Uptake of newer vaccines can provide alternative solutions in long term. in Chandigarh. Indian Pediatr;74:47-50. Their role in risk mapping of disease based upon vector density, type of soil etc. is already proved 9. Sharma VP, Srivastava A. 1997,Role of in communicable diseases. Epidemiologists and geographic information system in health planners are adopting new remote sensing malaria control.  Indian J Med Res. techniques to study a variety of vector-borne Aug;106:198-204. diseases. Associations between satellite-derived environmental variables such as temperature, 10. Jacob BG, Shililu J, Muturi EJ, humidity, and land cover type and vector density Mwangangi JM, Muriu SM, Funes J are used to identify and characterize vector etal. 2006,Spatially targeting Culex habitats. In recent years, landscape epidemiology quinquefasciatus aquatic habitats on has used satellite remote sensing and geographic modified land cover for implementing information systems as the technology capable of an Integrated Vector Management providing, from local to global scales, spatial and (IVM) program in three villages within temporal climatic patterns that may influence the the Mwea Rice Scheme, Kenya. Int J intensity of a vector-borne disease and predicts Health Geogr. 9;5:18. risk conditions associated with an epidemic. Prioritization of an area based upon GIS and 11. Dale PE, Ritchie SA, Territo BM, further initiation of vaccination drive and Morris CD, Muhar A, Kay BH 1998 , integrated vector management would help us to An overview of remote sensing and GIS make strategies more cost effective than the for surveillance of mosquito vector present. habitats and risk assessment. J Vector Ecol. 23(1):54-61. References: 12. Ageep TB, Cox J, Hassan MM, Knols 1. Japanese Encephalitis in India. 2004, BG, Benedict MQ, Malcolm CA, Babiker A, El Sayed BB. 2009,Spatial History and recent Developments. and temporal distribution of the malaria mosquito Anopheles arabiensis in PATH. northern Sudan: influence of environmental factors and implications 2. Dhillon GPS, Raina for vector control. Malar J.;8(1):123. VK.2008,Epidemiology of Japanese 13. Srivastava A, Nagpal BN, Joshi PL, Paliwal JC, Dash AP, 2009. Encephalitis in context with Indian Identification of malaria hot spots for focused intervention in tribal state of scenario. Journal of Indian Medical India: a GIS based approach. Int J Health Geogr. 20;8:30. Association; 106: 660-3 14. Cheng Q, Huang JF, Wang RC. 2004, 3. Annual Report. Ministry of Health and Assessment of rice fields by GIS/GPS- Family Welfare,2008, Government of supported classification of MODIS data. India, New Delhi 2007-08. J Zhejiang Univ Sci. ;5(4):412-7. 4. Weekly Epidemiological Record. 4 2006,World Health Organization.; 81, 325–40. 5. Reuben R, Gajanana A. 1997,Japanese encephalitis in India. Indian J Pediatr. 64:243-25. 6. http://www.fao.org/waicent/portal/ statistics en.asp Accessed on 7/1/2009. 7. Prasad SR, Kumar V, Marwaha RK, Batra KL, Rath RK, Pal SR.1993,An epidemic of encephalitis in Haryana:

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Spatial Analysis of 5-Year Typhoid Incidence in Kelantan, Malaysia Abstract Shamsul Azhar Shah Kelantan is one of the most affected states by typhoid diseases in Malaysia. Mohd Rohaizat Hassan Determining the high-risk area and clusters of typhoid cases are important part of its control. The objectives of this study are to identify and described the spatial Shaharudin Idrus and distribution and epidemiology of typhoid in four selected districts. Total number of Abdul Hadi Harman Shah. 1227 confirmed cases taken from four main districts with the highest number of cases from 2003-2007. Total of 1215(99%) of the cases were coordinated with GPS successfully. Spatial analysis was performed to determine the cluster and high-risk area of typhoid. Typhoid is not associated with race and sex. Most affected are form the age group of 5-14 followed by 15-24 year old. Typhoid has shown a significant tendency to cluster with the nearest neighbourhood ‘r’ values < 1. Total of 22 hotspots were found in Kota Bharu, Bachok and Tumpat with a few subdistricts identified as high risk for typhoid in Kota Bharu (Panji, Kota Bharu, Kubang Kerian, Badang, Kota, and Banggu), Bachok (Bekelam, Gunong), and Tumpat (Jal Besar, Kebakat, and Wakaf Bharu). The incidence among children was not related to their house as the main source as it was associated and clustered with adult groups. This study has successfully shown the clusters in the high risk areas for typhoid by using the spatial analysis.

The Knowledge and Attitude of Students of the Azad University of Saveh about AIDS and Challenges in Iran Abstract Esmael Shariat It has been estimated that 65 million people were living with HIV at the end of the and Ali Akbar Nazari year 2008, with young people being the group most affected and women being the [email protected] more vulnerable. Many infected people do not know that they are carriers and [email protected] millions of people have low knowledge of HIV/AIDS or do not know how to protect themselves against infection .There were 7.2 million people living with HIV in South-East Asia in 2002, and the first mode of transmission was through sexual contact and the second through intravenous (IV) drug abuse. In the Islamic Republic of Iran, it has been estimated that about 88 000 people are living with HIV. About 18000 cases are recognized, of whom 95.6% are men and 4.4% are women, and 66% are IV drug addicts. One study at a prison revealed that many inmates knew the modes of AIDS transmission, but 85% of them were IV drug users and 43% of addicts were using shared syringes [10]. In another prison, there were high rates of history of drug and alcohol use among prisoners [11]. Education on HIV/AIDS and its means of prevention is thus essential among such groups in order to control the disease. This research is a descriptive – analytic study. The aim was to investigate assess nurses knowledge and attitude student about AIDS. The samples included 600 students in different course that selected by cluster random sampling. Instrument was the questionnaire that includes three parts: 1- Students demographic data with 9 questions. 2- Student’s Knowledge about AIDS with 23 questions and 3- Student’s Attitude about AIDS with 26 questions. Data were analyzed statistically by both descriptive and inferential methods using SPSS Ver.11.5. The most of the research participants (68/8) have medium range knowledge and the least research participant (14/9) were in higher level of knowledge about AIDS. The most of the research participants (63/1) have low range knowledge and the least research participant(12/2) were in higher level of knowledge about AIDS. There were significant relationship between student’s knowledge and Student’s Attitude about AIDS But there were a significant relationship between nurses pain control post CABG knowledge and patient satisfaction (r=0.209 , p=0.037). According to the finding of study, between some of nurses demographic and pain knowledge and pain control post CABG knowledge were significant relation .also between patient satisfaction and some of demographic characterize were significant relation.

Technical Session - 3 Healthcare Planning and Management-1 Unplanned Urbanization, Emerging Environmental Perils and the need for Information Technology to Mitigate Resulting Health Hazards Faced by the Urban Population: A Third World Perspective Ankur Das……………………………………………………………………………….……………………52 GIS Based Public Health Information System in Punjab (India) Rajesh Bansal, L. N. Sharma, Sunil Kumar and Siby John………………………………………………..58 GIS Based Environment Data Management System for Public Health Guggilla Chanti, Srikanth Tangedipalli and Bommidi Raghasudha……………………………..……..…62 Environment Assessment for Health Management through Spatial Technology - A Case Study from India M. Govindaraju, V. R. Muthukumaran, P. Visvanathan, R. S. Ganeshkumar and M. Sivasankari………65 Adding Spatial and Temporal Dimensions to the Healthcare Srikrishna Pothukuchi………………………………………………………………………………………..69 Business Intelligence in Healthcare Jayakanth Dornadula and Sourabh Sarupria……………………………..…………………………………74 Integrating GIS in Health Care Planning: Government Initiatives in Orissa State of India G. Mathivathanan and Mithun Karmakar……………..…………………………………………….……75

UNPLANNED URBANIZATION, EMERGING ENVIRONMENTAL PERILS AND THE NEED FOR INFORMATION TECHNOLOGY TO MITIGATE RESULTING HEALTH HAZARDS FACED BY THE URBAN POPULATION: A THIRD WORLD PERSPECTIVE Ankur Das Graduate Student, School of Planning, DAAP, University of Cincinnati [email protected], [email protected] ABSTRACT: In the city of Guwahati in Northeast India, the pace of urbanization has brought along with it many perils. Rapid and unregulated urbanization has had a serious impact on the environment. And issues that were earlier nowhere in the horizon have crept up within the last decade in a manner where their impact is felt across all sections of the population. One of the problems that require immediate attention is the rising incidence of artificial floods within the city. The present paper will study the issue of artificial floods and their impact on the health of the affected population. The paper will try to understand the causes behind the emergence of this problem and whether sufficient technology has been applied, if not, how by their adoption, health hazards facing the city’s population due to this environmental problem can be managed and reduced considerably. KEY WORDS: Unregulated urbanization, Environmental problem, Artificial flooding, Public health 1. INTRODUCTION natural population increase. The second factor is minimal when compared to the rural-urban migration 1.1 Guwahati: The hub of the northeast levels. With the declining health of the traditional rural agricultural economy, the number of migrants coming Guwahati is the capital city of the state of Assam to Guwahati for employment opportunities has grown and has the distinction of being the only metropolitan tremendously and this has primarily contributed to the city in the whole of northeastern India. In the present expansion of the city limits. In Guwahati, the process day, the state of Assam comprises the fertile valley of urbanization has been crude, as the phenomenon has region of the Brahmaputra plain. The river not been accompanied by suitable city planning and Brahmaputra flows right through the capital city of regulation. Presently, Guwahati has taken the form of a Guwahati dividing the city into the north and south congested city with a host of environmental problems. banks. 2. ENVIRONMENTAL FALLOUT 1.2 Emergent Urbanization 2.1 Artificial Flooding & Water Logging Urbanization in the region and in Guwahati in particular, is a very recent phenomenon. Like other A major environmental problem that the city’s recently urbanized cities of the developing world, population is facing on an annual basis is an acute Guwahati is now faced with unprecedented population artificial flood and water-logging problem during the growth absorbing much of the urban population growth monsoons every year. This flooding problem is a of the entire northeast region. The Census of 1971 and recent phenomenon and has got exacerbated in the last 2001 state the count of the population in Guwahati to five years. This is a direct impact of urbanization in the be 1.46 and 8.1 lakhs respectively.1 The figures city. A principal reason for the occurrence of these indicate a five-fold growth within a span of 3 decades. artificial floods is that the natural drainage of the city The population has been projected to be above 1.75 has been hampered with, primarily due to million by 2021.2 In case of the city of Guwahati, the encroachment for human habitation. There previously factors that have brought about the rapid urbanization existed natural wetlands and water bodies with natural is primarily the rural-urban migration followed by drains connecting them around the city, which used to take care of the excess water during the rainy season. 1 Statistical data from Kar and Begum 2006 But these areas are increasingly being encroached 2 Statistical data from City Development Plan Guwahati through unrestrained construction in the name of urban (GMDA 2006). development. “One of the problems of the city is the 1

artificial flooding due to accumulation of rainwater. Guwahati city, as per Census 2001, was 8.09 lakhs and The topography of the city is such that the drainage the 1991-2001 decadal growth rate was 38.6 %. The system based on gravity flow along natural gradient is population has been projected to grow to 1.19 million not effective enough as water level of the Brahmaputra by 2011 and to 1.75 million by 2021’ (GMDA 2006). flowing by the city in which the city's water falls The increasing population pressure on the city is fluctuates” (The Hindu 2005). The river Brahmaputra clearly manifested by the high decadal growth of is the main destination of the city’s waste including 38.6% from 1991 to 2001. The increasing population sewer in addition to the rainwater. Due to siltation in has contributed to the increase of temporary structures the river the water level of the river has been rising for mainly in the hills and the increase in the number of the past several years. This assumes a more serious fringe villages whose figures were considerably high outlook during the monsoon season when the excess when measured in 1990. Due to this increased rainwater needs to be evacuated from the city. settlement in the hills, there has been extensive human intervention through illegal earth cutting and 2.2 The Causes deforestation resulting in loss of green cover. Due to this, we have had increasing incidences of soil erosion Floods per se have always constituted a severe and killer landslides and mudslides in the surrounding natural hazard, more so in the Ganga-Brahmaputra hills resulting in loss of human lives and property. Due basins. Guwahati, similar to many parts of northeast to soil erosion, we are faced with siltation and clogging India is subjected to intense rainfall during the of rivulets and drainage systems. This has given way to monsoon season. Although the floodplains of the artificial floods and water logging within the city and northeast have always been susceptible to floods, also in the fringe semi-urban areas. Due to the loss of Guwahati did not experience flooding within its city green cover and consequent soil erosion, the city is limits at the magnitude and scale that has been seen to also experiencing adverse climatic changes like dust be taking place for over one and a half decade. In the storms and air pollution due to which the health of the urban sphere, flooding is more an effect of urban population is increasingly at risk. anthropogenic factors than others factors. From the perspective of meteorological factors, even during a It is worth mentioning that the Deepor beel*, a normal monsoon year, some parts of the country such wetland of international importance, which lies in an as the northeastern states receive more rainfall than abandoned channel of river Brahmaputra, situated others. Exceptionally heavy to heavy rainfall during southwest of Guwahati city is the only major storm the monsoon season is generally associated with water storage basin for the city. But Deepor beel is monsoon depressions and cyclonic storms originating presently facing major threats due to large-scale over the Bay of Bengal (Kale 2003). Meteorological encroachment within the beel area and industrial causes have a high imprint on Guwahati by virtue of its development within the periphery of the beel geographical location on the floodplain of river (Goswami 2005). The natural channels that used to Brahmaputra. The din of artificial flooding in carry the storm water to the Deepor beel from within Guwahati city is more attributed to anthropogenic the city no longer perform their functions due to causes than to any other. Unregulated urbanization encroachment and human interventions along these compounded by population pressure has severely channels. impacted the city’s capacity to provide its inhabitants with a decent urban living. There is an overwhelming *beel is a freshwater body conformity among scientists, environmentalists and the local people to attribute ‘such emerging environmental 3. IMPACTS problems to changes in landuse, large-scale deforestation in the catchment areas and building 3.1 Threat to public health activity in the floodplains’ (CSE 1991, Chaphekar et al., 1985). The impact of artificial flooding in Guwahati city permeates in all dimensions. Displacement of the Artificial floods and water logging has been one of affected population is the immediate impact of this the direct outcomes of the pressure exerted by the environmental problem. Due to the temporal increase growing population on the city’s topography. Out of in water levels, people are forced to evacuate their the total area of 216 sq kms of the city, hills account homes and places of business operations and move to for an area of 71.17 sq kms, which is considerable. higher grounds (See Figure 1). This causes a severe ‘The forest cover of the City in 1990 was 13.60 % with disruption of daily urban life and several man-hours of total number of hills in the City being 18, with the total work time are lost. Physical damage to private and number of households in the hills estimated at 26,985 public property due to the flooding adds to the with permanent structures (8,681 nos), semi-permanent economic loss. There have also been numerous structures (7,510 nos), and temporary structures instances of human casualty as people have lost their (10,794 nos); along with 75 number of fringe villages lives due to the landslides and mudslides in the hilly on the hills’ (Dept of Forests 2005). ‘The population of settlements. In an unfortunate incident a couple of years back, a lady lost her life when returning home 2

while it was showering heavily. She fell into an open where farming and livestock rearing is still practiced, manhole, which she could not decipher as it was by the destruction of the harvest thereby reducing local camouflaged by the rising floodwaters. Incidents food production. Due to the increased incidences of similar to this are frequently on the rise which is flooding, the city’s population is greatly faced with worrisome. economic hardships on account of the escalating rebuilding costs involved from property damage every Figure 1: Evacuation operation by the army year. The citizens also have to bear the brunt of Source: http://images.google.com temporary food shortages as the prices of essential commodities escalate. A recent newspaper report Livestock is also affected as they drown in the stated – “The crumbling civic infrastructure of the city floodwaters and such unattended decomposing was exposed once again by last night’s heavy livestock pose a danger of the outbreak of epidemic downpour, with many localities and roads reeling diseases. Perhaps, the greatest fear from artificial under knee to chest deep water till late tonight. The flooding and water logging is the threat to public deluge completely disrupted people’s normal life” health by contamination of drinking water. The (The Assam Tribune 2007). The problem of artificial stagnant water brings with it a number of perils for the flooding has also compounded the difficulties due to affected population. The unhygienic condition that the lack of basic amenities that a growing city faces lingers post artificial flooding, give rise to water borne such as drinking water, drainage and sewerage system, diseases due to the stagnant water. The rainwater gets disposal of waste etc. mixed with the sewer and open drains and hence it can be imagined well that they pollute existing sources of 3.2 The Reach of the Environmental Problem potable drinking water such as public taps and tube- wells (See Figure 2). The ground water also gets Artificial flooding has touched the lives of all affected when the water remains stagnant in certain sections of the city’s population. It goes without saying pockets of the city for elongated periods of time. that the populations of the severely affected areas are the worst hit. But people who live on higher grounds and not affected directly by it also have their lives impacted upon in one way or the other. We cannot consider the problem of artificial flooding in isolation but have to consider it at the community level as all are affected by it. We will be in the wrong to consider it as occurring in someone else’s backyard as everyone’s lives are impacted by it. When it rains heavily for a couple of hours, most of the busy roads and intersections in the city come to a standstill due to flooding. Life in the city comes to a halt and people are unable to commute to their places of work and leisure (See Figure 3). It is several hours or even days before the water completely drains and traffic and life returns to a normal. And with each passing year, it is taking longer for the accumulated water to drain out from the city, which is of serious concern. Unless the issue is given due consideration and ameliorated for, the quality of life in the city in the years to come will deteriorate even more. Figure 2: Contamination of drinking water Figure 3: Water logging in the streets of Guwahati Source: http://images.google.com Source: http://images.google.com The dirty stagnant water also affects the urban 3 vegetation. As the floodwater remains for considerable period of time, the biochemical actions of the plant are severely altered as the water clogs the roots in the soil. Hence, non-tolerant species are continuously loosing the battle to frequent flooding. The environmental problem has also affected the areas within the city

4. LOOKING FOR SOLUTIONS 4.2 Embracing new alternatives 4.1 Ameliorating the problem The role of emerging technologies of Geographical Information Systems (GIS) and Remote Sensing is It is not too late to remedy this environmental crucial in such hazard mitigation procedures. From the problem. The need of the hour is comprehensive city perspective of artificial flooding in Guwahati, remotely planning to regulate the rapid urban growth of the city. sensed satellite images is a source of great help in Guwahati previously had two Master Plans. The most identifying and extracting the spatial regions of the city recent one was drafted in the year 1971. But these that are the cause as well as those regions that are the master plans were not implemented and followed in prime affected. This inventory is of immense resource earnest by the changing civic bodies and the state when put into a Geographical Information System. governments over the years. Amidst such a gloomy Artificial flooding is a complex environmental process. scenario, there have been however, developments in A GIS enables us to include such processes in the the past couple of years that gives hope. The media has decision making procedure by developing models played an important role in educating the public on which are known as process models. For example, a artificial flooding and water logging. As a result of the GIS in conjunction with a process model of population growing crisis, public participation through civic change will help us to predict where growth will occur action committees, which was previously non-existent, so that sufficient planning can be put in place. Hence, a has seen an emergence. process model which stimulates the real world process allows us to make inferred decisions about a spatial It is clear even to the lay person that it is due to phenomenon. And ‘from a philosophical point of view, obstruction to the flow of water, due to encroachments, a process model may be the only way of evaluating our garbage dumping and other human interventions in the understanding of the complex behavior of spatial Bahini and Bharalu which comprise the main rivulets systems’ (Heywood et al., 2006). The adoption and that carry the excess water out of the city, that the implementation of these new technologies which at flooding and water stagnation problem has taken a turn present can be said to be little to none at the for the worse. If these rivers are restored to their government level would need a great degree of change original width, and excavated to give proper gradient towards the attitude and commitment towards public to the river beds and obstructions removed, water will welfare and benefit. flow and can be pumped out to the Brahmaputra by the Bharalu Pump House. Water logging in Zoo Road A GIS also has the ability to bring public area, Nabin Nagar, Lachit Nagar and for that matter the participation onto a single platform for the decision entire catchment area of these rivulets that run through making process. ‘The public is an enormous data the city will be removed to a great extent. These are resource that can be of tremendous benefit to decision very basic practical solutions that have been makers. Participatory GIS uses this resource to recommended by the public to the government populate GIS databases with information on local agencies. It is the result of such active citizen knowledge and grassroots opinion. In return, the participation that the Water Resource Department has decision makers are able to make decisions that are undertaken the task for increasing the flow of water in more in tune with local feelings and needs’ (Heywood the Bahini and the Bharalu. Widening of the rivers to et al., 2006). A continued coordinated effort amongst their original size, concrete lining the sides of the river the citizens’ bodies across the city has seen the and the bed will increase the flow by several times. harnessing of public opinion in favor of the creation of Besides this, grading the river through proper slope to a comprehensive and structured plan for the the Bharalu Pumping Station, putting a ban on hill redevelopment of the city and the surrounding areas. cutting for prevention of silting of the drains and rivers ‘The Gauhati High Court has constituted a nine- are some of the projects that have also been adopted. member citizens' committee to monitor timely and The Guwahati Green Care Project also known as Seuj effective execution of schemes meant for improvement Prakalpa is a special focus mission of the Assam Forest of civic amenities of the city’ (The Hindu 2005). It is Department, through public–private partnership for primarily due to this plan of action by the general massive afforestation and green belt development public that people in power have woken up and taken programme (Dept of Forests 2005). This mission has notice. The drafting of ‘The City Development Plan been designed to combat the increasing problem of soil 2006’ and the new draft ‘Master Plan 2025’ has been erosion and deforestation in the city. These initiatives the direct result of this peoples’ movement. will undoubtedly ameliorate the problem to a great extent temporarily, but perhaps permanent and longer ‘The City Development Plan (CDP) is a dynamic lasting solution will ask for the adoption and document that has been the result of a consultative implementation of elaborate environmental policy and process that has taken into consideration the views and programs by the authorities. suggestions from across the different sections of the society such as citizens’ bodies, peoples’ representatives, confederation of industries, 4

academic/research institutions, and local urban bodies’ throughout the developing world is seriously (GMDA 2006). The CDP is a part of the broader urban outstripping the capacity of most cities to provide policy program of the central government launched adequate services for their citizens” (Cohen 2006). under the name of Jawaharlal Nehru National Urban This brings before us to the vital question whether Renewal Mission (JNNURM). The CDP incorporates these emerging cities in the developing countries have policies and programs to meet primary objectives some the resources necessary to absorb and provide the of which are to promote focused, balanced and opportunities for a clean healthy urban life. sustainable economic and infrastructure development, to provide for and build a natural environment that The recent developments have given the hope that would bring good quality of life for the residents and the city will now take a more acceptable look if the visitors alike, to provide basic services to the urban proposed policies and programs are implemented in poor and planned development. The CDP has perhaps earnest. Given past records, the earnestness of the for the first time put in place the division of powers administrators to solve the environmental problem may and responsibilities among the various urban raise questions in the minds of the citizens. But that the administrative bodies. This document has been problem craves for immediate re-address is beyond enthusiastically received and its early implementation doubt. The answer to the question as to why this is sought by all sections of the community. Following problem needs to be addressed lies in the concern for the CDP, the Guwahati Metropolitan Development the future wellbeing of the city. It is particularly Authority has published the draft Master Plan 2025 in important from the point of view of the direction that March 2007. This draft plan is now currently open to the city will take in the next twenty years. Guwahati discussion and debate. It incorporates the new landuse functions as the main gateway to the entire North plan, the new zones and zoning regulations. It has Eastern India and would be, possibly to the countries received mixed reviews and is being debated by many of Southeast Asia in the next few years under the Look groups who have called for various amendments, East policy of the central government. “The focus has inclusions and corrections before being adopted and now shifted to transnational and sub-regional implemented. cooperation between India and South-East Asian countries as it is seen as the only way to bail out the 4.3 To Conclude northeast region from its state of underdevelopment and political crisis” (Talukdar 2004). Given the The issue of artificial flooding and water logging as potential of the economy to grow and possible access a phenomenon is not unique to the city of Guwahati. to the flourishing markets of South East Asia, it is The metropolitan city of Mumbai of the state of imperative that the city gets its act together and Maharastra in the western region of the country has develops its physical and economic infrastructure. One been increasingly suffering from artificial floods of the objectives of the CDP states at improving inter during the monsoon season. The reasons for the and intra regional accessibility. This is significant if occurrences bear similar resemblance with those of Guwahati has to keep on functioning as an important Guwahati. Many cities of the developing third world economic and commercial gateway. This will depend are witnessing an increased incidence of artificial on how the city is run and managed. According to flooding. To mention, even cities like London, which Cohen (2006), ‘if well managed, cities offer important is the capital of a highly urbanized and developed opportunities for economic and social development’. nation of the world has also suffered from flooding in This holds true as Cohen speaks of cities in the recent years. The contributing factors to artificial developing world similar to Guwahati where the vast flooding vary from place to place. But however, for majority of modern productive activities are cities in developing nations such as Guwahati, there concentrated and where also lies the opportunities for are some common reasons such as the rising economic prosperity. The magnitude and scale at population due to greater rural urban migration and the which urbanization is taking place in Guwahati poses limited resource and infrastructure present in these formidable challenges. It remains to be seen how and cities. “And while cities command an increasingly to what degree the new policies are implemented and dominant role in the global economy as centers of both the benefits that accrue from them. production and consumption, rapid urban growth 5

REFERENCES The Hindu, 2005, “Citizens’ panel to oversee Guwahati civic amenities” Other States Section, 19 Begum,Semim W., and Bimal Kar, 2006. Changing April, Internet on-line. pattern of population growth and socio-economic http://www.hindu.com/2005/04/19/stories/2005041909 characteristics in the fringe villages of Guwahati city. 460500.html Database on-line. http://www.iipsindia.in/abstractfiles/ Talukdar, Sushanta, 2004, “Looking East.” Frontline, 200682231910_01_Semim(Full_Paper)-IIPS.doc Vol. 21, Issue 20, 2004, Database on-line. http://www.hinduonnet.com/fline/fl2120/stories/ Cohen, Barney. 2006, Urbanization in developing 20041008002104200.htm countries: Current trends, future projections, and key challenges for sustainability. Technology in Society 28 6 (2006) 63–80, E-Journal on-line. http://journals.ohiolink.edu/ejc/pdf.cgi/ Cohen_Barney.pdf?issn=0160791x&issue=v28i1- 2&article=63_uidcctpakcfs CSE, 1991, Floods, Flood Plains and Environmental Myths, (New Delhi: Center for Science and Environment). Chapekar, S. B., and Mhatre, G. N., 1985, Human Impact on Ganga River Ecosystems, (New Delhi: Concept Publishing Company). Department of Environment and Forests, Government of Assam. 2005, “Guwahati Green Care Project- Seuj Prakalpa.” Database on-line. http://assamforest.in/mission/seujPrakalpa.pdf Guwahati Metropolitam Development Authority (GMDA), 2006. City Development Plan Guwahati. Database on-line. http://jnnurm.nic.in/nurmudweb/toolkit/ CDP_Guwahati.pdf Goswami, Anil Kumar, 2005, “Wetlands:The unique gift of water eco-systems.” The recurring Flood Disasters of Assam, Ishani, Vol I No 6, 2005, E- Journal on-line. http://www.indianfolklore.org/journals/index.php/ ishani/article/viewFile/269/220 Ian Heywood, Cornelius, S. & Carver, S. 2005, An Introduction to Geographical Information Systems. 3rd Edition; Prentice Hall, Harlow Kale, Vishwas S., 2003, The Spatio-temporal aspects of Monsoon Floods in India: Implications for Flood Hazard Management. In Disaster Management, edited by Harsh K. Gupta, Hyderabad: Universities Press, pp. 22-47. The Assam Tribune, 2007, “Capital city reels under deluge,again.” City Section, 16 September, Internet on-line. http://www.assamtribune.com/scripts/details.asp? id=sep1607/at01

GIS BASED PUBLIC HEALTH INFORMATION SYSTEM IN PUNJAB (INDIA) Rajesh Bansal 1, L.N.Sharma2, Sunil Kumar3 and Siby John4* 1SDE, Engineering Department, Chandigarh Administration, Chandigarh, 2 Deptt. of Applied Sciences, Punjab Engineering College, Chandigarhv, 3GIS Professional, Punjab Engineering College, Chandigarh, 4Deptt of Civil Engineering, Punjab Engineering College, Chandigarh* [email protected] , [email protected] , [email protected] , [email protected] ABSTRACT: GIS plays a vital role in public health surveillance, including the design and monitoring of the implementation of health interventions and disease prevention strategies. In any disease control programme, there are several factors involved, namely estimation of disease burden, monitoring of disease trend, identification of risk factors, planning, allocation of resources, implementation etc. As a modelling and decision support tool, GIS can help determining the geographical distribution and variation of diseases and associated factors. It facilitates analysing spatial and longitudinal trends, mapping populations at risk and stratifying risk factors. GIS can also assist in assessing resource allocation and accessibility of health services, planning and targeting interventions. Other important GIS applications include routing functions and emergency dispatch systems. In this paper, an attempt has been made to develop a public health information system of Punjab (India) with regard to diseases like AIDS, Malaria, Leprosy etc using ARCGIS. The disease-wise data base is prepared at hospital, block and district level along with population, area, manpower and health resources available. The geographical spread of the data indicated strong spatial and temporal trends in the disease incidence and prevalence. The dynamic resultant maps can be integrated to continuous addition of new data and thus produce new outputs. Further, maps so generated with temporal variation prove to be a handy tool for planning, evaluation and allocation of resources for health care facilities in the region. The up dated information accessible to decision-makers at all levels of the public health system which allows them not only to easily visualise problems in relation to existing health and social services but also helps in effectively managing and monitoring public health programmes. The proposed interactive GIS information system using spatial analytical tool enables the decision makers to perform re-districting, re-locating health jurisdictions for effective utilization of health infrastructure at district as well as state level. KEY WORDS: GIS, Public Health Information System, Spatial and Temporal Variations, Decision Support System, Disease Control

1. INTRODUCTION eas of GIS and health Most of the diseases can on the distribution of the care. diseases with GIS oper- Public health and health occur in human society ated databases. It was care are considered to be also, aimed to create mul- important indicators of but policies and tiple layers of information the quality of life in a re- for different variables gion. The 21 targets of Kumar (2000) regulations can help in with reference to disease WHO states, “By the year surveillance along with 2010, people in the given demonstrated an preventing or lessening of the application of GIS as region of a community a database management should have much better optimisation model of the diseases occurrence. To system. This will provide access to family and com- rapid analysis leading to munity oriented primary locations of various map and monitor the time local calculations of types health care, supported by of diseases, draw out spa- a flexible and responsive health facilities in a and location of disease tial correlations under dif- hospital system” (WHO ferent social and environ- 2000) particular area for better happening, the spatial mental situations. geographical accessibility data is collected which and improvement of are in the form of point efficiency levels with the representing location of help of GIS. Pillay (2003) the individual patient or presented the spatial settlement along with variation of HIV/AIDS other attribute data and TB in consecutive representing regions years using GIS and their along with diseases Much of causing factors possible dependence statistics. In GIS of the diseases are suggesting preventive environment using 2. STUDY AREA essentially spatial; i.e. measures to be taken to geographical data, the Punjab is located in the their distribution and control both the diseases. attribute data and on the north part of India, with a concentration vary in Shankar and Sathish basis of attributes population of 20,281969 different locations. (2003) described the statistics, many thematic having 50362 sq km area. Therefore, GIS can be ability of GIS to provide a maps can be generated It extends from used as a decision support framework to relocate the that directly guide the 30°57'13.436\"N to system in order to help existing health health managers, policy 32°28'38.776\"N and the managers of public infrastructure and makers towards better 73°53'42.335\"E to health. In recent years, redistrict the area for best information based 76°56'9.869\"E. many applications of GIS possible utilisation of decisions. Mesgari and Agriculture is the main in public health are health services. Yadav Masoomi (2008) stay of Punjab economy. developed that include (2004) stressed the need demonstrated GIS From administrative point management of available of GIS and its applications in public the state is divided in 20 health resources, applications in health health as a decision districts. The health prediction, simulation and sector for planning and support system and facilities are provided management of epidemics implementation of discussed its limitations. mainly by government and monitoring and programs. Souris et al The relationships between and private sector. In the control of diseases (Colak (2004) analysed the the intensity of the government sector the and Yomralioglu, 2005; changing pattern of water diseases and the causing health resources are Sabesan and Raju, 2005; borne infectious diseases factors can be modelled managed at district level. Sankar and Selvakumar, and its relation to a using geo-statistical tools The policies, plans, 2003) changing environment in in GIS. Such models can programmes, and budgets the Chao Praya river be used to prioritize not of the government sector Basin in Thailand. only the affecting factors hospitals are approved 1.1 GIS and Public Nithikathkul et al. (2008) of the diseases but also and allocated by the State Health demonstrated that the the actions and Health Directorate and The GIS for health care mapping has been prac- spatial analyses regulations required for the State Health ticed since 1840’s. Since then, GIS have been con- performed with GIS could controlling the diseases. Department. A total tinuously used for the analyses of spatial health help to identify patterns number of 219 hospitals, related data. During this period, more GIS analyti- of high risk for 1.2 Objectives of the 1479 dispensaries, 3087 cal capabilities were de- Study veloped and more ad- enterobiasis infections doctors and 25,192 beds vanced and comprehen- The present paper at- sive spatial models among Thai school tempts to analyse the dis- were recorded in various evolved by the collabora- ease pattern of diseases tion of experts in both ar- children in Samut Prakan like Leprosy, Malaria, types of health T.B and HIV with the ap- province of Thailand plication of GIS tech- institutions existing in the niques with special refer- which helped in early ence to Punjab state in In- state. Health facility–wise dia. The broad objective implementation of of the study was to ana- details are depicted in lyse the spatial variation programs to control it. table 1. The location of 1.2 GIS in Public Health each health facility is Management shown in figure 1 with number of beds and number of doctors.

TABLE 1 Health ried out using map al- trends have been reported districts. The recorded TB Facilities in Punjab gebra. cases were found to have (Statistical Abstract, by several authors for increased with time in 4. RESULTS AND Ludhiana and its 2005) DISCUSSION vector-based diseases surrounding areas. 3. METHODOLOGY 4.1 Leprosy (Nakhapakorn., 2005). Figure 2 shows the Base map of the study district wise spatial and Sabesan and Raju, (2005) area was geo referenced temporal variation of to provide a projection Leprosy cases for the NO. OF INSTT. NO. OF BEDS system using ERDAS. For years 1997, 98, 99 with CATEGORY digitization and analysis population data of the Rural of health related data AR- census year 2001. The Urban CGIS was used. District disease is more Total wise health data (Census predominant in the areas Rural of India) was geo-coded of high industrial Urban and spatial analysis tool population with low Total was applied for the gener- income (LIG) i.e. ation of thematic maps Ludhiana Jallandhar and Hospitals 73 146 219 2746 1206 1481 showing spatial and tem- Amristsar. 64 39 103 9 5 poral distribution of popu- Hosp./ 416 25 441 lation, health facilities, 4.2 Malaria CHC/ 476 2632 3108 and diseases like Leprosy, Figure No.3 shows the PHC/ Malaria, T.B and HIV. distribution of Malaria CHC 1660 98 1758 The disease-wise data patients over the years base is prepared at hos- 1997, 1998 and 1999, PHC's pital and district level district wise. The number along with population, of patients decreased Dispensar 1221 258 1479 4857 654 5511 area, manpower and significantly through the health resources. Various years. The reasons could Total 177 46 224 106 1454 251 maps have been generated be attributed to improved 4 8 2 47 5 92 using different analytical drainage and sanitation. capabilities of GIS such The awareness and health described the use of GIS as Chorocrosmatic, intervention also showed Choro-schematic, Tint a marked difference for rural health and It was observed that both map, Choropleth and Dot during the period. Similar method. Inverse distance sustainable development Leprosy and Tuberculosis weighted method (IDW) was used for interpolation in India, with special were prevalent in areas of and the analysis was car- reference to vector – high population and low borne diseases. However, income groups. It also, their spatial variation in exhibited a strong the year 1999 showed that correlation with poverty the numbers of cases were level of the people. more in Gurdaspur, Patiala and Kapurthala 4.4 HIV + The figure No. 5 shows the district-wise variation 4.3 Tuberculosis of HIV+ cases in the Figure No. 4 shows the years 96 and 99 with a spatial and temporal variation of the TB clear indication of its patients in 1997, 1998 and 1999 over the predominance in Amritsar, Ludhiana, Jallandhar and Patiala. Using the map algebra

(Subtraction) in GIS, the and social services but Sabesan S, and Raju Application, Proceedings increase/decrease in the K.H.K, 2005, GIS for of Map India 2003 HIV+ cases was also helps in effectively rural health and sustain- interpolated for the time able development in In- 99 and 96. It was managing and monitoring dia, with special reference observed that the HIV+ to vector – borne dis- cases were pronounced in public health eases. Current Science; Souris, M, J.P. Gonzalez, the areas along the 88, 1749 – 1752. National Highway (NH - programmes. The C. Bellec, P. Barbazan, 1). Statistical Abstract, 2005. proposed interactive GIS Statistical Abstract, Gov- N. Nittapatina, G. 5. CONCLUSIONS ernment of Punjab, India As a modelling and information system using Chauvancy, V. decision support tool, GIS World Health Organiza- can help determining the spatial analytical tool tion. The World Health Herbreteau, 2004. Water geographical distribution Report, Health System: and variation of diseases enables the decision Improving Performance. Borne Infection Diseases and associated factors. Geneva: W.H.O., 2000. The dynamic resultant makers to perform re- in the Chao Praya River maps can be integrated to continuous addition of districting, re-locating Basin, Thailand new data and thus produce new outputs. health jurisdictions for Further, maps so generated with temporal effective utilization of variation prove to be a handy tool for planning, health infrastructure at evaluation and allocation of resources for health district level as well as care facilities in the region. The up dated state level. Apart from information accessible to decision-makers at all medical and clinical tools, levels of the public health system which allows them national programmes for not only to easily visualise problems in such a huge country as relation to existing health India also need state of the art management and Colak, E. and planning tools. GIS, Yomralioglu, T., 2005. which can effectively Creating GIS-Based help visualise and analyse Cancer Density Maps for the programme data, is Trabzon Province of undoubtedly the best Turkey, Proceedings of management tool. ESRI Health GIS Conference, Chicago, REFERENCES Illinois, USA Mesgari, 1M.S. and Z. Kumar, N, 2000. Loca- Masoomi, 2008, GIS Ap- tional analysis of public and plications in Public private health services in Health as a Decision Rohtak and Bhiwani dis- Making Support System tricts, (India), 1981 to 1996, and It’s Limitation in Iran www.gisdevelopment.net/ World Applied Sciences application/health/plan- Journal 3 (Supple 1): 73- ning/healthp0001 77. Nakhapakorn, K. and Nithikathkul, C, Suk- Tripathi N. K., 2005. Analysis of Spatial thana, Y, Wongsawad, C, Factors affecting dengue epidemics using GIS, Nithikathkul, A, Nith- Proceedings of the Health GIS symposium Bangkok, ikethkul, B, Wichmann, Thailand. http://www.j- geoinfo.net/HealthGIS/H O, Gonzalez, J, Hugot, J, G001.html Herbreteau., V, 2008. En- terobiasis infections among Thai school chil- dren: Spatial analysis us- Pillay, R, 2003. Using GIS to spatially portray the pre- ing a geographic informa- valence of HIV/AIDS and its demographic consequences tion system, Asian Bio- in selected countries in sub- Saharan Africa, Proceed- medicine, 2, 283-288. ings of Map India 2003 Yadav, S K 2004 Health Shankar. K. N and Sel- for All in New Millen- vakumar, S 2003. Spinfo nium – Is This Possible Health Map – A Health GIS Without GIS Applica- tions? J. Hum. Ecol., 15, 199-202

GIS BASED ENVIRONMENT DATA MANAGEMENT SYSTEM FOR PUBLIC HEALTH Guggilla Chanti1, Srikanth Tangedipalli2 and Bommidi Raghasudha3 System Analyst, IT Services, Weston Solutions India Pvt. Ltd, Hyderabad, A.P., India 1, Sr. Manager, IT Services, Weston Solutions India Pvt. Ltd, Hyderabad, A.P., India 2, GIS Analyst, GIS Services, Weston Solutions India Pvt. Ltd, Hyderabad, A.P., India 3 ABSTRACT: Traditional public health concerns, such as disease outbreaks, environmental hazards and access to health care have been joined by contemporary concerns: bioterrorism, crime, violence, and substance abuse. Each of these poses a threat to public health and wellness. Moreover, each calls for short and long-term solutions that lie well outside the traditional public health boundaries. In order to properly plan, manage and monitor any public health program, it is vital that up-to- date, relevant information is available to decision-makers at all levels of the public health system. As every disease problem or health event requires a different response and policy decision, information must be available that reflects a realistic assessment of the situation at local, national and global levels. This must be done with best available data. Disease transmission dynamics, demographics, availability of and accessibility to existing health and social services as well as other geographic and environmental features should also be taken into consideration. The web-based GIS services application provides Query and Display functionality to the users from multiple stakeholders departments such as Public Health, Food, Solid Waste, Land-Use, etc. The application has built-in queries for the most common requests and queries, segregated into different groups, depending on the type of user. The system also supports pop-up reports based on the user chosen queries, zoom, print and navigation across multi-page reports. The project involved building the application using Arc-IMS Image server and JSP thin client. KEY WORDS: CUPA- Certified Unified Program Agency, HazMat- Hazardous Materials, PWA- Public Works Agency Public Health, ArcIMS I. INTRODUCTION Because of these advancements, many people who were unable to get their required information easily are now Public Health Mapping is one of the best options for having it readily available. With Internet connections making better analysis of Health services, especially, in getting faster and faster, the amount of information that case of developing countries to overcome this problem. can be transferred over the internet is quite high. Analysis Thus, in order to properly plan, manage and monitor any of data by a widely scattered group can also be public health program, it is vital that up-to-date, relevant accomplished in a faster, more efficient manner when the information is available to decision-makers at all levels of information is available almost everywhere in the world. the public health system. The Public Health Mapping has been developed with the goal of providing greater access The prime concern during any environmental hazards or to simple, low-cost geographic information and related disease outbreaks is the availability of the right spatial data management and mapping systems to public health information at the right time. In addition, the administrators at all levels of the health system. Alameda dissemination of this information to all concerned users County Public Health Department has worked for over 50 to make right decisions is also equally crucial. In this years to improve the health and safety of its residents as way, distributing geospatial information on a network of well as of the people residing in the surroundings areas. information gives a chance to the decision-makers to The web technologies will enable better dissemination of access easily the information about all levels of public health information to various users. When GIS data and health. Therefore, a Web-based GIS has considered for functionality are made available over the Internet, the managing the public health program during the hazards. system is referred to as \"Web GIS\". With Web GIS, users do not need to purchase and install expensive GIS Hence, a Web-based Environment Data Management software in order to access and work with maps and System has planned by using ArcIMS Image Server and databases. In addition, users do not need to become JSP thin client, etc. It is envisaged to develop a map- experts in sophisticated GIS applications, since the based web site for hosting the health information and to functionality are made available through a regular web support decision-making. The detailed study about the browser and an integrated Viewer with a simple, user- design and development has been carried out in detail in friendly interface. further chapters.

II. METHODOLOGY queried facility by clicking on the facility Id on the search results window (Figure 4). The system is designed and The application accommodates several user groups, used by Alameda Department of Environmental Health, wherein each user group (CUPA1, Food Inspector, Alameda, and Houston. HazMat2, Land Use, Public Health, PWA3, and Solid Waste) has access to a different set of built-in queries. Figure 1 ArcIMS Architecture For example, a user whop requires information related to food inspection will be provided information with the Study Area restaurants, retail food facilities, etc., in the county to ensure a safe and wholesome food supply for the public. Health department of Alameda County actively involves Food facilities include restaurants, markets, bakeries, residents in the planning, evaluation and implementation liquor stores, bars, certified farmers' market, and food of health activities in their communities The Alameda service. The application will allow logical queries and County's interactive Environmental GIS mapping Web interactions with the map window, including zoom, pan, application provides user-friendly, standard query, and and feature identification functions. It will also allow you display functionality to the users of the Alameda County– to display an overview of the map (index). The food Department of Environmental Health (DEH). Apart from program conducts routine and follow-up inspections, this, the site also contains information related to county’s investigates complaints and suspected food borne hazardous material, solid waste underground illnesses, carries-out food recalls, conducts plan reviews tanks/dumps; toxic substances information all through the for new and remodelled facilities, and issues permits. county can be known. The Alameda DEH Display and This site helps users to know any of the problems with Query site will be two separate websites, one for the food facilities in the county that becomes advantageous to public and another for Alameda DEH staff. Public has public and to decision makers for taking any necessary limited queries. The Web application will allow logical actions. queries and interactions with the map window including zoom, pan, and feature identification functions.  To provide the planners an accurate spatial view of To locate a property quickly, click the \"Search\" tab; the county at different levels simply use the navigation tools to \"Zoom-In\", \"Zoom- Out\", or \"Pan\" until you find the feature of interest. Click  To provide the planners with a detailed the \"Layers\" button to view the relevant layer list and demographic data and education, & health related then toggle them on or off as desired. It will also allow data without a GIS environment. you to display an overview of the map (index).  III. APPLICATION DEVELOPMENT The development model and its implementation are based on a technology that allowed the development of spatial enabled applications. These mapping components can be integrated in any standard development environment. For designing web-based GIS applications, variety of programs and forms are available. However, the web applications are based on the same model called client/server. The client makes a request to a server. The server processes the request and returns the information to the client. A web-based system can be developed using this client-server architecture. To place the geographic information to the web, ArcIMS is used to host the health and environmental information. It contains the map wbe pages designed using ArcIMS through which the user can view the searched data of the selected city based on the type of user logged into the application. A public health related user when logged in, can query for “Food borne illness complaints”, “Water borne illness complaints”, etc. The user is provided with display and few general GIS functions, such as pan, zoom, select, identify, and some other functionalities for specific GIS operations. Utilization of relevant GIS functions makes managers to decide rapidly. For required city region, information is provided with search results (Figure 3) for related query with available details. The user can view the maps for the

Figure 2 Alameda County DEH website Log in screen for The site has data about certain chronic illnesses, commu- restricted users. nicable diseases and birth and death vital statistics. The data and reports are organized into several categories. Figure 3 View of search results showing an example for Copy of reports/ data can be viewed or downloaded on “Public Health Queries” single click. The site allows the user to: Figure 3: View of search results showing an  Process geographic data, such as selecting various at- example for “Public Health Queries” tribute data for a map to display. Figure 4 showing the queried area  Allow the user to download the various queried in- formation either in the form of JPEG’s or PDF’s and also analyze interactively  The inspected results by the inspector can be down- loaded for each queried results. This attempt can be further enhanced by using Java en- abled services, with content management system. V. CONCLUSION This web-based GIS that provides access to spatial datasets is pertaining to Health in Alameda County. It is designed to allow viewing, querying, and analyzing geographic information. The main potential of the tool is to:  Timely Updates  It offers maximum functionality with the minimum effort.  Fast or Immediate Measures for decision makers.  Acts as a search tool to public for various departments’ information. As part of future work, this can be extended for real time usage tool for general public and also for decision makers for more significant information regarding various departments and agencies integrated into single site. The extension to PDA devices can be made that helps the inspecting personnel from time consuming tasks, such as revisiting the office for reporting their inspection, etc. Web-based GIS can be considered as an alternative to non-traditional approaches, for obtaining useful data for geographic analyses. This application best reflects the utilization of the currently available GIS–ESRI technologies, and the identification of a public-private partnership to create a win-win solution. REFERENCE i) http://www.acgov.org/index.htm Figure 5 Alameda Department of Environmental Health Web application showing selected Layers. IV. RESULTS AND DISCUSSIONS

ENVIRONMENT ASSESSMENT FOR HEALTH MANAGEMENT THROUGH SPATIAL TECHNOLOGY - A CASE STUDY FROM INDIA M. Govindaraju, V. R. Muthukumaran, P. Visvanathan, and R. S. Ganeshkumar Dept. of Env. Biotechnology, School of Environmental Sciences, Bharathidasan University, Tiruchirappalli – 620 024, India. E-mail: [email protected] ABSTRACT: Remote sensing is a powerful tool to assess spatial distribution and changes on land use / land cover in urban environment because of its high dynamic activities. GIS is also one of the major supportive software which can integrate the varieties of data in a single platform for analysis. In this study spatial and spectral analysis have been made with use of high resolution satellite imageries for environment assessment of Tiruchirappalli City Corporation, Tamil Nadu state. Thematic layers (factors) like land use / land cover, drainage network, transportation, surface and ground water quantity and quality, pollution status, medical facilities, diseases prevalence, vector breeding habitats, population density and distribution and so on. Arc GIS 9.2 spatial analyst were applied for data integration process. Map over lay method is applied for data analysis. Criterion analysis has been made for the correlation environment and health factors. The study concludes that poor land use practices, low sanitary condition, high pollution rates, over population density, regional environmental status and influence on micro climatic conditions are act as major role on public health. Final results are verified with ground truth studies. Also it is observed that poor land use practice is the main reason for urban sanitary problems, development of vector breeding habitats, water resources depletion. So the environmental condition of the city is very poor for more than 50% of the corporation area. Based on the results management planning strategies were suggested for the improvement of environment and health conditions. KEY WORDS: Tiruchirappalli, Remote sensing, GIS, Arc GIS. 1. PREAMBLE temperature ranges from 41 – 180. The population density is about 499 (per sq.Km).The average rainfall is Environment of any place is inter-dependent on the 821.4mm. (Abdul Jameel and Sirajudeen, 2006). natural and manmade factors. Population, Land cover, Health, Transportation, Pollution etc. play a major role in Figure 1 Study area map shaping up an environment. The environment is under Tiruchirappalli City Corporation consists of 60 wards constant stress due to manmade activities. Rapid and 4 zones, 15 wards to each zone namely, Srirangam, urbanisation and industrialisation has been deemed to be Ariyamangalam, Ponmalai and K.Abishekapuram. a major cause of concern for the depletion of (www.trichycitycorporation.com) the city corporation environment. Remote sensing is a powerful tool to assess area and ward details are as shown in the figure 2. The spatial distribution and changes on land use / land cover key area to be addressed at present study includes the on in urban environment because of its high dynamic environment and health status of Tiruchirappalli City activities. GIS is also one of the major supportive Corporation. Hence data regarding the population, Vector software which can integrate the varieties of data in a borne disease – its prevalence, Land use, sanitation and single platform for analysis. The data have been used to other related factors are to be collected. prepare maps and interpret them using ArcGIS 9.0 software. Tiruchirappalli City Corporation, Tamil Nadu state is taken as field for this pilot study. 2. STUDY AREA Tiruchirappalli, situated on the banks of the river Cauvery is the fourth largest city in Tamil Nadu. Tiruchirappalli City is located 10 – 10.30’ N Longitude and 75.45-78,50’ E Latitude as shown in the figure.1. The total Area is 4403.83 Sq.km. The city has a population of 21,96,and 473 where Males constitute 49.97% of the population and females 50.03%.respectively. It is 78m above the sea level and the

Areas including Srirangam, Chatram bus terminus, Central bus terminus, KK Nagar etc. have been found to be on the higher side ( > 500 per sq.km) while outer regions of the city remains to be less populated. 3.2 Solid Waste Disposal sites The corporation has roadways including National Highways for 32.4 km out of the total 92.20 km. The total length of the Underground Drainage system at present is 147.30 Kms.  Solid waste disposal sites have been located at 2 sites, Ariyamangalam (19.31 Acres) and Panchapur (25 Acres) at about 10 km and 8 km away from the city respectively. The composition of municipal solid wastes is as given in Table 1. The ward in which waste disposal sites are located are shown in Figure 4. (Muthukumaran and Ambujam, 2003). Table 1 Percentage wise composition of municipal Solid wastes. Figure 2 Geographical Distribution of Tiruchirappalli 1. Bio degradable 75 City Corporation Map 2. Glass  1.5 3. Rags 5 3.1 Population Density 4. Paper 1 5. Plastic 1 6. Leather & rubber 0.5 7. Metals & other domestic hazardous 1 8. Inert 15 The present and the future population trends are as given in Table 2. (Muthukumaran and Ambujam, 2003). SOLID WASTE DISPOSAL SITE MAP ± Method Year Year Year 2000 2010 2020 1. Arithmetical method 773696 875151 976607 1 2 2. Geometrical Increase 805384 936257 1152356 34 6 5 3. Incremental increase 792319 925381 1072759 9 The population density of Tiruchirappalli is as shown in 8 60 58 57 10 11 Figure 3 59 55 56 12 13 15 54 51 14 Disposal sites 50 17 16 7 18 Ariyamangalam Panchapur 53 49 19 2021 POPULATION DENSITY MAP ± 52 48 27 28 46 23 2422 29 47 25 30 44 26 31 33 45 32 43 34 1 41 42 35 36 2 40 34 6 5 9 8 60 58 57 10 11 37 38 59 55 56 12 13 15 39 54 51 14 Population (per sq. km) 50 17 16 7 18 <500 300-500 53 49 19 2021 >300 52 48 27 28 46 23 2422 29 47 25 30 44 26 31 ZONE WARD NUMBER TOTAL 15 33 SRIRANGAM 1,2,3,4,5,6,8,9,10,11,12, 15 45 32 13,16,17 & 18 15 15 34 43 40 41 35 36 ARIYAMANAGALAM 7,14,15,19,20,21,22,23,24, 42 25,26,27,28,29 & 33 PONMALAI 30,31,32,34,35,36,37,38, 39,42,43,44,46,47 & 48 37 K. ABISHEKAPURAM 40,41,45,49,50,51,52,53, 38 54,55,56,57,58,59 & 60 39 Figure 4 Solid Waste Disposal Sites ZONE WARD NUMBER TOTAL 15 SRIRANGAM 1,2,3,4,5,6,8,9,10,11,12, 15 3.3 Drainage System Details 13,16,17 & 18 15 15 ARIYAMANAGALAM 7,14,15,19,20,21,22,23,24, 25,26,27,28,29 & 33 PONMALAI 30,31,32,34,35,36,37,38, A network of sewage collecting systems, sub pumping 39,42,43,44,46,47 & 48 stations, a main pumping station and a sewage treatment plant is used for sewage treatment. The old K. ABISHEKAPURAM 40,41,45,49,50,51,52,53, 54,55,56,57,58,59 & 60 Figure 3 Population Density

Tiruchirappalli town has been provided with an out the most vector prone habitats. The data has been underground drainage system (about 77%) while the presented in Figure 7. areas of Golden Rock and Sri Rang am zones are completely unsewered areas. The wastewater generated in WATER BODY MAP ± this area ultimately mixes into the river Cauvery through surface channels and polluting the river. Air pollution is 1 6 also on the rise due to increasing vehicular traffic. The 2 zones adjacent to Railway junction, Bus terminus has 34 been shown to contain exceedingly high level of 5 Particulate matters (SPM), NO2 than the permissible limits. The pollution status of Tiruchirappalli city 9 corporation are as shown in Figure 5. 8 3.4 Wastewater Treatment at Panjappur 60 58 57 10 11 The sewage treatment plant is located at Panjappur, 7 km 59 55 56 12 13 15 away from Tiruchirappalli. Four lagoons are located in a 54 51 14 total land area of 232.28 ha. Sewage treatment is done by Water bodies 50 17 16 7 biological degradation in the three facultative ponds with 18 a detention time of 18 days. After the treatment, the Tanks sewage water is allowed to mix in the Koriyar river and it 53 49 19 2021 pollutes the river. 52 48 27 28 46 23 2422 29 47 25 30 44 26 31 33 45 32 43 34 41 35 36 40 42 37 38 39 ZONE WARD NUMBER TOTAL 15 SRIRANGAM 1,2,3,4,5,6,8,9,10,11,12, 15 13,16,17 & 18 15 15 ARIYAMANAGALAM 7,14,15,19,20,21,22,23,24, 25,26,27,28,29 & 33 PONMALAI 30,31,32,34,35,36,37,38, 39,42,43,44,46,47 & 48 POLLUTION STATUS MAP ± K. ABISHEKAPURAM 40,41,45,49,50,51,52,53, 54,55,56,57,58,59 & 60 Figure 6 Water Bodies Map 1 2 34 56 9 ±PREVELANCE OF VECTORS DISTRIBUTION MAP 1 8 2 34 60 58 57 10 11 56 59 54 55 56 12 13 51 POLLUTION STATUS 50 17 16 15 7 18 14 Highly polluted Moderately polluted 53 49 19 20 21 Less polluted 52 48 27 28 46 23 2422 29 47 25 30 44 26 31 33 9 45 32 8 43 34 41 60 58 57 40 35 36 59 10 11 42 12 13 17 16 Prevelance of Vectors 55 56 15 Culex quinquefasciatus 54 51 18 14 7 50 27 Aedes aegypti 53 Culex quinquefasciatus 49 19 2021 32 Anopheles subpictus 48 28 37 52 23 2422 29 38 39 46 47 25 30 44 26 31 33 45 34 43 ZONE WARD NUMBER TOTAL 41 35 36 15 40 15 42 SRIRANGAM 1,2,3,4,5,6,8,9,10,11,12, 15 13,16,17 & 18 15 ARIYAMANAGALAM 7,14,15,19,20,21,22,23,24, 25,26,27,28,29 & 33 PONMALAI 30,31,32,34,35,36,37,38, 37 39,42,43,44,46,47 & 48 38 39 K. ABISHEKAPURAM 40,41,45,49,50,51,52,53, 54,55,56,57,58,59 & 60 Figure 5 Pollution Status ZONE WARD NUMBER TOTAL Data Source: 15 SRIRANGAM 1,2,3,4,5,6,8,9,10,11,12, 15 Department of Public Health 13,16,17 & 18 15 and Preventive Medicine, 15 Tamil Nadu. The water bodies also add to the woes of pollution by ARIYAMANAGALAM 7,14,15,19,20,21,22,23,24, being a vector habitat site. Tiruchirappalli has many 25,26,27,28,29 & 33 traditional form of open tanks in temples, canals. These mostly stagnant water source might causes an increase in PONMALAI 30,31,32,34,35,36,37,38, vector population and the locations of water bodies are as 39,42,43,44,46,47 & 48 shown in figure 6. K. ABISHEKAPURAM 40,41,45,49,50,51,52,53, 54,55,56,57,58,59 & 60 Figure 7 Distribution of Vectors 3.5 Distribution of Vector – Mosquitoes The Presence of the vectors have been identified in the wards 1- 4, 17, 21, 28, 37-39, 44, 48,49,51,52. These An analysis of the distribution of mosquitoes (Culex, wards include the areas adjacent to solid waste disposal Aedes, Anopheles Sp.,) in the wards of Tiruchirappalli sites, Ariyamangalam and Panchapur. Also wards in were done and the data obtained has been mapped to find Srirangam and Chatram bus terminus are more prone for vector distribution. Hence the risk of occurrence of

diseases like Malaria, Chikungunya, Dengue in those Muthukumaran, N and Ambujam., N.K. “ Wastewa- wards are much higher than the rest. ter treatment and Management in Urban Areas – A Case study of Tiruchirappalli City, Tamil Nadu, In- 4. INFERENCE dia “ in Martin J Bunch, Madha Suresh, V and Vas- antha Kumaran. Eds. Proceedings of the third Inter- An abundance of vectors distribution has been noted in national Conference on Environment and health, the wards located around the waste disposal sites, Chennai, India 15-17 December, 2003. Panchapur, Ariyamangalam and Srirangam. Location of compost yard, food grain godown in Ariyamangalam area www..trichycitycorporation.com could be a reason for increased presence of vectors in the area. Areas around panchapur also faces a similar fate. www.jsk.gov.in. Since the areas adjacent to these wards are well populated, the risk of transmission of vector-borne iseases like Dengue, Chikungunya (Aedes sp.,), Filariasis (Culex Sp.) and Malaria (Anopheles Sp.) are high. Discharge of sewage, industrial effluents, dumping of garbages in the river Cauvery and its tributaries poses a healthy breeding ground for disease causing vectors. Srirangam zone is primarily affected due to the urban sewage discharges into water bodies. Water bodies like Uyyakondan canal, open tank, lake, pond also serve as breeding zones and is vastly polluted. Seasonal Overflow of Drainage and Sewers compound the pollution status of the city. The Land use maintenance in the Corporation limits has been improper and has undergone a sea change due to the twin explosion of Population and Urbanisation. 5. CONCLUSION This study shows a lack of urban planning and management strategies in and around Tiruchirappalli city corporation. Improper method of dumping of wastes , rapid urbanisation has been a major cause for the deterioration of the environment. Areas around Ariyamangalam, Panchapur have known to be the most affected as they serve as good breeding sites for the vectors. Air Pollution due to vehicular traffic and Water pollution caused by sewage an effluent discharge into open tanks and canals adjoining the Cauvery river are also major causes of concern. Due to these, vector borne diseases like Dengue, Chikungunya, Malaria and Filariasis has had seasonal impact on the population. Due to the prevailing tropical temperature, the spreading of vectors might be kept in check. Improper Land use coupled with the emergence of vector-borne diseases thrusts a huge stress on the well-being of the environment. Overall, the environment and the health sector of the Tiruchirappalli city corporation needs to be improved considerably to meet the future challenges. REFERENCES Abdul Jameel., A. and Sirajudeen., J. 2006. Risk As- sessment of Physico chemical contaminants in ground water of pettavaithalai area, Tiruchirappalli, Tamil Nadu, India. Environmental Monitoring and Assessment. 123: 299-312.

ADDING SPATIAL AND TEMPORAL DIMENSIONS TO THE HEALTHCARE Srikrishna Pothukuchi CSC India Pvt Ltd, Bldg 7, Mindspace IT Park, Madhapur, Hyderabad 500081, India [email protected] ABSTRACT: This paper presents unification of three vital concepts to leverage the benefits out of each other in tandem – space, time and health. Typical healthcare systems have several components built into it modelling either after the medical paradigm of the healthcare or the social paradigm of healthcare. Most of the spatial systems integrated to reap benefits use the latter model. It is used for healthcare analysts, social scientists or even health insurers to arrive at certain decisions. Less research has happened on combining the spatial or temporal concepts of IT into the medical paradigm of healthcare. Even though certain systems like the Radiology Information Systems or Picture Archiving and Communication Systems drew concepts heavily from the mathematical foundations of computing science and image processing, generic healthcare IT could not leverage the same out of GIS completely yet, hence an effort made to fill the vacuum. KEY WORDS: Spatial, Healthcare, Temporal, Database, System 1. INTRODUCTION industry as USD 40 billion set to grow double in next 5 years. Healthcare industry is being evolved into managed healthcare with organized and well distinguished Another report from Datamonitor suggests that Global segmentation over last few decades. Level of IT Software & Services revenue shoot up by 10.5% to a automation and systems integration in some health value of USD 2239 billion in the year 2008 followed by establishments is amazing. Enormous amount of data is IT Consulting and Application Software at USD 501 being processed and stored every second with every billion and 78 billion, respectively. transaction. Typical applications of these systems are for online transaction processing. Unless these datasets are Although the managed healthcare and IT sectors are structured, organized, and visualized, wealth of nearly competing in terms of value, healthcare IT information cannot be leveraged in preventive expenditure is phenomenally low, limiting application healthcare and / or for medical research. software development or IT consulting services restricted to industry segments other than the healthcare. This paper attempts in bringing the concepts of geospatial information systems and temporal methods Legislations enabled healthcare providers to digitize and together to integrate storage, retrieval and analysis of maintain patient records in electronic form in some healthcare information in a streamlined fashion. countries, caused increasing demand for healthcare IT systems and services. Initial sections walk-through the reader on hidden opportunities in the healthcare IT sector. Subsequent 3. ELEMENTS OF HEALTHCARE sections on overviews of essential elements of spatial, INFORMATION AND ALLIED SYSTEMS temporal and healthcare systems throw light on potential integration opportunities. Sections on adding space and Healthcare Information System or HIS was time dimensions and leveraging contemporary predominantly administrative system for hospitals. As technologies discuss conceptual feasibility of the more facets of healthcare are getting integrated into HIS, subject. This paper concludes with summarizing the its scope became vast and complex. Modern day HIS are findings and future direction in the subject area of capable of extending the interfaces into external payer research. systems and implement country specific rulebase. 2. KEY STATISTICS Many allied systems like the Radiology or PACS integrate their outputs with the HIS. Below sections Datamonitor forecasts market value of the Managed provide a brief glance of several elements in a typical Healthcare sector to be touching USD 2,535 billion in healthcare system enabling to understand feasibility of the year 2009. Technopak valuates Indian healthcare

each subsystem for provisioning of spatio-temporal Device manufacturers supply PACS software along with dimensions to each or part of them. the devices. Modern day PACS systems store images in DICOM (Digital Imaging and Communication in 3.1 Electronic Medical / Health Record Medicine) format. These images are viewed by PACS workstations or even some of the RIS applications. EMR or EHR is the most vital aspect of a healthcare system. Lack of unified standard in structuring the fields Image processing techniques of PACS vary between the of a medical record and complexity of the medical implementations with efficiencies directly dependent on record often pose challenges in capturing the patient the hardware acceleration and algorithms. Varied data or even using it effectively. methods of data acquisitions among modalities do not deter adapting best practices in image registering, Although the EMR and EHR are used synonymously reconstruction and interpretation techniques. Research is there are distinctions as per Healthcare Information & under way in adapting satellite image processing Management Society (HIMSS). This paper treats both techniques like image convolution and high performance the terms synonymously and uses EMR where medical FFT even to medical imaging. practitioner’s access is predominant and uses EHR where patient’s access to the record is more emphasized. 3.5 Miscellaneous Components Data that flows into an EMR ranges from patient Healthcare IT comprises several other components and demographics, physiological parameters, pathology lab systems supporting ADT (Admit, Discharge, and inputs, inputs from radiology lab, clinical trials, etc. Transfer), Pharmacy, Clinical Data Management, Capturing data for an EMR happens in several ways Pathology Lab, Bed and Operating Room Management, based upon the application software, viz. data entry, Emergency Care, Payer Domain Systems, etc. Designers scanning the paper records and data migration from of effective healthcare IT solutions keep more priority other systems and case records. on business process flows like scenarios of end-to-end patient journeys in a healthcare setup. Although 3.2 Computerized Physician Order Entry workflows are important, more significant one is reliability of messaging and compliance to the CPOE involves entering physician’s instructions prevailing standards. including pharmacy orders into the system. Often this application is called as ePrescription. When combined 4. ELEMENTS OF GEOSPATIAL SYSTEMS with inventory system of the pharmacist, CPOE reduces cost of drug procurement. Tremendous research is Scope of geospatial information systems is vast and this happening in integrating data encapsulated in CPOE section discusses elements of relevance and of stores to support clinical decisions. conceptual importance to healthcare. For the benefit of applications in the healthcare, this section oversimplifies 3.3 Radiology Information System the traditional treatise on raster-based and vector-based systems and outlines key concepts. RIS applications store, manipulate and distribute patient data and imagery from several modalities like 4.1 Spatial Database System Computerized Tomography, Magnetic Resonance Imaging, Ultrasound, Digital Radiography, etc. Heart of any modern spatial information system is its data store. Data store can be a simple file or more RIS is central part of diagnostic healthcare since they complex object relational database, but it is more need to be interfaced properly with technically complex important to understand capabilities of the data store. systems like the Picture Archiving and Communication Systems (PACS) and other elements of the HIS. Spatial data store serializes complex and abstract data types like areas, buffers, and centroids. Programs built Messaging from RIS needs to comply with standards and into the database systems support several coordinate protocols like the HL/7 and DICOM. Properly defined systems and transformations. Some of the object RIS offers several features ranging from patient work relational systems even support storage of satellite list to modality work list and scheduling and modality imagery. management. Design of spatial index is utmost important in choosing 3.4 Picture Archiving and Communication System the database. Several schemes exist in spatial indexing from simple grid and quad-tree structures to more PACS applications are used to store and render data complex kd-trees. Power of the database system lies in from all modalities independent of any specific its query engine and spatial databases support many manufacturer and replace film radiology with digital locational predicates and spatial algebraic constructs radiology. like overlapped region of a polygon or even aggregation of component geometries.

4.2 Geocoding Thematic visualization helps taking decision like building viable care centres near to the patient Geocoding is a powerful feature that enables virtually population by inspecting spatial patterns and conducting anything to be location aware. In its most primitive proximity analysis. form, geocoding happens by entering patient’s demographic details like textual location along with 5. ELEMENTS OF TEMPORAL SYSTEMS precise geographic coordinates in the database system. Database supporting timestamps at attribute level is the Thus a particular patient can be mapped to a pair of major element of a temporal system. In a temporal coordinates at an instance of time. In its advanced form, system, attributes of a feature may change with entire EMR can be geocoded. When multiple EMRs for reference to time. Land use scheme of theme showing a single patient geocoded in different time intervals, vegetation 10 years back may be an arid zone later. One coordinate pairs at the origin of disease to be recorded. time patient with fractured limb a year back might have Default coordinate pairs alone relating to patient’s postal cured and readmitted a year later with influenza. address may not always help in analysing disease origin precisely. Temporal systems are event driven and capture all information with reference to change in attributes of a 4.3 Projection System feature or transformation of the feature itself. Each transient may not necessarily have a correlation between In order to display undistorted map, choosing an events like the case of influenza in the patient above. appropriate projection system is needed. For smaller But correlation can be made with prevalent diseases in applications and database projected data itself can be the area with respect to time and changed climatic stored in the data store, where as for huge systems conditions or even the impact of drugs administered to containing geocoded patient data records unprojected the patient in between different time intervals. storage of decimal latitudes and longitudes is recommended. Projection engine must be efficient Themes of the health conditions and spatial changes are enough to project chunks of datasets based upon the structured into continual frames in order to make a preserving parameters, viz, direction, shape, area, or movie clip which helps in decision making. distance. Archaeology institutes apply temporal techniques over DTMs to assess work in progress and have complete 4.4 Visualization Engine visualization on pending excavations. Spatial visualization is the major concept that distin- 6. ADDING SPACE AND TIME TO HEALTH guishes spatial information systems from others. Applications to healthcare are many with an efficient Classic visualization schemes are explained at length in query system. the GIS literature and many projects were undertaken in correlation of quality of health segmented over a region. For example, disease classification schemes like the These projects analyze impact of epidemics; forecast of ICD-10 (International Classification of Diseases) be at- vulnerable areas for spreading of a disease and many tached to the main HIS repository and be linked to pa- more applications. Altitudinal impact of health is being tient records even for active patients undergoing treat- researched as a major in academia as well in the ment, not just for morbidity reasons. military. Since patient records are already geocoded, direct asso- Convergence of image processing techniques like usage ciation between ICD and several coordinate pairs be of morphology is equally applicable on a biological cell achieved and created as a theme. Spatial pattern of dis- and remotely sensed satellite imagery of an arid region, ease can be obtained from thematic mapping. sedimentation or crater surface, while the intensity of techniques differing. Some software application vendors use visualization techniques like selective overlay of digital terrain mod- With position tracking techniques on a living organism, els and ortho-rectified images to produce three dimen- biological changes and impact of drugs can be analysed sional thematic maps. Usage of DTM associated with and often linked to earth’s magnetic intensity and patient data often provides altitudinal health patterns, altitude towards the physiological functioning of an which is another research area. In the context of health- organism. This dimension is studied only with larger care, one can associate several parameters to the map statistical base and proper interpretation of data like disease classification, morbidity rate, and drug im- visualized under spatial context. pact recovery time, to name a few. Standardizing the DICOM tags to associate precise locational data can uniquely identify the person at a

specific transient of time. With smaller image slices Properly anonymized case sequences and accessibility of identified with a locational tag across a specific the same across medical and research fraternity will geographic region, can aggregate data in different bring uniformity in treating patients and thus reduce cost scheme for conducting macro spatial health research. of healthcare. These techniques add security to teleradiology applications while preserving anonymity of patient to Commercial viability of health data grid is feasible in geocoded scheme. several manifestations and government organizations in some of the developed nations are in initial stages of 7. LEVERAGING CONTEMPORARY implementation in varied forms. There is a huge TECHNOLOGIES potential in public-private partnership in establishing spatio-temporal healthcare data grid and reap benefits. There is no dearth of technological advancements in the IT and hardware. Technologies are becoming simpler 7.2 Smart Cards conceptually, and architectures becoming more robust. With availability of more memory, processing power, Advances in smartcard technology allow larger non- increased standards of software development and volatile memory on smaller silicon area. Smartcards are reduced lifecycles of churning new products virtually in use for storing patient health records awhile. With every quarter, organizations can focus on leveraging common health data grid as explained in the previous opportunities with technologies available. subsection, individual can download his medical records from any authorized health data center. 7.1 Health Data Vault 7.3 RFID-enabled Tracking of Health Assets Health data is an asset for any medical facility or research institute. There is certain amount of ambiguity Radio Frequency Identifiers are used in larger shopping on the ownership of patient’s data stored in the malls and bookstalls for tracking the assets. In a modern radiology centres or hospitals. Added to the data storage healthcare set up, RFIDs are being used to track critical and ownership paradigm, data security concerns are of assets and resources. Interfacing RFID streams to a low paramount importance. Need arises in free and scale spatial system geocoded with the building plan controlled exchange of patient’s data across institutions helps visualizing movement of critical resources like for consultation and research purposes. medical staff and movement of surgical equipment, availability and utilization statistics of beds and operat- Data becomes a commodity and ownership rights on ing rooms. Serializing the RFID streams in frequent time sensitive information like the modality data blurs – intervals to the underlying spatial database provides his- whether patients owns or the diagnostic facility owns tory of movements of resources and health assets en- becomes a question. In the age of digital economy, abling security without having any physical surveillance. storage of information attracts cost per mega byte. 7.4 Healthcare Support Systems as Web service Here is an opportunity to store medical data in most accommodative way by distributing spatially in similar Software as Service is gaining momentum with esca- lines of the National Spatial Data Infrastructure (NSDI) lated software development costs and decreased IT initiative. Usage charges of data and fees per unit of data spending budgets. In such scenario few product manu- for long retention periods, say 20 years will benefit all facturers are transforming into software service vendors. the stakeholders. This concept is modelled after athletes With Service Oriented Architecture and XML based storing own blood in blood banks for later use and messaging schemes, exposing healthcare support sys- people susceptible to genetic diseases storing their stem tems to multiple health establishments with data security cells for long retention periods. Storing of vital health in place is viable. From end-user perspective, benefit is data in most accessible way is not going to be an enormous by using standard workflows and software exception. without need for coding a system from scratch. Inclusion of locational services beyond street mapping offered on Since medical data is huge in nature, some scheme of contemporary websites is desired in the supporting ar- storage needs to be planned in order to reap benefits of chitecture in order to visualize long-term benefits of faster access and ease of maintenance and scalability in having rich datasets as mentioned in the previous sec- magnitudes of several thousands. A spatial scheme of tion. storing medical data units as per patient’s geographic origin would create multi-dimensional indices. Time 7.5 Impact of Social Networking on Better stamps on each medical data unit add temporal Healthcare dimensions and users can visualize not single instance of an incident but all the history. Role of social networking can never be underestimated, especially since arrival of Web 2.0 and healthcare has no exemption. With organized usage of professional net- working, a doctor or health establishment is ranked by

the authorized patients with real examples thus benefit- Garets, Dave, and Davis, Mike, 2006, Electronics ing patients in general and chances of improving a par- Medical Records vs. Electronic Health Records: Yes, ticular health establishment with valuable feedback. There is Difference (HIMSS Analytics) Social rating system can be backed by historical data Gatrell, Anthony C, and Elliott, Susan J, 2009, captured over time and with powerful tools of spatial Geographies of Health: An Introduction, 2nd Edition analysis. Opportunity arises here in establishing a cen- (Wiley-Blackwell) tralized agency to monitor ratings of private as well as public hospitals in lines similar that of credit rating Gorawski, Marcin, and Dyga, Adam, 2009, Indexing of agencies. This is possible only by initiating capturing Spatio-Temporal Telemetric Data Based on Adaptive time-bound health information. Well established rating Multi-Dimensional Bucket Index, Fundamenta system makes doctors, health institutes and insurance Informaticae, Vol. 90 Issue 1/2, p73-86 companies more accountable benefiting the patient and exchequer to some extent. Goshtasby, A. Ardeshir, 2005, 2-D and 3-D Image Registration for Medical, Remote Sensing, and 8. CONCLUSION Industrial Applications (John Wiley & Sons) Healthcare sector is fragmented for its IT use and Harmon, John E., and Anderson, Steven J., 2003, The enablement. Adopting spatio-temporal elements in Design and Implementation of Geographic Information decision making, logistics, and research will provide Systems(John Wiley & Sons) tremendous opportunities for organizations, end-users and individuals at large. Since healthcare IT is still in Johnson, Ian, and Wilson, Andres, 2003, The TimeMap nascent stages, capturing spatio-temporal information in Project: Developing Time-Based GIS Display for early stages would benefit designing and implementing Cultural Data, Journal of GIS in Archaeology, Volume I forthcoming applications since data is more precious (Archaeological Computing Laboratory, University of than the software applications or processes. Creating Sydney) clean applications and retaining neat message interfaces from the initial stages itself will benefit seamless Kallem, Crystal, and David Gans, 2007, Aligning the integration and make applications future-proof. Demands for Performance Data, Journal of AHIMA 78, p56–60 REFERENCES Lisitsa, Alexei, and Potapov, Igor, 2009, On the Böcker, Michael, and Vogt, Joachim, 2007, Safety and Computational Power of Querying the History, Health in High-altitude Observatories, The Messenger Fundamenta Informaticae, Vol. 91 Issue 2, p395-409 127 (University of Copenhagen) Lowe, Henry J, 2003, The Electronic Medical Record, Chen, C.H., et all, 2006, Image Processing for Remote Stanford University School of Medicine Sensing, (Taylor and Francis) Muza, Stephen R et all, 2004, Altitude Acclimatization Claramunt, Christophe, and Thériault,Marius, 1995, Guide, US Army Research Institute of Environmental Recent Advances in Temporal Databases; Managing Medicine Time in GIS: An Event-Oriented Approach, Proceedings of the International Workshop on Temporal Databases, Neri, E., et all, 2008, Image Processing in Radiology - p23 - 42 (Springer-Verlag) Current Applications (Springer-Verlag) Datamonitor, 2009, Global Application Software Open Geospatial Consortium Inc, 2008, OGC Reference Industry Profile Model, Version 2.0 Datamonitor, 2009, Global IT Consulting & Other Pianykh, Oleg S, 2008, Digital Imaging and Services Industry Profile Communications in Medicine (DICOM) - A Practical Introduction and Survival Guide (Springer-Verlag Datamonitor, 2005, Global Managed Healthcare Berlin) Industry Profile Technopak Advisors, 2009, India Healthcare Outlook, Datamonitor, 2009, Global Software & Services Volume 4 Industry Profile The Economist Intelligence Unit, 2006, World ESRI, 2009, HL7 and Spatial Interoperability Standards Healthcare and Pharmaceuticals Forecast for Public Health and Health Care Delivery

Business Intelligence in Healthcare Abstract Jayakanth Dornadula Healthcare organizations are swimming in an ever-deeper pool of data. But without a and Sourabh Sarupria program in place to target, gather, deliver and analyze the most relevant data, these organizations will continue to be data rich but information poor. To achieve the full benefits of BI, healthcare organizations must take an enterprise wide, strategic approach vs. tackling small tactical projects, and realize that the greatest efficiencies come from integrating data historically in financial, operational and clinical systems. Cost savings are the main driver for implementing BI in healthcare organizations, followed by the need to improve medical outcomes. A strategic approach to BI, which cuts across the organization, requires buy-in from not only top executives but also physicians and clinical staff. This paper brings in the Need, Challenges, applications and Framework of Business Intelligence in Healthcare.

INTEGRATING GIS IN HEALTH CARE PLANNING: GOVERNMENT INITIATIVES IN ORISSA STATE OF INDIA G. Mathivathanan and Mithun Karmakar National Rural Health Mission (NRHM), Dept. of Health & FW, Govt. of Orissa Nayapalli, Unit-8, Bhubaneswar-751012 [email protected] ABSTRACT: The environmental degradation, socio-economic decline, and extreme weather patterns are contributing to changing pattern of morbidity and mortality and posing serious challenge to public health. The problems of health are increasing in both spatial and temporal dimension to many newer places, especially in the rural areas due to increased risk of disease transmission fuelled by developmental activities, demographic changes and introduction of newer products. However, with advanced knowledge on the principles underlying the disease transmission dynamics, prediction of occurrence of diseases is possible based on environmental factors and satellite-based remote sensing data. Limited physical access to primary health care is also a major factor contributing to the poor health of rural populations in India. Emerging technological developments like remote sensing, Global Positioning System and Geographical Information Systems (GIS) have now come in handy to address the issues on the disease surveillance, control, monitoring and evaluation. GIS, integrated with GPS and remote sensing, provides an environment for surveying, collecting information and analyzing environmental factors as well as socio-demographic controls responsible for occurrence and dispersal of diseases. In this context, NRHM-Orissa has emerged as a pioneer in the country to incorporate this technology in its planning, monitoring and evaluation process with proven success. Key Words: Health, Socio-demographic factors, Environmental Factors, GIS, Disease Surveillance 1. INTRODUCTION physical access to primary health care is also a Ever increasing population and lack of adequate major factor contributing to the poor health of rural health care facilities, particularly for the rural populations in India. Emerging technological masses are a matter of concern for India. The developments remote sensing, Global Positioning continued practice of open drainage system, System and Geographical Information Systems indiscriminate disposal of water and industrial (GIS) have now come in handy to address the issues effluents into water bodies, and added to this, the on the disease surveillance, control, monitoring and increased migration from rural areas have resulted in evaluation. GIS, integrated with GPS and remote large slums in our urban centres creating an sensing, provides an environment for surveying, environment unsuitable for healthy living and thus collecting information and analyzing environmental aggravating the spread of water-borne diseases like factors as well as socio-demographic controls cholera, typhoid, tuberculosis, dysentery and responsible for occurrence and dispersal of diseases gastroenteritis. The environmental degradation, (Fig. 1). So our responsibility in the immediate socio-economic decline, and extreme weather future should be to provide technical information on patterns are contributing to changing pattern of these, facilitate formulation of policy, preparation of morbidity and mortality and posing serious strategic plan, and promote effective linkages with challenge to public health. The problems of health all partners. This article explains how GIS facilitates are increasing in both spatial and temporal utilization of resources, preventing disease and dimension to many newer places, especially in the promoting health care, working towards the overall rural areas due to increased risk of disease rural development and thereby ensure sustenance of transmission fuelled by developmental activities, the programme at all levels. Infact Orissa is one of demographic changes and introduction of newer the leading States in implementing GIS based health products. However, with advanced knowledge on sector planning in India. The scope of GIS assumes the principles underlying the disease transmission significance as most of the activities envisaged in dynamics, prediction of occurrence of diseases is NRHM Programme, health determinants, diseases possible based on environmental factors and surveillance, etc are being monitored and planned satellite-based remote sensing data. Limited through a GIS based health information System.

Some of the initiatives taken up by the health Orissa by applying GIS technology, are discussed department under National Rural Health Mission, below. REMOTE GPS GIS SENSING MAPPING INTEGRATED PROJECTING APPROACH (Health Care Facilities, (Requirements, Service Providers, ) IDENTIFYING Priority Areas) MONITORING (Gaps, MODELLING Unserved Areas, (Geographical Spreading Diseases, (Evaluating Alternatives) Programme Performances ) Loopholes ) MEASURING PRESENTING (Impact of Initiatives, (Upto Date & Timely Disease Degree of Achievement, Scenario, Requirements) Programme Performances, Facility Status ) Fig. 1 2. ANALYZING THE SPATIAL DIMENSION OF INCIDENCE OF DISEASES Based on secondary data sources available with various Cells under Disease Control Programme, spatial dimension of various diseases like TB, malaria, diarrhea, leprosy, HIV, polio, etc, are being mapped. Based on the GIS analysis, action plan on the steps to be taken in terms of allocation of more resources to endemic prone areas on priority basis, training of health personnel, public awareness campaign, etc are being made. 2.1 Case Study: Kashipur, Diarrhea outbreak During last year (2007), diarrhea took the shape of an epidemic in Kashipur block of Rayagada district killing 51 people and affecting more than 5000. In order to prevent such epidemic this year a detailed action plan by the Health Department was prepared in which GIS based analysis (undertaken by NRHM Orissa) played a significant role in identifying the vulnerable Villages (Fig. 2) and preventive steps to be taken to counter the occurrence of diarrhea this year. Fig. 2

2.2 Case Study: Polio Mop Up landmarks, roads, etc which helped them in planning the booths for polio mop up. Similarly, A case of wild polio virus was detected in Polio was detected in a village called Golabandha Bhubaneswar urban slum area on April 2008. So, under Rangeilunda block of Ganjam District for in order to plan a responsive mop up on polio which detailed GIS based analysis was done (Fig. vaccination, the National Polio Surveilance 3), which proved to be very effective for the Programme, Bhubaneswar unit was provided a concerned officials to plan mop up programme. detailed GIS based analytical map showing slum area, urban healthcare facilities, important Fig. 3 3. ANLYZING SERVICE AREA COVERAGE OF HEALTH UNIT & IDENTIFICATION OF UNDERSERVED AREAS In order to analyze the area coverage of each getting basic health care facilities. This also helped subcentre and its proximity & accessibility, sector in allocating additional resources to these maps were prepared for each block of Deogarh underserved villages through Mother NGOs. district. It helped in finding those villages which Underserved subcentres of 17 districts have been remain underserved or inaccessible in terms of mapped (Fig. 4).



Fig. 4 4. DIGITAL TERRAIN MODELING IN HEALTH CARE PLANNING Digital terrain modeling is the method of representing terrain, which along with landuse / landcover, plays a vital role in evaluating physical accessibility of health care facilities in respect to their location and situation, so that proper intervention can be ensured. In this context Fig. 5 and Fig. 6 represent an attempt made by NRHM to perform the similar task for Malkangiri district in order to identify the Subcentres lying in physically inaccessible areas and to initiate specific health activities in collaboration with NGOs. The same has been planned to be done for the whole state. 5. URBAN HEALTH GIS Provision of assured and credible primary health services of acceptable quality is a priority for both the Central and the State Governments in view of the increasing urbanization and growth of slums and low income population in the cities. In this regard Mission Directorate, NRHM, Orissa has developed Urban health GIS (Fig.7) for 8 class-I urban centres of Orissa namely, Bhubaneswar, Cuttack, Berhampur, Rourkela, Puri, Sambalpur, Balasore and Baripada, using advanced techniques of Global Positioning System (GPS), Remote Sensing and GIS (Geographic Information System).

Fig. 5 Fig. 6

Ward No.10 URBAN HEALTH GIS Fig. 7 Methodology An integrated approach of GPS survey, Remote Sensing data and GIS with reference inputs from authentic secondary sources was used for carrying out the activity. The following layers of information were generated: Administrative Boundaries: Municipality/ Urban area boundary, Ward Boundaries Transport Network: Roads, Railways, Water Bodies: Natural Drainage, rivers, Ponds. Health care Facilities: Government, Private, NGO run. Other Important Locations: Slums, Police Stations, Institutions, Administrative offices, Monuments, Railway Stations, Market, Major Squares, Industrial area, etc. Attribute database: Data related to facilities available in each of the surveyed health units was also collected through a questionnaire format developed by Mission Directorate. The format is available in the NRHM Orissa website for future updation by respective health units and for new additions to the current database. Rationale The Urban Health GIS helps in: analyzing the availability and density of health care services and facilities analyzing proximity and accessibility of health care services and facilities to urban residential areas, slums areas, important institutions and administrative offices. analyzing the specialist services available in various govt./ private health units and their geographical concentration. The survey will also help in identifying the various AYUSH institutions available in the urban areas and the various health care treatment provided by them. Identify Potential private partners for either tier to improve the quality and standard of health among the urban poor, to capitalize on the skills of potential partners, encourage pooling of resources, and to reduce the investment burden on the government. It will help in Strengthening Monitoring and Evaluation of urban health care system by regular updation of the database. The database is available in the NRHM Orissa website so that every health concerned person can know Where is My Doctor ?.

6. CONCLUSION Buckeridge, D and L. Purdon, “health data mapping in southeast toronto: a collaborative One of the primary goals of public health, and of project”, in geographic information systems in many health care providers, is to maximize the public health, third national conference, Toronto, impact and effectiveness of limited resources in Canada improving health care. However the most important problem is the availability of health care planning Burrough, P.A.(1987),“Principles of Geographical organizations equipped with rich database and Information System for Land Resource planning tools. In the area of public health and Assessment”, Clarendon Press, Oxford. health care management, geographic information system (GIS) technology has emerged as a Chorley, R. and Hagget, P. (1967) “Models in powerful tool for integrating and communicating Geography”, Edward Arnold Ltd., London. information, a tool that offers significant advantages over traditional methods for health Giok Ling Ooi and Kai Hong Phua, Urbanization surveillance as well as to develop a spatial analysis and Slum Formation, Journal of Urban Health: and modeling support system for forecasting future Bulletin of the New York Academy of Medicine, health care needs and planning health management Vol. 84, No. 1, 2007 programs. In this context, NRHM-Orissa has emerged as a pioneer in the country to incorporate Longley PA, Goodchild MF, Maguire DJ, Rhind this technology in its planning, monitoring and DW. 1999. Geographical information evaluation process with proven success. systems:Principles, techniques, applications and management. New York: Wiley. REFERENCES Stern RM. 1995. The added value of geographical A situational analysis on the availability and use of information systems in public and environmental health services in urban slum areas of major towns health. In: Environment and health data in Europe of Orissa (2003), Infant Mortality Reduction as a tool for risk management: Needs, uses and Mission, Govt. of Orissa & Development strategies. Stern RM. Boston: Kluwer Academic Innovators, Bhubaneswar. Publishers. 3–24.

Technical Session - 4 Emerging Diseases -1 Survey about Congenital Hypo Thyroidism Patients Follow up and Prevalence from 2005 to 2008 at Tehran University's Region Azita Karimi, Fatemeh Haji Ali Asgari, Hamid Khodabandehloo Soltani and Mahdiyeh Khan Mohammadi …………………………………………………………………………..…....83 How to Integrate High Spatial Resolutions in Health Impact Assessment for Traffic Related Air Pollution in Flanders, Belgium? Stijn Dhondt, Wiedemann Torsten and Hens Luc.……………………………..…………………................85 GIS Application in a Social Gerontology Study in Baguio City, Philippines Alicia G. Follosco , Ma. Cecilia San Luis and Ma. Ana B. Diaz…….……………………………..……….90 The Relationship between Inversion and Tehran Air Pollutants by using Multiple Variation Regression Test (Synchronous Entrance Method) Saeid kamyabi and Mahnaz Parvazi..………..…………………………..…………………………………..95 Filariasis Monitoring and Visualization System P. Sampath Kumar, Y.V.S. Murthy, M. Srinivasa Rao, K. Sri Ram, K. Madhususudhan Rao and U. S. N. Murty..………..……………………………………………..………….………………………100 Using GIS in Explaining Spatial Distribution of Brucellosis in an Endemic District in Iran Ali-Akbar Haghdoost, Leo Kawaguchi, Ali Mirzazadeh, Hossein Rashidi, Afshin Sarafinejad, Ali-Reza Baniasadi and Clive Davice..………………………………..……...…………………………..…105

SURVEY ABOUT CONGENITAL HYPO THYROIDISM PATIENT S FOLLOW UP AND PREVALENCE FROM 1384TO 1387 AT TEHRAN UNIVERSITY S REGION. Azita Karimi, Fatemeh Haji Ali Asgari, Hamid Khodabandehloo Soltani and Mahdiyeh Khan Mohammadi Tehran University of Medical Sciences, Tehran, Iran Email: [email protected], [email protected] ABSTRACT: It is an important cause of mental retardation that can prevented and defined as plasma TSH Above 5mu/l on filter paper at 3-5 days after birth. Most hypothyroid newborns have very few or no symptoms and signs before discharge from the nursery and are detected by screening although infants appear NL at birth. It was descriptive cross sectional study, which data gathered from new born screening centers of this university. 70046 neonate were screened (34247 girls & 35799 boys). 47654 cases were examined at 3-5 days after birth. 332 patients were recognized in Tehran university region. 274 patients were treated before end of first month of birth. New born screening is the best method for early detection of hypo thyroids (especially at 3-5 days after birth). Normal IQ if treated early, if not so: progressive loss of IQ, 5 points monthly. Also it causes for gathering important information about epidemiology & physiopathology of this disease. KEY WORDS: IQ, screening, hypothyroidism, mental retardation 1. INTRODUCTION Transient hypothyroidism 1: 40000 - drug induced - Thyroid Hrn. Is essential for normal CNS maturation: maternal antibody induced - idiopathic neuro genesis, neural cell migration, dendrite and axonal growth, gliogenesis …This Hrn. Has effects on Clinical Presentation: Most hypothyroid newborns have development of the visual and auditory cortex and basal very few or no symptoms and signs before discharge ganglia, and it dependent brain development extends from the nursery and are detected by screening until 2 - 3 years of post natal life. The most critical period of dependence is the first 6 - 8 months postpartum. Applications to Human Infants Neonatal hypothyroidism is decreased thyroid hormone • Severe iodine deficiency in fetal & maternal production in a newborn. In very rare cases, no thyroid hypothyroidism : MR, deaf mutes, spastic diplegia hormone is produced. & microcephaly If the baby was born with the condition, it is called • maternal hypothyroidism : impaired cognitive congenital hypothyroidism. If it develops soon after function of the offspring birth, it is referred to as hypothyroidism acquired in the newborn period. • infants with cong. Hypothyroidism born to euthyroid mother :normal IQ if treated early, if not so : progressive loss of IQ, 5 points monthly Etiology of Congenital Hypothyroidism: Thyroid Neonatal Screening digenesis 1: 4000 – agenesis - hypo genesis – • Before screening : among 800 children with cong. Hypothyroidism mean IQ was less than 80 ectopic • After screening : infants with hypothyroidism Thyroid dyshormonogenesis 1 : 30000 - TSH detected by screening 3 - 6 days after birth had normal mean IQ unresponsiveness - iodide trapping defect - • check TSH if: the lowest 10% to 20% of T4 level organification defect - defect in thyroglobin - CH with normal T4 and high TSH will be missed (15-20% of CH) iodotyrosine deiodinase deficiency Hypothalamic- pituitary hypothyroidism 1 : 100000 - hypothalamic- pituitary anomaly - panhypopituitarism - isolated TSH deficiency - thyroid hormone resistance

Check T4 if: TSH > 20-25mu/ml (3-5 days) and very top students from abroad; · has more students in medical based courses than any other higher education secondary hypothyroidism will be missed (1/50000).CH institution in Iran. It is covered south of Tehran, eslamshahr and ray. with decreased T4 and delay in TSH rising will be 3. MATERIAL AND EQUIPMENT missed (10% of CH). Deficiency of TBG will not be The screening was present in all centers of neonatal identified. Both programs will miss 5% of CH screening from 1384 (2005). Tums University has 11 screening centers for neonates. Our data gathered from 3- Evaluation of Congenital Hypothyroidism: 5 days neonates (from hills) of these centers. Now in Iran are diagnosed gene defects with genetics exam for • Diagnosis of cong. Hypothyroidism if : patients & their parents. There is do abortion if it s defect • 3 - 5 days of life: TSH > 5 mu/l it needs is diagnosed in other pregnancies and there is genetic consultation for familial marriage too. evaluation of other lab. Such as T4,T3RU,TSH Possible Complications    Treatment:  Mental retardation Early diagnosis is very important. Most of the effects of  Growth retardation hypothyroidism are easily reversible. Replacement  Heart problems therapy with thyroxin is the standard treatment of hypothyroidism. Once medication starts, thyroid blood Prevention: If pregnant women take radioactive iodine tests are regularly done to make sure levels are within a for thyroid cancer, the thyroid gland may be destroyed in normal range. Start with 10-15mic/kg/d Levothyroxine . the developing fetus. Infants whose mothers have taken Measure TSH and FT4 after 7, 14, 28 days of Rx. then such medicines should be observed carefully after birth monthly to age 6 months, then at 3-month - interval to for signs of hypothyroidism. age 2 yrs and annually thereafter. 4. CONCLUSION Blood tests will be done to check thyroid function. Other tests that may be done include: The maps are prepared using GIS to visualize the situation of one important this disease, CH. The world is  Thyroid scan fighting to eradicate it. Many countries have screening  X-ray of the long bones   programs for detecting that. The use of GIS has shown the impact zone .GIS helps in analyzing the available 2. HISTORY ABOUT MEDICAL SCIENCE OF information as a result the system can become more TEHRAN UNIVERSITY efficient, productive and capable to make up the future tasks very efficiently .This study is a representative of The first modern center for medical training in Iran was any public health system in the developing country. It is founded in 1851. It was a part of the Institute for Higher suggested that the similar study is done for the larger area Education (Dar-ol-Fonoon). The School of Medicine was would become more useful and effective established as a part of the University of Tehran in 1934. It is the oldest and the most outstanding medical center REFERENCES in the I.R. of IRAN; · is one of the country's top research universities, receiving an annual grant of over 300 billion Harris KB, Pass KA. Increase in congenital Rials from the government; · accepts applications from hypothyroidism in New York State and in the United only the most qualified Iranian high school graduates States. Mol Genet Metal. 2007; 91(3):268-277. who have already passed the National Entrance Exam Alan Greene, MD, FAAP, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital; Chief Medical Officer, A.D.A.M., Inc. Previously reviewed by Robert Hard, MD, Professor

of Endocrinology, Department of Biology, Xavier University, Cincinnati, OH, an

HOW TO INTEGRATE HIGH SPATIAL RESOLUTIONS IN HEALTH IMPACT ASSESSMENT FOR TRAFFIC RELATED AIR POLLUTION? Dhondt Stijn, Wiedemann Torsten and Hens Luc Vrije Universiteit Brussel (VUB), Human Ecology Department, Brussels, Belgium [email protected] ABSTRACT: The adverse effects of transport-related air pollution on human health are widely recognized. Geographic Information Systems (GIS) are increasingly being applied in environmental health risk studies to assess the relation between traffic exposure and health. In this paper we present a methodology of the application of GIS in Flanders, in the North of Belgium, to assess the health impact of traffic related air pollution. Flanders, one of the densest regions in world and characterized as one urban nebula, has one of the most dense road networks. When assessing the relationship between pollution and health it is therefore essential to use high-resolution maps from both exposure and health data. Exposure data are provided into grid cells of 1x1km, for health indicators confidentiality issues restrict such a detailed assessment, but still allow sufficient level of detail to perform a health impact assessment. In this paper the assumptions are discussed when integrating the different datasets required for a health impact assessment. Two main issues prevail in this discussion: which geographical level to use as the master geography level and with methods to use to recast data to different levels. In this paper we propose dasymetric mapping through the use of postal address points as recasting method and the use of the municipality level as the master geography level, as it still offers sufficient level of detail on which to base the calculations in the health impact assessment. KEY WORDS: Health Impact Assessment (HIA), exposure assessment, transport, air pollution, Geographic Information Systems (GIS) 1. INTRODUCTION For health studies, such as health impact assessments and epidemiology it is essential to Flanders, the Northern part of Belgium, is a rely both on accurate and detailed population and highly dense region and has one of the most health data, as well as clearly defined exposure dense road networks. Transport is one of the assessments (Jarup, 2004; Beale et al., 2008). main contributors to the emissions of air However, while current technologies are able to pollutants, including particulate matter (PM) and provide very detailed environmental hazard nitrogen dioxide (NO2). On average the maps, e.g. ambient and individual air pollution contribution of transport to PM10 in Flanders is concentrations, health data are more than often 28% and 35% for PM2,5 (Dumont et al., 2005). only available on an aggregated level. Therefore For NOX the share of traffic was 44% of the total many epidemiological and health studies need to NOX-emissions in 2002 (Fierens, 2008). Recent recast areal data to new zone design systems to research consistently indicates that outdoor air integrate the different data sets. This process pollution harms health, and points to air pollution involves two major choices: which zone design stemming from transport as an important system to use as the master geography, and how contributor. to redistribute the source data to these target Health impact assessments (HIAs) allow zones (Briggs et al., 2007a). This paper tries to quantifying the effect of transport emissions on find the most suited solutions to these questions. health (Künzli et al., 2000; Forsberg et al, 2005). The main steps of a HIA serve as a guideline in In this paper, methods are explored to integrate the motivation of the methodological choices all required data, such as concentration, health being made. and population data, using GIS, in order to estimate the impact of traffic related air pollution on health in Flanders. 1