Geo ICT for Epidemic Control and Healthcare - 2015

GIS In Planning, Implementation and Monitoring Of National Health Programme - National Leprosy Eradication Programme Reetika Yadav and Anil Kumar DGHS, India E-mail: [email protected], [email protected] ABSTRACT The use of GIS in National Leprosy Eradication Programme is an application area still in its infancy, however, it is recognized as providing potentially transformational capabilities in public health efforts. GIS mapping systems provide an excellent means of analyzing epidemiological data, revealing trends, dependencies and inter-relationships that would otherwise remain hidden in data shown only in a tabular format. In order to strengthen planning, implementation and monitoring of activities in Central Leprosy Division, it was suggested to create a roadmap for activity in high endemic districts. This special activity also called as Leprosy Case Detection Drive is to be conducted over a period of 15 days in which house to house search for leprosy cases would be carried out in a campaign mode. GIS mapping was used in analysis of annual data received from all states and UTs for the financial year 2014-15 as spreadsheet or database table alone is not easy to interpret. Preparing GIS maps enabled visualization of district wise data pertaining to annual new case detection rate and prevalence of the disease spatially which was previously done manually. Pinpointing of high endemic districts in a color coded fashion helped us in micro planning for the special campaign in 50 high endemic districts across seven states. Since pockets with adjacent high endemic districts could be easily discerned visually, we could plan for a more impactful campaign both in terms of cost and output. Further, GIS can help in spatial focussing by creating buffer areas around child cases detected and cases detected with disability during the special activity for further contact surveys. Further scope of use of GIS in NLEP includes. 1) Tool to continuously monitor whether programme objectives are being achieved. Serial comparison of data over time to see for reduction in disease burden and transmission. 2) Serial comparison to look for increased endemicity of disease in a particular region to initiate epidemiological investigation into the cause for resurgence. 3) Establishing correlation of leprosy with socioeconomic indicators to initiate corrective actions in coordination with the concerned ministry. KEYWORDS: Leprosy Case Detection Drive, buffer areas, epidemiological investigation, management tool

Animal Health Management and Intensive Livestock Production Analysis by using GIS and Remote Sensing Ravi Kumar, Mohammed, N., Abhimanu and Kataria, A. K. Centre for Excellence for Use of Space Based Technology in Animal Science College of Veterinary and Animal Science, Rajasthan University of Veterinary and Animal Sciences, Bikaner, India, E-mail: [email protected] ABSTRACT Livestock diseases are the greatest impediments in livestock production systems. Causing population and production losses with many subsequent financial impacts as well as risk to human health through communicable disease. Livestock disease management can reduce these losses through improved animal husbandry practices viz. controlled breeding, controlling entry to farm lots, and quarantining sick animals and vector control techniques etc. The paper aims to describe and give an overview of the possibility and potential use of GIS (Geographical Information System) in the field of surveillance and monitoring of animal disease. A GIS can be used as significant tool for any discipline, which deals with the data that is related with geographical locations such as regions, countries, or community. GIS has been used as decision support system for control of infectious diseases in animals. The developments in Information Technology over the past few decades are tremendous and offer great potential in improving animal health through various measures like effective disease forecasting, rapid and accurate disease diagnosis, modern therapeutic measures etc. Epidemiology of livestock disease and production management could be understood in a better way by using advantages of mapping locations of farms, animal population and other facilities for livestock. In case of a disease outbreak it could make the management of the situation efficient and easier, and also provide a tool to evaluate different strategies in preventing the spread of infectious disease. GIS has evolved as an essential tool which is required everywhere in livestock disease management. Strategies can be formulated and can be generated with the help of GIS. KEYWORDS: Animal Health, Livestock Production, GIS, Remote Sensing, Epidemiology and Disease Control

Spatial Epidemiology and Prevalence of Mycobacterium avium Subspecies paratuberculosis Infection in Cattle Herds of Tamil Nadu Vinodh Kumar, O. R,1 Gunaseelan, L.,2 Sinha, D. K.1 and Singh, B. R.1 1Division of Epidemiology, ICAR-Indian Veterinary Research Institute, Bareilly-243 122, India E-mail: [email protected] 2 Tamil Nadu Veterinary and Animal Sciences University, Chennai, India ABSTRACT Paratuberculosis or Johne’s disease (JD), caused by Mycobacterium avium subspecies paratuberculosis (MAP), is the most important disease of domestic ruminants causing substantial economic losses to the livestock industry world over due to reduced milk production, loss of body condition, progressive weight loss, diarrhoea, emaciation and death. Sampling was done between 2008 and 2011 in Tamil Nadu (13.0900° N, 80.2700° E) using single stage stratified sampling of 1034 dairy cattle selected. By use of standardized questionnaire the epidemiological data regarding animal, environment and owner details were collected. The collected faecal samples were processed for IS900 PCR and serum for antibody based ELISA. Statistical analysis was performed by initial univariate analysis of the influence of the different independent categorical variables on the MAP status (positive/negative) using chi-square test. The variables associated with positivity at P ≤ 0.05 at the 95% confidence level were tested for colinearity and included in a multivariate logistic regression model (SAS, 8.2). The spatial mapping and interpolation (inverse distance weighted) was done with Quantum GIS 2.8.2. The cluster analysis was performed by SaTScan 9.1 and spatial analysis was performed by R 3.2.2 software. The PCR and ELISA showed high statistical significant difference in chi-square model (233.18**, P≤0.01). The linear regression analysis showed significant difference between artificial insemination per conception (OR= 1.463, 0.27**), milk yield (OR= 0.702, - 0.011**) and body condition (OR= 0.235, -0142**). The prevalence of paratuberculosis on animal basis was 12.24 per cent. KEYWORDS: spatial mapping, paratuberculosis, cattle

Travel Time to Reach Health Facilities in Disadvantaged Regions: Evidence on the Supply And Demand Sides of the Health System using Network Analysis Lalitha Vadrevu Indian Institute of Health Management Research, India, E-mail: [email protected] ABSTRACT In the present article we explore the issue of geographical inaccessibility from the supply and demand sides of the health system using network analysis. The article is based on the GIS study conducted in Patharpratima Block of the Sundarbans. All health facilities and road and water transport networks were mapped as a part of the study. We used ARC GIS 9.3.1- network analyst, to analyse travel times and map service areas of the facilities to assess the access issue from the demand side of the system. We also present results from the facility based survey exploring the issues that providers face due to geographical inaccessibility. The results show that the block has a serious shortage of primary health facilities. Although the sub centres- the first point of contact in the health system – are adequately placed and can be reached by majority of the villages in the region within 20 minutes of travel, the primary health centres take almost an hour in most of the villages. 30 out of the 87 villages in the block did not have access to any primary health centre within 60 minutes of travel time. Of the 57 villages that can access a primary health centre within 60 minutes, the average time was 38.76 minutes. Geographical Inaccessibility also surfaced as an important factor from the supply side. The facility assessment showed that logistics, equipment maintenance and transport were the key issues faced by the facilities. Long travel times to reach the health facilities, is a major impediment in remote and geographically challenged regions like the Sundarbans. They influence the general operation of health centre along with accessibility to the population. There is an urgent need to improve transport network and develop context specific solutions to improve coverage. KEYWORDS: access, health system, network analysis, health work force, Sundarbans

Air pollution Exposure Assessment in Urban Slums of Mumbai Abhay Anand IITB, India, E-mail: [email protected] ABSTRACT The aim of this study was to assess the outdoor PM2.5 and BC exposures in four urban slums of Mumbai and their intra and inter spatio-temporal variations using mobile monitoring technique. DustTrak and microAeth were employed to measure the real time PM2.5 and BC concentrations. The PM2.5 concentrations were observed to be similar in all of the four slums, whereas BC concentrations were not similar in all the four slums with high concentration observed in three of four slums which are in the periphery of heavy traffic roads. The spatial distribution of PM2.5 concentrations was comparatively homogeneous within each of the four slums where as it was observed to be heterogeneous in the case of BC concentrations. Multi variable regression analysis shows that type of road and type of slum are the significant predictors of outdoor PM2.5 and BC concentrations with the model explaining 71% and 47% variability in BC and PM2.5 concentrations. This study shows that the people living in all the four monitored slums are exposed to high levels of PM2.5 and BC, with the population residing along heavy and medium traffic roads being the most exposed KEYWORDS: Air pollution exposure, Urban Slums, Mobile monitoring, Black Carbon Fine Particulate Matter, Multivariable Modeling

Need of Geo Spatial Analysis while Converting Wet Lands to avoid it be a breeding Ground for Mosquitoes – Study of Thiruvallur Town Yogan Gandhi Raja,1 Sindhu Maheshwaran,2 Edith Esther Edwin,3 Balasubramaniyan Mani4 and Ghouse Mohamed Shaik5 Sri Venkateswara College of Engineering and Technology, Thirupachur, Thiruvallur Anna University, Tamil Nada, India, E-mail: [email protected] [email protected],2 [email protected],3 [email protected] [email protected] ABSTRACT Mosquitoes kill two to three million people and infect another appx. 200 million every year by transmitting malaria. Ten millions are killed by host of other mosquito-borne diseases, including filariasis, yellow fever, dengue and encephalitis. We think malaria is something other people get somewhere else. Even residents of the United States are not immune. Mosquitoes are capable of carrying and transmitting malaria still inhabits most parts of the country. Influx of malaria-infected persons has produced localized malaria transmission in some areas of the countries. The threat of developing encephalitis from mosquitoes is far greater than the threat of malaria. Encephalitis, meningitis and other diseases can develop from the bites of mosquitoes infected with certain viruses. The hazard urban development of Thiruvallur is studied to form Geo spatial data base using GPS, Cloud Computing and Information Technology with 3G internet network. The Task of Creation of Geo spatial database of Ground Water quality of study between Cooum and Kakkalaur Tank in Thiruvallur is given to Sri Venkateswara college of Engineering and Technology Thirupachur, Thiruvallur with Private Public Participation. The project is funded by Department of science and Technology, Govt of India, to form Public Health Data Management system in networking mode with 14 Research institutions in Hospitals, Universities, Colleges who have expertise in their area. The project area was once wet lands with paddy cultivation, The Development has taken place in bits and pieces as housing colony of NGOs, Poonga Nagar, VOC Nagar, Ma Po Si nagar, Indra Nagar, MGR Nagar, Railway colony Housing boards flats were developed in isolated condition. Southern Part is in under Thiruvallur Municipality with better roads and drainage. Whereas the Housing Colonies in North are Kakkalur Panchayath with narrow lanes. The septic tanks and water wells are in each house under health hazad. The open drainage line carrying bath room and Kitchen water from Houses are not having flow and has become the breeding ground for mosquitoes and other bacteria, Contamination of surface water and ground water is studied to keep the drainage lines clean and dry. 30 % plots are vacant with grasses. These vegetation is also assisting Mosquito growth. The GIS has been created indicating environment and health hazard which helps breeding of mosquitoes. 1. INTRODUCTION sucking up fluids) and the hair-like scales on Mosquitoes belong to the family of insects its body. The female mosquito’s live for few known as diptera, or flies. Mosquito means weeks or a month while Males typically live “little fly” in Spanish. Diptera means “two only about a week. Mosquitoes hatch from wings” which distinguishes flies from other eggs laid in places which are or to be filled types of insects5. A mosquito is different with water. The eggs hatch into worm-like from other types of flies because of its larvae that usually lie just beneath the proboscis (long tubular mouthparts for water’s surface, breathe through tubes on

the tail end of their bodies, and feed on 2. CULEX MOSQUITOES microscopic organisms, such as bacteria. Culex are medium-sized mosquitoes6 that Most mosquitoes attack birds and are brown with whitish markings on the mammals, though some feed on the blood abdomen. These include the house of reptiles and amphibians (Figure 1). mosquitoes (C. pipiens and C. quinquefasciatus) in urban areas and the western encephalitis mosquito (C. tarsalis) found in rural areas. They typically bite at dusk and after dark. By day they rest in and around structures and vegetation. The West Nile virus is transmitted by Culex mosquitoes. Culex lay “rafts” of eggs on still water (Figure 2). Figure 1: Hatching process of formation Figure 2: Culex Mosquitoes (House lava which remains at the top of water to Mosquitoes) breath 3. AEDES MOSQUITOES Only female mosquitoes bite, because a The Aedes group of mosquitoes includes blood meal is usually required for egg many nuisance mosquitoes, as well as laying. All male mosquitoes, and the species that transmit disease to humans. females of a few species, do not bite. They This is a diverse group that includes the feed on nectar and other plant juices inland floodwater mosquito (Aedes instead of blood. Usually within three days vexans), the Asian tiger mosquito (Aedes the pupa will transform into an adult albopictus). Flood water mosquitoes lay mosquito. The larvae of some mosquito their eggs on soil that becomes flooded, species eat larva of other species though allowing the eggs to hatch and larvae to the predatory larvae of some species will develop in temporary pools. Asian tiger develop into blood-feeding adults. They and tree hole mosquitoes are container- can detect carbon dioxide exhaled by breeding mosquitoes, laying their eggs in their hosts many feet away mosquitoes also small, water-filled cavities, including tree sense body chemicals, such as the lactic holes, stumps, logs, and artificial containers, acid in perspiration. Some people are more such as discarded tires. Adult Culex attractive to mosquitoes than others mosquitoes do not fly far from where they mosquitoes can fly long distances; some develop as larvae. And unlike other more than 32km from the water source that mosquitoes that die with the coming of the produced them. But they don’t fly about 4 first hard frost in autumn. The house miles an hour. They typically fly into the mosquito can “over-winter” in protected wind to help detect host odors. When it places like sewers, crawlspaces and finds one, it injects saliva into the wound. basements (Figure 3). The saliva contains an anticoagulant that ensures a steady, smooth flow of blood. Unfortunately, the mosquito’s saliva also may contain pathogens such as malaria parasites or encephalitis virus.

Figure 3: Vegitaion near vacant pots near 5. STUDY AREA houses The high resolution Geo-eye imagery of part of project area1 in Thiruvallur,Tamil Nadu at Mosquitoes rest on vegetation and the the junction of Avadi road and exterior walls of structures. This involves Poonthamalle road is shown in Figure 4. Both applying liquid pesticides as a coarse roads and streets, housing colonies of part of spray. Reducing the amount of vegetation Jaya nagar at west, Kakkalur area along the around the edges of ponds or around Kakkalur Tank shore line, VOC nagar, home can, in turn, help reduce the amount Ma.Po.Si.Nagar may be seen in Figure 5. of breeding sites for mosquito larvae Figure 5: Satellite imagery of Kakkalur VOC 4. THE MOSQUITO TRANSMIT DISEASE and Ma po si nagar segment Most mosquito larvae require water containing organic material, such as leaves The development of Thiruvallur Town in Tamil or sewage to serve as food for Nadu India between Coouam and microorganisms that will be consumed by Kusasthalai rivers wet lands from late 1960’s the developing mosquito larvae. Water in a was a slow and non-homogeneous. Many variety of natural and man-made colonies were formed viz Jaya Nagar, MGR containers, including abandoned tires, bird nagar, Indira nagar, NGO colony in Periya baths, buckets, catch basins (storm drains), kuppam village, near Thiruvallur railway clogged gutters, debris of all sorts, station and Coouam river in Thiruvallur decorative ponds, ditches, flower pots, Municipality. Ma.Po.si nagar, Poonga Nagar non-chlorinated swimming and wading in Kakkalur Panchayth. The Municipality pools, sewage and septic system water, areas have broad roads with storm water tree holes, and water-retaining junk. They drains. The sewage treatment plant for cannot develop in running water and Municipal area is under construction and it water that is present less than a week will take some time. Till such time Municipality (Figure 4). area people also have to depend on septic tanks which are polluting water wells in each Figure 4: The process to protect from house. The bath room and Kitchen water is mosquito bite let in to open storm water drains. The sewage and night soils in septic tanks which are 10000 lit to 15000 lit capacity, are pumped out and collected by sewerage collection lorries for dumping in waste management sites at Putlur at south near Coouam river. The natural slope is from South to north as this area was paddy fields irrigated from

Coouam river and finally drained in mosquito bites. Whatever repellent chosen, Kakkalur Tank. The housing plots are narrow. be sure to read the label directions before The flood water drains in streets which were applying. Products containing lemon oil of developed from 2007 are having slope from eucalyptus should not be applied to North to south and the flow is against younger children. gravity and the sewage water in street flood drains is stagnant. This has become a breeding ground for mosquitoes and bacteria. The street drains are to be cleaned occasionally by engaging labour. Still there are big stretch of housing plots vacant with bushes and plants. The bushes and the open drains with sewerage water, pits and ponds in the study area affect the health of the residents as the mosquitoes and insects breed in the still water. 6. HEALTH GIS PROJECT Figure 6: Vegitaion fallow natuarl drainage The haphazard urban development sytem near Kakkalur process of Thiruvallur was studied to form Geo spatial data base using GPS, Cloud 7.2 Managing to Kill Larva of Moquitoes. Computing and Information Technology Larviciding based on 3G internet network to form Historically the most effective mosquito Health GIS in networking mode. 14 control has been larviciding, which is the Research institutions in Hospitals, application of pesticides formulated to kill Universities, Colleges who have expertise in mosquito larvae before they become their area were linked to study the issues biting adults. Larviciding typically involves depending on problems in their area to applying pesticides containing metho create a National Health Geo Data base prene or Bacillus thurin giensis israe at the next stage. Task of Creation of Geo lensis or B. sphaericus bacteria, to water spatial database of Ground Water quality where mosquito larvae develop. of study at the area between Cooum and Kakkalaur Tank2 in Thiruvallur is given to Sri Figure 7: GIS Layers of Vegetation and Venkateswara college of Engineering and Water stagnant area Technology Thirupachur, Thiruvallur. The As mosquito larvae feed, the Bacillus are population density is 1200 per sq km in the ingested. Once ingested, a bacterial toxin project area. It has lot of grass and bushes perforates the mosquito’s gut, killing it. where water stagnant even for a few mm Larvicides containing the insect growth rain fall because of poor surface drainage. Dependence of septic tanks in the absence of underground drainage system led to pollution of aquifer.4 The area with vegetation is given in green. The low lying area which is flood affected is indicated in blue colour. The small study area segment is given in the Arc GIS layer created above (Figures 6, 7). 7. PREVENTION AND CONTROL 7.1 Repellents Repellents are the first line of defense against mosquito bites. Many products provide some degree of protection against

regulator, methoprene, work by disrupting BIBLIOGRAPHY the larva’s metamorphosis, preventing it from developing into an adult. The toxicity 1. Foundations of parasitology. Dubuque, of both types of larvicide is quite low, and Iowa: Wm. C. Brown. ISBN 0-697-26071-2. both are considered safe to use in waters Brunette, Gary W. (ed), CDC Health containing fish. Information for International Travel 2012. 7.3 Adultciding (application of pesticides) 2. The Yellow Book, chapter 3. Oxford University Press. ISBN 978-0-19-976901- The application of pesticides to control 8 (2011). Content source: Centers for Disease Control and Prevention: National adult mosquitoes (adulticides), except for Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of general use pesticides applied on the Global Migration and Quarantine (DGMQ) applicator’s property, requires mosquito control certification. Control of adult mosquitoes usually involves application of fine droplets of pesticides released as 3. ISPRS VIII/2: Health,Int Conference Melbourne Australia Seo 2012, Monitoring a space or ultra-low volume (ULV) Enviroinment with GIS for Part of Thiruvallur Town using Cartosat1 Stero PAN & treatment from specialized truck or aerial Resourcesat LISS4 MSS Merged Data Ghouse Shaik Mohamed, Ramakrishnan equipment. This type of “fogging” can VenugopalVenkatchalam, Mahendran. Ramamurthhy, Radhika Janakiraman have a significant impact on localized Gummidipoondi, Murthy Ramillah mosquito populations. Some that provide little or no relief from mosquitoes include: 1. purple martins and bats 2. insect electrocuting devices 3. ultrasonic and electronic devices 4. so-called “mosquito plants” 4. ISPRS TC VIII Mid-Term Symposium 2014 Health Session Hyderabad, India. 5. nutritional supplements or vitamins December 9-12, 2014. p512, Location based hazad vulnerabilty assessment, 8. CONCLUSION Assesing health and environment hazard With Geo spatial analysis it is possible to using Gis to build Thiruvallur as a healthy map breeding area of Mosquitos. Source smart city, Sindhu Venkat, Thiyagarajan reduction, the elimination of water from Jayaraman Kantharaj, Gandhi Raja Yogan, places where mosquitoes lay eggs. This can Dr Kamal Natarajan,Dr Ghouse3 Mohamed be accomplished by draining ponds, Shaik ditches, backwaters and lagoons, and by keeping water out of natural and artificial 5. ISPR TC VIII Mid-Term Symposium 2014 containers3. Each one of us has Therefore, every effort should be made to prevent Health SessionHyderabad, India. water from accumulating in containers or, at least, empty water out of them on a December 9-12, 2014Environmental Risk weekly basis factor analysis. Paper 518, Pilot Study to assess Environmental Risk Factors of ACKNOWLEDGMENT Kakkalur Tank in Thiruvallur Town to We acknowledge Dr K C Vasudevan, Chairman, Dr B Sasi Kumar Principal SVCET, Develope as an enviroinmental park - J. Dr Bhoop singh Advisor Head NRDMS, DST, Dr I.V.Muralikrihna National coordinator Radhika, S. Devi, Retina sababthy, Dr N Health GIS, Dr Murthi Ramila ISRO, Mrs Radika, Mrs Devi and Mr Rethina sababthy Kamal, Dr S Mohamed Ghouse for their encouragement and support for this work 6. ISPRS Commision TC, WG VIII/2: Health Heath Care emergency Management 507 GIS for Healthcare Emergency Management at Thiruvallur Taluk Balasubramam, Janakiraman Radhika, Malathi, P. Rethina sababthy, Dr. Ghouse Mohamed Shaik

Technical Session: 7 84 85 Wellbeing and Preventive Healthcare System 86 Mapping Road Traffic Accident Hot Spots and Evaluating the Causative 87 Factors of their Probable Causes in Minna, Niger State 88 Oluibukun G. Ajayi, Ifeanyi C. Onuigbo, Joseph O. Odumosu, Taiwo J. 89 Adewale and Adamu M. Gbedu 90 91 Built Environment and Physical Activity in Urban Delhi- a GIS Based Analysis Mohammad Tayyab, Safraj Shahul Hameed, Atiqur Rahman, Roopa Shivashankar, Ajay S Vamadevan, Venkat, K. M., Mohammed K Ali, Nikhil Tandon and Dorairaj Prabhakaran Integrated School Health Services Through Mobile Health Clinics – A Strategic Model For Health And Oral Health Care Delivery In India And Other Developing Chandrashekar B. R and Suma S Mapping the Immunization Status of Children in Southern States of India with a Special Focus on the Newly Carved States Sairam Challa and Pallavi Amirapu A Mathematical Model to Estimate Obstetrical Complications Related Blood Requirements for a Support Population Hemant Misra and Sujitkumar Hiwale A Grid-Based Approach to Analyse the Relationship between Socio- Economic Conditions and Sickle Cell Disease in Nilgiri District of Tamilndu, India Brindha, B. and Prashanthi Devi M. Geriatric Care Hospitals- Need of the Hour Sudharsan Balasubramanian and Murali, R. Remote Sensing and GIS for the Improvement of Tribal Health Management System-A Case Study Govindaraju, M., Suganthi, P., Selvaraj, M., Sarojini Devi B., Rajiv Das Kangabam, Suganthi, K. and Kurinji, S.

Mapping Road Traffic Accident Hot Spots and Evaluating the Causative Factors of their Probable Causes in Minna, Niger State Oluibukun, G. Ajayi, Ifeanyi C. Onuigbo, Joseph O. Odumosu, Taiwo J. Adewale and Adamu M. Gbedu Federal University of Technology, Minna, Nigeria E-mail: [email protected], [email protected], [email protected], [email protected], [email protected] ABSTRACT Using Accident based method, attempt has been made in this research to map road traffic accident spots, depict their spatial distribution on a digitized street guide map, highlight annual variation (2003 -2014) and monthly variation of Road Traffic Accidents and also evaluate the causative factor of some probable causes of road traffic accident in Minna, the capital city of Niger state from 2010 to 2013. Results obtained shows that the highest number of reported cases of Road Traffic Crashes (RTC), Injured and killed people between 2003 and august 2014 was recorded in the year 2012 accounting for 22.01%, 36.68% and 28.01% respectively while the lowest record was reported in 2004 with 3.31% reported cases, 1.82% injured cases and 2.49% rate killed. It was also discovered that the months with the highest reported cases of RTC were February, March, October and December for 2010, 2011, 2012 and 2013 respectively. Speed Violation (SPV) has the highest percentage causative factor of all the probable causes of Road Traffic Crashes between 2010 and 2013. Other notable probable causes with significant causative factors are Dangerous Driving (DGD), Loss of Control (LOC) and Sign Light Violation (SLV). Based on the findings, recommendations were proffered for the mitigation of road traffic accidents. KEYWORDS: Accident Mapping, Road Traffic Crashes, Spatial Distribution, GPS receivers Geospatial Modelling, Geographic Information System

Built Environment and Physical Activity in Urban Delhi- A GIS Based Analysis Mohammad Tayyab,1 Safraj Shahul Hameed,1 Atiqur Rahman,2 Roopa Shivashankar,1 Ajay S Vamadevan,1 Venkat, K. M.,3 Mohammed K Ali,3 Nikhil Tandon,4 and Dorairaj Prabhakaran1 1Public Health Foundation of India, India, E-mail: [email protected], [email protected], [email protected], [email protected], [email protected] 2Jamia Millia Islamia, University, India, E-mail: [email protected] 3Emory University, USA, E-mail: [email protected], [email protected] 4All India Institute of Medical Sciences, India, E-mail: [email protected] ABSTRACT Cardiometabolic diseases (CMD) are a major cause of mortality and morbidity worldwide. Among South Asians the onset is at a much younger age and involves all sections of the society. A major risk factor for CMD is inadequate physical activity (PA). ‘Built environment’ plays an important role in influencing participation in PA. However, the relationship between neighbourhood built environment and PA has been sparsely investigated in Low and Middle Incomes Countries. The primary objective of the present study was to objectively assess the relationship between Physical activity and Built environment in Urban Delhi. The Geographical Information System component of the Centre for Cardiometabolic Risk Reduction for South Asia Surveillance study (CARRS-GIS study) was carried out in 3 major South Asian cities; Delhi, Chennai and Karachi. CARRS-GIS aimed to study the relationship between built environment, CMD and its risk factors in South Asia. Here we present data from the Delhi Site. We located all participant households, collected data on select built environment features from the study neighbourhoods and performed GIS analysis of participant data overlaid on geographic data. PA data was measured using a culturally adapted version of the International Physical Activity Questionnaire and transformed to Metabolic Equivalent Task scores. Cluster analysis was carried out using the hotspot tool and distance calculations using the network analysis tool in ArcGIS. As part of the study we geocoded 2487 households from 138 neighbourhoods. Preliminary analyses reveal a mixed picture with varying levels of PA in study neighbourhoods. Cluster analysis revealed statistically significant hot and cold spots. High physical activity clusters (hotspots) seemed to have better access to green and open spaces. PA Cold spots were found to be hotspots of higher than average Systolic Blood Pressure and Fasting Blood Glucose levels. Exploratory spatial analysis shows that physical activity is related to neighbourhood built environment and other CMD risk factors in urban Delhi. KEYWORDS: Cardiometabolic Diseases (CMD), Physical Activity (PA), Neighbourhood Built Environment and Geographical Information System (GIS)

Integrated School Health Services through Mobile Health Clinics – A Strategic Model for Health and Oral Health Care Delivery in India and Other Developing Countries Chandrashekar B. R. and Suma S JSS Dental College and Hospital, Mysuru, India, E-mail: [email protected] ABSTRACT Health is a fundamental human right and oral health is an integral component of general health. India’s economy grew 55% from 2001–2006. The health manpower is increasing at an alarming rate in the last 1-2 decades. However, diseases such as dengue fever, hepatitis, tuberculosis, malaria and pneumonia continue to plague India along with other non-communicable diseases (NCDs) such as diabetes, hypertension and cardiovascular diseases. NCDs due to excessive consumption of junk foods and sedentary lifestyle have their origin in early childhood and adolescence. The prevalence of oral diseases such as dental caries, periodontal diseases and oral cancer are also showing an upward trend despite an alarming raise in the dental manpower in the last two decades. It is evident that the improving economy and raising health as well as oral health manpower has not contributed significantly to the health promotion of its general population. This suggests that the existing health and oral care deliveries which are predominantly urban oriented, curative and offered mainly by private sector are not effective to fulfill the set targets. There is urgent need for a novel, innovative, cost effective, integrated prevention oriented strategy that focus upon rural India where almost 68% of its population reside. School health programs have proven effective in promoting health in many developed countries. Schools provide a platform for the promotion of health and oral health not only for the students, but also for the staff, families, and members of the community as a whole. In India, students aged less than 18 years constitute about 40% of the total population and there are only few organized school health programs, through which a major section of the population can be reached and the lifestyle changes effected. This paper provides a strategic school based integrated model to offer comprehensive health and oral health care delivery using mobile health clinics through public private partnership. The model can be pilot tested for its appropriateness in developing countries such as India. KEYWORDS: School health programs, health promotion, oral health promotion, mobile health clinic, private public partnership.

Mapping the Immunization Status of Children in Southern States of India with a Special Focus on the Newly Carved States Sairam Challa and Pallavi Amirapu 1Apollo Institute of Medical Sciences and Research, India 2Free Lance Biochemist, India E-mail: [email protected], [email protected] ABSTRACT In 2013, an estimated 21.8 million infants worldwide were not reached with routine immunization services, of whom nearly half live in 3 countries: India, Nigeria and Pakistan. India’s progress towards new sustainable development goals requires high immunization coverage in all the states including the newly carved southern states of Andhra Pradesh and Telangana State. An attempt is made to analyze the available data in the field of child immunization in the southern states of India. To study the trends in the immunization status of children in the southern states of India and map high risk districts. Secondary data published in the District Level Household and Facility Survey -4 is analyzed. Chloropleth map was developed to identify high risk districts. Kerala has highest child immunization coverage followed by Karnataka, Andhra Pradesh, Tamilnadu and Telangana. Karnataka is the only southern state that has no district with immunization coverage less than fifty percent. The reasons for the steep fall in immunisations can go beyond the reasons for low coverage and could be territory specific. Since Immunization is an eternal event it requires a strong monitoring system to identify and take timely measures to fix the issues at all levels. KEYWORDS: Immunization Status, Southern States of India, Telangana State, Andhra Pradesh

A Mathematical Model to Estimate Obstetrical Complications Related Blood Requirements for a Support Population Hemant Misra and Sujitkumar Hiwale Philips Research India, India E-mail: [email protected], [email protected] ABSTRACT Morbidity and mortality due to loss of blood is an important issue in a healthcare system, especially in obstetrics, where blood loss during pregnancy is responsible for almost 38% of maternal deaths in India and 25% worldwide. Unfortunately, blood is a perishable commodity with a short shelf life of approximately 35 days; therefore it cannot be collected much in advance to meet the unforeseen future needs. In absence of any reliable data to predict the future blood requirements of a population, the current practice of blood collection is on the basis of some gross estimates. As a consequence, despite having huge shortage of blood supply for needy population, a significant percentage of the blood is wasted because of it being outdated. For pregnancy related complications, it may be possible to reliably estimate the blood requirement of a population. In the course of pregnancy, the expected delivery date, the blood group and Hb level of the pregnant ladies are recorded in their ANC visits; the prevalence of haemorrhage can be estimated from the past records. In this paper a mathematical model is proposed which uses all the above parameters to estimate the obstetrical blood requirements of a population. This model can help the blood banks in organizing their inventory better and also help them drive their blood collection campaigns as per their projected needs. KEYWORDS: Prediction model, Blood requirement estimation, Obstetrical complications, Blood banks

A Grid-Based Approach to Analyse the Relationship between Socio-Economic Conditions and Sickle Cell Disease in Nilgiri District of Tamilnadu, India Brindha, B.* and Prashanthi Devi M. Department of Environmental Management, Bharathidasan University Tiruchirapalli – 620 024 India, E-mail: [email protected] ABSTRACT There is a consensus that the health status of the tribal population is very poor due to their isolation, remoteness and of being largely unaffected by the developmental process in India. For centuries, they have been living a simple life based on the natural environment and have developed cultural patterns congenial to their physical and social environment. The economic, health, nutrition and medico-genetic problems of diverse tribal groups have been found to be unique and present a formidable challenge for the health planners. The present study focuses on Sickle cell disease, a genetic disorder, which was conducted among four primitive tribal groups of Nilgiri district, Tamilnadu. The poor socio-economic status is known to have an adverse effect on the nutritional status and thus reducing hemoglobin levels of SCD patients leading to severe effect during pain crises. Our idea is that community health is a nonlinear function of environmental and socioeconomic effects that are not normally distributed among communities. The objective was to integrate multivariate data sets representing social, economic and physical environmental factors to evaluate the relationship with similar environmental characteristics that exhibit similar distributions of disease distribution. The data for the study was collected from NGO’s and total of 2867 cases were identified with Sickle cell disease. The socio-economic and demographic variables like occupation, education, income, marital status, age, ethnicity and other geographic variables like land use land cover ,vegetation pattern , climate were also used for the present study. The Arc GIS platform was used to generate the systematic 1 km x 1 km grid procedure and geo- coordinates of house locations of patients were overlayed on the grid. The land use land cover map, NDVI, temperature and rainfall map were superimposed along with socio- economic variables and regression is carried to analyse the relationship between disease risk and the factors.Outcomes of the research conducted on spatially varying relationships point out that selected socio-economic factors of the community are responsible for SCD prevalence. Disease risks were found to be significantly lower in one community compared to other community. This is possibly due to their cultural difference which resulted in carrying forward to the other generations. Indigenous people are amongst the poorest and most marginalized population groups experiencing extreme levels of health deprivation. KEYWORDS: Sickle cell disease, Socio-economic, grid analysis

Geriatric Care Hospitals- Need of the Hour Sudharsan Balasubramanian and R. Murali Chettinad Hospital & Research Institute, India E-mail: [email protected] ABSTRACT Aging is a natural process. In the words of Seneca. ‘Old age is an incurable disease’; Sir James sterling commented ‘you do not heal old age, you protect it; you promote it; you extend it’. Old age should be regarded as a normal inevitable biological phenomenon. Discoveries in medical science and improved social condition during past few decades have increased the life span of human. The expectation of life at birth in developed countries is above 70 and in developing countries is nearing 70. The geriatric population are facing so many problems as the result of the physiological aging and due to some pathological causes. The approach towards them varies according the changes and the family member’s mood behavior. These population has to be taken extra care in health care sectors, they should be provided with priority, care and proper response along with the guidance. This study was framed to bring out the basic structure how the geriatric friendly hospital has to be, based on the observation on where the elderly are suffering and the areas which are to be focussed to bring out the best care to the elderly. KEYWORDS: Geriatric, Friendly Hospital. Elderly

Remote Sensing and GIS for the Improvement of Tribal Health Management System-A Case Study M. Govindaraju, Suganthi, P., Selvaraj, M., Sarojini Devi, B., Rajiv Das Kangabam, Suganthi, K. and Kurinji S. Biospatial Technology Research Unit, Department of Environmental Biotechnology School of Environmental Sciences, Bharathidasan University, Tiruchirappalli 620024 Tamil Nadu, India, E-mail: [email protected] ABSTRACT India is the world’s second largest populated country has lack of proper public health management system especially medical facilities, in rural areas is hindering the growth of the country. With more than 70 % of the population living in rural areas, mortality rate due to diseases transmission are rising due to change in socio economic demographic and environmental conditions. But with the knowledge of disease transmission and dynamics, prediction of occurrence of disease is possible based on the environmental factors. Remote Sensing and GIS have been use in a number of health studies for monitoring, surveillance, or risk mapping, particularly of vector-borne diseases. The aim of the present study is to identify vector habitats using Remote Sensing and GIS in Sitheri Hills, a remote area in Dharmapuri District of Tamil Nadu. Attribute data like water, climatological data, and Epidemiological survey were collected and analysis and the result was incorporated in GIS platform. The result from the analysis were prepared as map for the different themes. The study identified the influence by seasonal variations in vector density distribution. The outcome was use to predict the relevant information to understand the spatial variation of the vector biodiversity, vector abundance and the vector-borne diseases in correlation with environmental factors. This approaches will help to reduce the burden of vector borne disease in rural areas where no medical facilities for tribal people who are living in the study area. KEYWORDS: Vector Borne Disease, Remote Sensing and GIS, Sitheri Hills, Rural area, Epidemiology

Poster Session Geospatial Analysis of Lung Cancer Mortality and its Related Fine 93 Particulate Matter (PM2.5): A Case Study in Rayong Province, Thailand Haoran Zhang Nitin Kumar Tripathi, Priyanka Kakria and Nutthapong 94 Khangkhun 94 95 Smartphone Based Heart Rate Monitoring, Reporting and Alarming 96 System 97 Priyanka Kakria, Nitin Kumar Tripathi and Peerapong Kitipawang 98 99 GIS Mapping to Obtain a Global Perspective in Epidemiology and Common Trends Observed in Leptospirosis Shruthi, G. and Chandan, S. Analysis of Longitudinal Data of Inpatients in a Tertiarycare Teaching Hospital Divya Rao, B. J., Mamatha, H. K. and Sheryl Laura Braganza Investigation of Spatial Risk Factors for RVF Disease Occurrence using Remote Sensing and GIS—A Case Study: Sinnar State, Sudan Kowther Mohamed Saeed, Amna Ahmed Hamid and Abbas Doka Context Aware Patient Flow Management Muhammad Amir Izhar and Nitin Kumar Tripathi Diagnosing Healthcare from Afar: Understanding why Industrialized Nations must lead the charge in expanding Telemedicine Susmit Tripathi The Application of Geographical Information System to Analyzing the Risk of Hemorrhagic Fever Occurrence of People in Muang Phetchabun District Phetchabun Province Wirasiri Waseeweerasi and Dilok Onla

Geospatial Analysis on Lung Cancer Mortality and its Relationship with Fine Particulate Matter (PM2.5): A Case Study in Rayong, Thailand Haoran Zhang, Nitin Tripathi and Prinyaka Kakria Remote Sensing and Geographic Information Systems Field of Study, School of Engineering and Technology, Asian Institute of Technology, Pathumthani, Thailand, 12120 ABSTRACT Cancer in Thailand is becoming a significant health problem. It is the leading cause of deaths in Thailand. Lung cancer is highly related to particulate matter (PM) especially fine particulate with diameter of 2.5 µm or less (PM2.5). Recent studies have indicated a strong correlation between particulate matter and lung cancer. With advancement made in computer technologies, Geographic Information Systems (GIS) nowadays provide powerful spatial analysis tools to examine spatial characteristics of particulate matter (PM). Maps of the spatial distribution of PM2.5 can be produced with a GIS to facilitate in-depth studies. A high incidence of lung cancer was found in people living industry areas especially Chonburi and Rayong Provinces. Objectives of this study are to map and analyze the particulate matter measured from 10 stations in Chonburi and Rayong Provinces and its’ spatial pattern related to land use; temporally and spatially analyze the lung cancer morbidity and mortality rates; geospatial analysis hotpot of lung cancer associated to particulate matter. The air quality monitoring using residual interpolation optimized technique (RIO) is introduced and applied to the study. This technique is widely used to derive real-time, daily and yearly concentration maps from regional or national air quality monitoring networks. Maps of regional morbidity and mortality rates will be prepared as they are the useful tools in determining spatial patterns of disease. And then, the spatial agent based modeling (ABM) process analysis of association will be performed to study the correlation between PM2.5 and lung cancer. Finally, we developed maps of lung cancer hot spots based on industry locations and used geospatial analysis. KEYWORDS: Environmental, GIS, Spatial Analysis, Lung Cancer, PM2.5, Health, Industry, Land Use, Hot Spot

Smartphone Based Heart Rate Monitoring, Reporting and Alarming System Priyanka Kakria, Nitin Kumar Tripathi, Haoran Zhang, Peerapong Kitipawang Department of Remote Sensing and Geographical Information Systems School of Engineering and Technology, Asian Institute of Technology, Thailand E-mail: [email protected] ABSTRACT With the developments of health cognizance and rising the aging population, health care demand becomes more significant. Ubiquitous health information systems provide health care services at anytime, anywhere has become more promising and advantageous now days. These heath monitoring information systems are possible because of recent rapid growth in mobile wireless technologies. This study consists of two Bluetooth (BT) based wearable remote monitoring devices (Zephyr BT and Polar BT), inbuilt heart monitoring application enables android smartphone and conventional ECG machine to perform the calibration process. Thirty four patients (with age between 25 to 65 years) admitted at Thammasat Hospital (Pathumthani, Thailand) participated in this research study. Enrolled patients were given remote monitoring device and 3G enabled android smartphone. Both BT Sensors and inbuilt heart monitoring smart phone device were calibrated with the available conventional machine. Results of Zephyr BT monitoring sensors found more closely to the conventional ECG machine, Zephyr BT further used to send the vital signs of heart of heart prone patients in remote areas to the doctor in super specialty hospital with generating alarming signals in case of emergency. KEYWORDS: Heart rate monitoring, Zephyr BT, Polar BT, Smartphone inbuilt sensor GIS Mapping to Obtain a Global Perspective in Epidemiology and Common Trends Observed in Leptospirosis Shruthi, G. and Chandan, S. Faculty of Life Sciences, JSS University, Mysore-570015, Karnataka, India ABSTRACT Leptospirosis is a serious zoonotic disease, which occurs worldwide caused by a spirochete Leptospira. It is found that this is one of the reemerging infectious disease and has been demonstrated from the large outbreaks of Leptospirosis in India, Nicaragua, Brazil, Southeast Asia, Malaysia, United States, Philippines, etc., where thousands of people died recently and continue to die every year. The disease symptoms of Leptospirosis overlaps with that of the other commonly known diseases such as jaundice and yellow fever and are misunderstood to be some other disease resulting in delayed diagnosis. Since Leptospirosis has to be controlled by intravenous administration of Benzyl Penicillin for 7 days but the delay in proper diagnosis of Leptospirosis leads to lethal infection in the patients resulting in increased casualties every year. Hence by creating GIS map from the common trends observed in Leptospirosis outbreak ranges, we can alert the regions which are likely to face Leptospiral outbreaks, leading to increased preparedness in health care centers and hospitals to deal with the outbreaks efficiently resulting in less casualties every year.

Analysis of Longitudinal Data of Inpatients in a Tertiarycare Teaching Hospital Divya Rao, B. J., Mamatha, H. K. and Sheryl Laura Braganza JSS University, Mysore, India ABSTRACT The evaluation of communicable and non-communicable disease management can be done through public health agencies, have a long tradition of monitoring pattern of diseases and death and trends in medical, social, and behavioural risk factors that may contribute to these adverse events. Patterns of the diseases observed, provide invaluable information for needs assessment, program planning, program evaluation, and policy development activities. Examining data over time also permits making predictions about future frequencies and rates of occurrence. The change in trend of diseases over period of time necessitates that healthcare providers create facilities to render appropriate services to the needy. Many studies have revealed the change in disease trend and pattern and hence understanding the requirements in healthcare facilities can improve the quality of care for the patients and also provide information for the administrators to make plans for future requirement in healthcare services. To identify the increasing or decreasing trend of major diseases ,the temporal disease pattern ,the magnitude of disease types and their temporal interaction and also to identify the highly increasing diseases so that the hospital can make necessary preparations for future. To analyze the interaction of disease and time, a time series data of major diseases are required. Hence, secondary data was obtained from the Medical Records Department of a tertiary care teaching hospital catering to the needs of 5 districts of southern Karnataka. The data was collected from 2004-2011 on yearly bases. The data wsa collected for both communicable and non – communicable diseases for adults and children. The data was analysed using graphical method and two- way analysis. From the study, we concluded that the disease pattern does not follow any uniformity temporally as well as individual disease type. These results are useful for planning the bed allocations, nursing staff, doctors on duty and other resources. They should be planned properly for tertiary care hospital which will provide:  Inpatients management  Health care resource allocations. The ever increasing patronage of the tertiary care teaching hospital requires that adequate preparations in terms of personnel and logistics are made in advance. The findings of the study would therefore help the Hospital Management to adequately prepare for the large number of prospective patients. This is likely to help them make advanced plans in terms of manpower and logistical requirements for better service delivery to the satisfaction and expectations of clients.

Investigation of Spatial Risk Factors for RVF Disease Occurrence using Remote Sensing and GIS—A Case Study: Sinnar State, Sudan Kowther Mohamed Saeed1, Amna Ahmed Hamid2 and Abbas Doka3 1Ministry of Animal Resorces and Fishers and Range, Sudan 2Remote Sensing Authority and Seismological 3College of Agricultural Studies, Sudan University of Science & Technology, Khartoum, Sudan E-mail: [email protected], [email protected], [email protected] ABSTRACT Rift Valley Fever (RVF) is an emerging, mosquito-borne disease with serious economical and negative implications on human and animal health. This study was conducted to verify the factors which influenced the spatial pattern of Rift Valley Fever occurrence and identified the high risk areas for the occurrence of the disease at Sinner State, Sudan. The normalized difference vegetation index (NDVI) derived from Moderate Resolution Imaging Spectroradiometer (MODIS) satellite and rainfall data in addition to the point data of RVF clinical cases in humans were used in this study. In order to identify the RVF high risk areas, remote sensing data and rainfall data were integrated in a GIS with other information including, soil type, water body, DEM (Digital Elevation Model), and animal routes and analyzed using Spatial Analysis tools. The information on clinical cases was used for verification. The Normalized Difference Vegetation Index (NDVI) was used to describe vegetation patterns of the study area by calculating the mean NDVI. The results of the study showed that, RVF risk increased with the increase in vegetation cover (high NDVI values), and increase in rainfall, which both provided suitable conditions for disease vectors breeding and a good indicator for RVF epizootics. The study concluded that, identification of high risk area for RVF disease improved the understanding of the spatial distribution of the disease and helped in locating the areas where disease was likely to be endemic and therefore preparedness measures should be taken. The identification represents the first step of prospective predictions of RVF outbreaks and provides a baseline for improved early warning, control, response planning, and mitigation. Further detailed studies are recommended in this domain KEYWORDS: Rift Valley Fever, Vector-Borne Diseases, Spatial Risk Factors, Normalized Difference Vegetation Index

Context Aware Patient Flow Management Muhammad Amir Izhar and Nitin Kumar Tripathi Asian Institute of Technology, Thailand E-mail: [email protected] ABSTRACT Intensive use of health information systems have improved performance of healthcare facilities but operational systems in healthcare facilities are still under tremendous pressure especially in developing countries and countries with large population. Once patients are in hospitals they frequently need to be seen by multiple medical staff members and need to be treated with multiple hospital resources at different hospital locations. Efficiently moving patients through the various rooms can be prone to human error and can be incredibly difficult, especially as patients hit bottlenecks throughout the day. Healthcare professionals have to communicate/interact with hundreds of patients every day to facilitate them in medical checkup process simply because patients are not aware about the steps they need to perform to complete medical checkup and secondly they are not aware about the location of required facilities(Labs, Pharmacy etc.) inside a healthcare facility. For years, hospitals responded to these issues by adding resources, more beds and buildings or more staff, as the only way to deal with an increasingly needy population. Various researches have shown that that adding resources is not the answer whereas delays are not a resource problem; they are a flow problem. This paper presents a framework which aims to solve the issue of patient flow management. Framework is divided into two parts. One part of the framework facilitates hospital administration in registering patients, creating appointments etc. and then tracking the current workflow status of patients. Staff can change workflow based upon feedback of physicians which will be communicated to patients in real time. Second part of the workflow guides patients about the steps they need to perform and helps them to navigate inside a healthcare facility to complete medical checkup with minimum possible human to human interaction. Based upon the proposed framework two separate application are developed. A desktop application for hospital administration allows staff to manage patient registration, patient referrals and creation of patient’s appointments and medical checkup workflows. Second application is a mobile application which is installed on smartphones carried by patients. Once mobile application is launched and patient enters its appointment number, it shows a 3D model of hospital on one side of screen and floor plan of current story in the second part of screen along with steps which patients need to perform in order to complete the workflow. Patient can click on any item in the workflow assigned to it and application will highlight the location of facility where patient need to go in order to perform that step. For example if patient requires a blood test then it will be added to its workflow which can be seen on patient’s smartphone immediately. If Patient clicks on the item then application will highlight the location of lab in the floor plan and will also highlight the related story on 3D model. Bluetooth low energy beacons have been used to get contextual information, mobile application uses this information to identify current location of patient and this information is passed to the central server which updates administration about current activity of patients. Administration at any time can inquire about the workflow status of any number of patients or can generate a report about current workflow situation in hospital and can take actions accordingly. KEYWORDS: Healthcare Informatics, Context Awareness, Patient Flow Management, Bluetooth low energy Beacons, Smartphones

Diagnosing Healthcare from Afar: Understanding why Industrialized Nations must lead the charge in expanding Telemedicine Susmit Tripathi Albert Einstein College of Medicine, USA E-mail: [email protected] ABSTRACT Industrialization and economic strength do not guarantee robust healthcare. Current systems in Germany, United Kingdom, and Japan have been compared favorably to the maligned, seemingly fractured healthcare in the United States. However, all four systems present with unique challenges. A significant percentage of each country’s Gross Domestic Product is spent on health expenditure, defined as the sum of public and private costs, including the cost of preventative, curative, and emergency services. While the US is the leading spender worldwide at 17.1%, the lowest spender among these four, UK, stands not far behind at 37th with 9.1%. With rapidly aging populations in all four nations, and with the bulk of spending going towards the sickest few, it is likely that healthcare spending will continue to surge globally for the foreseeable future. In spite of sizeable spending, access to healthcare remains an issue. This includes access to specialists as well as palliative care, family planning services, and nutritional guidance. The costs associated with bringing these services to the population can be mitigated through more widespread use of telemedicine-driven services. Consequently, this article summarizes key areas where the adoption of remote monitoring and real time interactive services can transform the way care is delivered to patients. Identified within are vulnerable populations that would benefit the most from the easy access provided by telemedicine. Additionally, this article argues for telemedicine as a cost-effective method for improving compliance and treatment outcomes in all patients, including those that do not experience problems in accessing healthcare. KEYWORDS: Healthcare, Telemedicine, Compliance and Treatment Outcome

Application of Geographical Information Systems for Analyzing the Risk of Hemorrhagic Fever Occurrence in Phetchabun, Thailand Wirasiri Waseeweerasi1 and Dilok Onla2 1Faculty of Public Health, Western University, Thailand E-mail: [email protected] 2Public Health Official Muang Phetchabun District, Phetchabun Province, Thailand ABSTRACT The objective of this analytical research was to investigate the risk factors of hemorrhagic fever occurrence and the application of geographical information system in analyzing the risk of hemorrhagic fever occurrence of people in Muang Phetchabun District, Phetchabun Province. The study had been made among people with hemorrhagic fever during the year of 2011-2013. That covered total of 204 people, 105 people, and 1,318 people for each year respectively. The secondary data were collected through questionnaires from various involved agencies in July in the year of 2014. Then the secondary data were used to analyze the risk levels of hemorrhagic fever occurrence by importing the factors that were important to predict the hemorrhagic fever occurrence with geographical information system software package and multiple logistic regression analysis. The spatial data were presented by using a software package with the overlapping information. The results of the study showed that the factors associated with the occurrence of hemorrhagic fever at 0.05 level of significance in the year of 2011 included the density of population, the density of houses, and the number of houses found the mosquito larvae. In the year 2012 all studied factors were not significant. Regarding the year of 2013, the factors associated with the occurrence of hemorrhagic fever at 0.05 level of significance included the density of population, the density of houses, and the gender of patients. Then multiple logistic regression was analyzed to test the relationship between the risk factors and the occurrence of hemorrhagic fever in the year 2013, it was indicated that the factors associated with the occurrence of hemorrhagic fever at 0.05 level of significance included the density of population, the amount of rainwater and the gender of patients. Then the risk factors of hemorrhagic fever occurrence in Muang Phetchabun District, were created in to the spatial models to analyze the risk levels of hemorrhagic fever occurrence by the application of geographical information system from all 17 sub – districts, they were determined to be the risk zones according to the following 3 levels; firstly at a high risk level totally 6 sub - districts accounted for 35.29 % ; followed by a medium risk level totally 9 sub- districts accounted for 52.94 and lastly at a low risk level totally 2 sub – districts accounted for 11. 77 % respectively. This study suggested that the agencies responsible in the area should take action to prevent and control the hemorrhagic fever by focusing on the whole areas. KEYWORDS: The Application of Geographical Information System, the Risk Analysis of Hemorrhagic Fever

1. INTRODUCTION Office, Muang Phetchabun District, The World Health Organization states that Phetchabun Province, 2013). Being in such the hemorrhagic fever is one of forty new a crtitical scenario of the hemorrhagic epidemic coming back diseases, and it is fever the researcher and team have also a public health problem in more than realized the significance in solving the 100 countries. There are around 50 – 100 problems on an outbreak of the million people/ 100,000 who get hemorrhagic fever, thus it is important to hemorrhagic fever infection worldwide, study the application of geographical and more than half of them require information system for analyzing the risk of treatments in hospitals. Because of this hemorrhagic fever occurrence of people number, more than 25,000 people died per in Muang Phetchabun District, Phetchabun year. The population at risk of hemorrhagic Province in order to bring the information fever were found each year approximately obtained to plan the prevention and 2,500 million people. The germs of control of hemorrhagic fever more hemorrhagic fever have developed efficiently. Research Objectives were. to themselves and propagated into new study the application of geographical areas including the countries in the Frigid information system for analyzing the risk of Zone. The World Health Organization has hemorrhagic fever occurrence of people prepared a strategic plan for prevention in Muang Phetchabun District, Phetchabun and control of hemorrhagic fever in Asia Province. Pacific during the year of 2008-2015 because this area is found to have more 2. METHODOLOGY than 70 percent of the people at risk of This study had been made among people hemorrhagic fever infections across the with hemorrhagic fever during the year of worldwide. Therefore, this strategic plan 2011 – 2013 that covered totally 204 can help reducing deaths to less than one people, 105 people, and 1,318 people percent and reducing the number of respectively. The secondary data were people with hemorrhagic fever infections collected through questionnaires from at twenty percent per year, (ASTV Online various involved agencies in July in the Manager, 21st December 2013). Regarding year of 2014. Then the secondary data the situation of hemorrhagic fever in were used to analyze the risk levels of Thailand on 25th December 2013, the hemorrhagic fever occurrence by patients with hemorrhagic fever were importing the factors that were important indicated totally 154,444 people, with the to predict the hemorrhagic fever morbidity rate at 241.03 per hundred occurrence with geographical information thousand population, a number of patients system software package and multiple who died were 136 people with the death logistic regression analysis. The spatial data rate at 0.21 per hundred thousand were presented by using a software population,(Bureau of Vector – Borne package with the overlapping information. Diseases, Department of Disease Control, 2013). Referring to the situation of 3. RESULT hemorrhagic fever in Muang Phetchabun Part1. It relates to the similarity regarding Area, Phetchabun Province on 31st the similarity between demographic December 2013, the patients were characteristics and general characteristics reported totally 1,343 people, with the of patients with hemorrhagic fever in morbidity rate at 636.35 per hundred Muang Phetchabun District, Phetchabun thousand population. (Public Health Province.

Figure 1: The Graph Show Demographic Characteristics of Patients with Hemorrhagic Fever in Muang Phetchabun District, Phetchabun Province in the Year 2011-2013 The relationship between the risk factors population, the amount of rainfall, and the and the occurrence of hemorrhagic fever gender of patients then Creating an in Muang Phetchabun District, in the year Equation to Analyze the Risk Areas of of 2011 (n = 204) was performed. The results Hemorrhagic Fever the multiple regression of the study found that the factors equation was created follow as: associated with the occurrence of hemorrhagic fever at 0.05 level of Risk Levels significance included the density of population, a number of houses, and the 11.77% A high risk 6 number of houses found with the Mosquito Sub-district larvae.In the year of 2012 (n = 105) all studied factors were not significant. In the 35.29% A medium year of 2013 (n = 1,318)the results of the risk 9 Sub- study indicated that the factors associated 52.94% d is tr ict with the occurrence of hemorrhagic fever at 0.05 level of significance included the A low risk 2 density of population, the density of Sub-district houses, and the gender of patients. Part 2: The Results of an Analysis of Events Using Figure 2: Risks of Hemorrhagic Fever Risk Factors for the Occurrence of Occurrence from All Factors of Sub-district Hemorrhagic Fever and an Analysis of Risk Area in Muang Phetchabun District, Factors Influencing the Occurrence of Phetchabun Province Hemorrhagic Fever. Forecasting When multiple logistic regression was analyzed to 4. DISCUSSION test the relationship between the risk This research shows the data analysis factors and the occurrence of especially in the year of 2013. To hemorrhagic fever, it was found that the investigate the risk factors of dengue factors associated with the occurrence of hemorrhagic fever occurrence regarding hemorrhagic fever at 0.05 level of an analysis of the risk factors and the significance included the density of

occurrence of dengue hemorrhagic fever 2. To analyze the risk levels of hemorrhagic of the people in Muang Phetchabun fever occurrence in Muang Phetchabun District were performed. The results of the District, Regarding the risk levels towards study showed that the factors associated the occurrence of hemorrhagic fever in with the occurrence of hemorrhagic fever Muang Phetchabun District., they could be at 0.05 level of significance included the discussed that the spatial information was density of population, the density of the basic information that could be houses, the number of houses found analyzed and planned to solve the mosquito larvae because the community problem of dengue hemorrhagic fever in with density of houses, density of the area of Muang Phetchabun District, population, and a number of houses with 3.To study the factors that influenced the much more mosquito larvae with it was a risk levels of the occurrence of dengue major factor causing the occurrence of hemorrhagic fever in patients by the hemorrhagic fever, which was explained severity of the disease according to the that the mosquito flied for food in the diagnostics of the doctor in the year of daytime in close proximity to its origin. It 2013 in Muang Phetchabun District, might fly distances ranging from 100 feet to According to the factors influencing the 300 feet. Aedes mosquito has a close occurrence of dengue hemorrhagic fever, relationship with people, and it stays in the they were the density of population, the house or residential buildings to suck amount of rainfall, and the gender of human blood or animals and hide itself at patients. These could be discussed that the the corner of cabinet or on the ceiling, etc. density of population was quite easier to Aegypti mosquito sucks blood likely from an epidemic of dengue hemorrhagic humans rather than other animals. Life fever. Patients could multiply quickly cycle of mosquitoes may vary from 3 days because the mosquito has dengue to 3 weeks or more. An adult mosquito may infection, and if one mosquito bites, it can be the basis of a long life of about 4 bring the disease to spread to others the months, and it carries contagion among next. In terms of rainfall, the rains can result humans, (Department of Communicable in a more mosquito breeding because Disease Control, 2001). The density of when it rains much, people will usually store population and the density of houses were rainwater for utilization and will result in a easier to an epidemic of dengue more mosquito breeding. If the container hemorrhagic fever. Patients could multiply that is stored rainwater has no cover lid quickly because the mosquito has dengue due to much rain, there might be some infection, and if one mosquito bites, it can waterlogging around the house or in the bring the disease to spread to others the unused containers such as tires, cans, next. There was a report of an interesting leaves, coconut shells, bottles, etc. This study about transovarial transmission of dengue virus in mosquitoes from result was inconsistent with theories about generation to generation, which was the source of mosquito breeding which studied at the laboratory in India, and it says that mosquitoes will lay eggs on was found that the dengue virus species 3 submerged containers with stagnant water (DEN – 3) could transmit the virus from an and clear water, and water may be clean infected mosquito to the first generation or not. Mosquitoes prefer to lay eggs in and to the next seven generations, (Group some rainwater the most. So, the breeding of the Medical Entomology, Institute of source of Aedes aegypti is often in drinking Public Health and Science, 1999).Therefore, water jars and water that does not cover when the mosquito with germ bites the both inside and outside the house, and people, it makes that person to be sick, other containers called cement ponds in and the number of new patients of dengue the bathroom, pantry saucers, flower pot hemorrhagic fever has increased steadily. saucers, vases, sink wash, tires, jars, container used for water filling for pets,

scrap containers such as cans, broken jars, occurrence of people in Muang and coconut shells, and so on; whereas, Phetchabun District, Phetchabun Province Aedes albopictus usually lays eggs outside When the risk levels of hemorrhagic fever the house on the leaf sheaths of plants like occurrence were obtained, then such coconut, banana, lily, caladium plant, cup information was taken to create the spatial of latex tree hallow, coconut shell, models. The study results found that if the bamboo tube filled with water, and so data were analyzed in qualitative or on,(Department of Communicable Disease quantitative methods in a descriptive or Control, 2001a). Referring to the study of narrative pattern or were presented in the gender factor, male patients got dengue form of tables, it remained invisible pattern hemorrhagic fever rather than females, of distribution of important risk factors for which was consistent with the study on the the disease according to results clearly. prognosis of dengue hemorrhagic fever in However, when geographical information the Public Health Region, Area 1 in the year system was applied to create the spatial of 2012 found that the study of gender models, it would help in analyzing the risk data during the years of 2002-2011 found levels of hemorrhagic fever occurrence of male patients and female patients at people in Muang Phetchabun District, similar ratio that was found that the clearly, which was in accordance with the proportion of males with dengue study of using GIS to identify areas hemorrhagic fever was slightly higher than vulnerable to environmental factors for the females, (Haruehansapong and Namgate, incidence of dengue hemorrhagic fever 2012). 4. To create the spatial models to case study in Chaiyapum Province analyze the risk levels of hemorrhagic fever (Prabpala, S., 2008). Figure 3: The risk levels of hemorrhagic fever occurrence from the factor of population density

Figure 4: The risk levels of hemorrhagic Figure 5: The risk levels of hemorrhagic fever occurrence from the factor of the fever occurrence from the factor of the gender amount of rainwater Figure 6: The risk levels of hemorrhagic fever occurrence from all factors The study found that creating the spatial And the spatial models have helped out to models for retrieving areas at risk of analyze risk levels of hemorrhagic fever dengue hemorrhagic fever from the occurrence of people in Muang integration of the related factors by using Phetchabun District, Phetchabun Province GIS (Prabpala, 2008). were illustrated according to Figure 3-6

5. CONCLUSION Office of Public Health, Muang The application of Geographical Information System (GIS) for analyzing the Phetchabun District.Phetchabun risk of hemorrhagic fever occurrence of people in Muang Phetchabun District, Province. Epidemiological Work. (2013) Phetchabun Province, the results of the study found that the factors associated Situation report of dengue hemorrhagic with the occurrence of hemorrhagic fever. When the risk levels of hemorrhagic fever fever.Phetchabun. Office of Public occurrence were analyzed, they showed that all 17 sub – districts in Muang Health. Muang Phetchabun District. Phetchabun District were determined to be the risk zones according to the following 3 Phetchabun Province, 2013.Prediction of levels. And Then the Geographical Information System was applied in creating dengue hemorrhagic fever (Using time the spatial models, it would help in analyzing the risk levels of dengue series analysis) area of responsibility. hemorrhagic fever occurrence of the people in Muang Phetchabun District more Department of disease control, 2001, clearly.The results of this study suggested that the agencies responsible in the area Denguehemorrhagic fever should take action to prevent and control the hemorrhagic fever by focusing on the Miscellaneous Volume. 2nd edition (2). whole areas and highlighting during the rainfall in order to reduce the morbidity Nonthaburi: Agricultural Cooperative rate of the hemorrhagic fever. Community of Thailand. ACKNOWLEDGEMENT The researchers would like to thank Assoc Group of the Medical Entomology, Institute Prof. Dr. Sutham Nanthamongkolchai, Asst. Prof. Dr. Songpol Tornee Mr. Somchart of Public Health and Science, 1999, Rungchareon, Mr. Napapong Bamrungpong, Mrs. Siriwun Wisetkaew, Mrs. Dengue hemorrhagic fever. Bangkok: Warangkana Poonnark, and all involved people who assisted in doing this research Division of Public Relations. Department and also, to all those whose names are not mentioned here. of MedicalvSciences. Ministry of Public REFERENCES Health. Thailand severe dengue hemorrhagic fever Haruehansapong, W. and Namgate, W., in thepast 20 years (21st October 2013).ASTV 2012, Prediction of Dengue Online Manager. Hemorrhagic Fever in the Public Health (http://www2.manager.co.th/Around/Vie wNews.aspx?NewsI560000131810) Area 1 Bangkok 2012. Bureau of Vector – Borne Diseases, Prabpala, S., 2008, Using Geographical Department of Disease Control, 2013, Office of Information System to identify areas Communicable Disease. Department of vulnerable to environmental factors for Disease Control.Ministry of Public Health http://www.thaivbd.org/n- the incidence of dengue hemorrhagic /dengues/view/374 fever case study in Chaiyapum Province.Thesis of Master Degree of Science, Khon Kaen University.

AUTHOR INDEX A.K. Kataria 74 Janani Selvaraj 24, 25 96 Jefferson Fox 2 Abbas Doka 77 Jesada Surawan Abhay Anand 74 Joseph O. Odumosu 43 Abhimanu 84 Jun Zhaoand 84 Adamu M. Gbedu 85 Kalra, O. P. 35 Ajay S Vamadevan 96 Katiyar, S. K. 30 73 Klarnarong Wongpituk Amna Ahmed Hamid 41 Konda Reddy 7 Anil Kumar 44 44 Anitha Subbappa 25 Kowther Mohamed Saeed 57 Anothai Trivanich 30 Kurinji, S. 96 Anupama Natesh 26, 36 Lalitha Vadrevu 91 Arun Kumar Sharma 85 Lam Nguyen 76 Ashok, N. C. 59 Latha, K. C Atiqur Rahman 21 M. Bhaskara Rao 2 Babu Doraismy M. Mallika Rao 39, 57 Balaji Gummidi 22, 26, 36, 39, 56, 57 Madhu, B. Balasubramanian, S. 53 78 Mahesh Kumar Jat 53 Balasubramaniyan Mani 58 Mamatha, H. K. 36 Balbir Singh 40 Manjula Devi 48 Bhagyalakshmi, A. 49 Melinda Hadi 56, 95 Bharath Gavini 5, 89 Michael Gebreslasie 39 Brindha, B. Mohammad Tayyab Chada Narongrit 3 Mohammed K Ali 4 Chandan, S. 94 Mohan, S. 6 Chandrashekar B. R 86 Mohanraj Rathinavelu 85 Chayanin Pratoomsoot Mohanram Govindarajulu 85 Chingchai Humhong 3 21 Chinh Tran C. 3 Muhammad Amir Izhar 49 Choosak Nithikathkul 2 Mukesh Kumar 67 Christina Christopher 43, 44, 45, 46 Murali, R. 97 Damodharan Rangama Naidu Muralidharan Balakrishnan 30 Devesh Dubey 50 N. Mohammed 28, 50, 90 67 Nagabhushana Doggalli 67 Dilok Onla 46 Nandlal Bhojraj 74 Dipti Mukherji 99 Nikhil Tandon 55 Divya Rao, B. J. 27 Nikhil, S. V. 38 Dorairaj Prabhakaran 56, 95 Nishant Maloo 85 Duncan Athinya 85 Nitin Kumar Tripathi 21 Duong Nong H. Nutthapong Khangkhun 37 Edith Esther Edwin 4 Oluibukun G. Ajayi 47, 51, 93, 94, 97 Ghouse Mohamed Shaik 2 Pacharamon Promsuan 78 Pallavi Amirapu 93 Govindaraju, M. 14, 59, 67, 78 Peerapong Kitipawang 84 Gunaseelan Phaiboon Pensuwan 44, 45, 46 GVRK Acharyulu 91 Pipat Reungsang 87 Haoran Zhang 75 Prabhakaran, D. 94 Harathi, P. B. 53, 58 Prashanthi Devi M. 43 Helen Pates Jamet 93 Prerana, M. 8, 45, 46 Hemant Misra 22, 24, 25 Priya Thomas 21 Hemanth Kumar H. Priyanka Kakria Hutcha Sriplung 4 Raghavendra Shanbhog 5, 22, 24, 25, 26, 36, 39, 89 Ifeanyi C. Onuigbo 88 Janakiraman Radhika 5, 25 56 35 46 84 51, 93, 94 59 38

Rajeev Aravindakshan 54 Vasna Joshua 23 91 Venkat, K. M. 85 Rajiv Das Kangabam 59 Venkatasubramanian, S. 23 Ramakrishnan V. Venkatachalam 21 Vidyalakshmi, R. 26, 36 Rao, B. 74 Vinodh Kumar, O. R. 75 Ravi Kumar 21 Wilas Kampangsri 45, 46 Reddy, K. S. 73 Wilas Kampangsri 46 Reetika Yadav 38 99 Revathi Jaisingh Wirasiri Waseeweerasi 43 Rittirong Junggoth 8 Witthaya Radmad 78, 59 Roopa Shivashankar 85 Yogan Gandhi Raja Rupanjali Dasgupta 27 Safraj Shahul Hameed 85 Safraj, S. 21 Saini, N. K. 30 Sairam Challa 87 Sakda Homhuan Sakthivel Anbu 3 Sandeep Chavan 14 37 Sarojini Devi B. 91 Sasikumar Balasundaram 14 91 Selvaraj, M. 14 Senthilkumar S. Sambandan 35 Shama Virani 95 Sheryl Laura Braganza 40 Shivalinga, B. M. 59 Shridhar T. Srinivasan IAS Rtd 94 Shruthi, G. 48 Shuchi Mala 78 Sindhu Maheshwaran 75 Singh, B. R. 75 Sinha, D. K. 44 Siripen Kalayanarooj 27 Souvik Bandopadhyay 47 Sravan Sajja 56, 57 Sridhar, R. 22 Sridhar, S. 26, 36 Srinath, K. M. 90 Sudharsan Balasubramanian 91 91 Suganthi, K. 88 Suganthi, P. 30 Sujitkumar Hiwale 86 Sulabh Saini Suma S 2 Sumeet Saksena 28 Surya. B. 55 Sushma Rudraswamy 98 Susmit Tripathi 84 Taiwo J. Adewale 67 Tamilarasan 21 Tandon, N. 37 Tasneem Raja Thandi Kapwata 6 Thiyagarajan J. Kantharaj 14, 67 Valarmathi, S. 22