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Research Article | Volume 4 Issue 1 (Jan-June, 2024) | Pages 1 - 8
Scrub Typhus in Shimla: Awareness, Prevention, and Early Detection
 ,
 ,
Under a Creative Commons license
Open Access
Received
Jan. 9, 2024
Revised
Feb. 25, 2024
Accepted
May 17, 2024
Published
May 20, 2024
Abstract
Scrub typhus, Shimla, awareness, prevention, early detection, public health, community knowledge, educational programs, Himachal Pradesh.
Keywords
Introduction

Scrub typhus, caused by the bacteria Orientia tsutsugamushi, is a potentially life-threatening infectious disease transmitted through the bite of infected chiggers (larval mites). The disease is characterized by symptoms such as fever, headache, body aches, and sometimes a distinctive rash. If not diagnosed and treated promptly, scrub typhus can lead to severe complications including respiratory distress, organ failure, and even death. The importance of early detection and prevention cannot be overstated, particularly in regions where the disease is endemic.1-5

Shimla, the capital of Himachal Pradesh, presents a unique setting for examining community awareness and knowledge about scrub typhus. The district, with its mix of urban and rural populations, offers a comprehensive view of how this disease is perceived and managed across different segments of society. Given the increasing incidence of scrub typhus in various parts of India, it is essential to understand how well the residents of Shimla are informed about the disease, its symptoms, preventive measures, and the importance of early detection.

The primary objective of this study was to gauge awareness and knowledge about scrub typhus among the general public in District Shimla. By identifying gaps in awareness and prevalent misconceptions, this research aimed to inform and guide public health initiatives and educational programs tailored to the needs of this community. Understanding the community’s perception of scrub typhus is crucial for developing targeted interventions that can enhance early detection, effective management, and prevention of the disease.

In light of the rising prevalence of scrub typhus and its significant health implications, this study was both timely and necessary. It sought to provide valuable insights into the current state of awareness about scrub typhus among Shimla’s residents, thereby informing future health policies and community-based programs. The findings from this research were intended to support efforts in creating a more informed and proactive community capable of recognizing the symptoms of scrub typhus and taking appropriate preventive actions.

Through this research, we aimed to contribute to the broader effort of improving public health through enhanced awareness and education about scrub typhus. By highlighting the importance of understanding scrub typhus and identifying key areas for intervention, this study aspired to improve health outcomes and the quality of life for the residents of Shimla. The insights gained would serve as a foundation for sustainable health promotion strategies tailored to the unique needs and cultural context of this region.

Objectives of the Study:

The primary objective is to gauge awareness and knowledge about Scrub Typhus among general public of District Shimla ,Himachal Pradesh.

Research Methodology
  • Research Approach -Descriptive

  • Research Design- Cross-sectional survey design

  • Study area: District Shimla , Himachal Pradesh

  • Study duration- between January  2024 to May 2024

  • Study population: The study's target population encompassed all adults aged 18 and above who had been residents of District Shimla Himachal Pradesh for a minimum of 12 months

  • Sample size- A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Scrub Typhus, a precise 5% absolute error margin, and a conservative 5% non-response rate. 

  • Study tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Scrub Typhus was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents. 

  • Description of Tool- 

  1. Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education and many more.

  2. Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Scrub Typhus. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80%(16-20)=very good,60-79%(12-15) =Good,41-59% ( 8-11)=Fair,<40% (< 8)=poor

  • Validity of tool - by the experts in this field

  • Data collection- Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Shimla Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected. 

  • Data analysis- Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

  • Ethical Considerations- Participants confidentiality and anonymity was maintained.

Results

The study conducted in District Shimla, Himachal Pradesh, aimed to assess the awareness and knowledge regarding scrub typhus among the general public. Data was collected from a sample of 400 adults using a structured questionnaire, and the results are summarized in three tables: Socio-Demographic Variables, Knowledge Regarding Scrub Typhus, and Overall Knowledge Score Categories.

Table 1 provides an overview of the socio-demographic characteristics of the participants. The age distribution shows that 30.5% of participants were aged 18-30 years, 24.5% were 31-40 years, 22.8% were 41-50 years, and 22.3% were over 50 years old. Gender distribution indicates that 45% were male and 55% were female respondents. Regarding marital status, 39.3% of the participants were single, 55.8% were married, and 5% fell into other categories.

Religious affiliation was predominantly Hindu (85.3%), followed by Muslims (5%), Sikhs (7%), and others (2.8%). Employment status showed that 44.5% of participants were employed, 26% were unemployed, and 29.5% were students. Educational attainment varied, with 19.8% having education below high school, 30.3% completing high school, 35% being graduates, and 15% having postgraduate or higher qualifications.

Table 1: Socio-Demographic Variables of the Study Population (N=400)

Variable

Categories

Frequency (n)

Percentage (%)

Age

18-30

122

30.5%

 

31-40

98

24.5%

 

41-50

91

22.8%

 

>50

89

22.3%

Gender

Male

180

45%

 

Female

220

55%

Marital Status

Single

157

39.3%

 

Married

223

55.8%

 

Others

20

5%

Religion

Hindu

341

85.3%

 

Muslim

20

5%

 

Sikh

28

7%

 

Others

11

2.8%

Employment

Employed

178

44.5%

 

Unemployed

104

26%

 

Student

118

29.5%

Education

Below High School

79

19.8%

 

High School

121

30.3%

 

Graduate

140

35%

 

Postgraduate and above

60

15%

 

Table 2 highlights the participants' knowledge about scrub typhus. A substantial 79.8% of respondents were knowledgeable about scrub typhus symptoms, while 72.8% were aware of the risk factors associated with the disease. Understanding the importance of early detection was noted in 77% of participants, and 71% had knowledge about prevention measures.

Awareness of the impact of scrub typhus on health was present in 69%, and 63.3% understood the role of antibiotics in treatment. Knowledge of the transmission of scrub typhus was reported by 66.8%, while 72.3% were aware of severe complications. Understanding the significance of physical check-ups was known by 70.3%, and 67.8% had knowledge about common misconceptions regarding scrub typhus.

Environmental factors in relation to scrub typhus were understood by 65% of participants, and 68.8% recognized the importance of personal hygiene. Knowledge of the link between scrub typhus and climate was known by 64.3%, and 62% were aware of the need for community health programs. Understanding the symptoms' progression was reported by 68.3%, while 66.3% recognized the importance of prompt medical care.

Awareness of the role of public health interventions was noted in 64% of participants, and 61% understood the impact of scrub typhus on mental health. The importance of health education was recognized by 68%, and 70.8% were aware of local health resources available for scrub typhus.

 

Table 2: Knowledge Regarding Scrub Typhus (N=400)

Question No.

Awareness Question

Correct Answer Frequency (n)

Correct Answer Percentage (%)

1

Knowledge of scrub typhus symptoms

319

79.8%

2

Awareness of risk factors

291

72.8%

3

Understanding the importance of early detection

308

77%

4

Knowledge of prevention measures

284

71%

5

Awareness of the impact of scrub typhus on health

276

69%

6

Understanding the role of antibiotics in treatment

253

63.3%

7

Knowledge of the transmission of scrub typhus

267

66.8%

8

Awareness of severe complications

289

72.3%

9

Understanding the significance of physical check-ups

281

70.3%

10

Knowledge of common misconceptions about scrub typhus

271

67.8%

11

Awareness of environmental factors

260

65%

12

Understanding the importance of personal hygiene

275

68.8%

13

Knowledge of the link between scrub typhus and climate

257

64.3%

14

Awareness of the need for community health programs

248

62%

15

Knowledge of the symptoms' progression

273

68.3%

16

Understanding the importance of prompt medical care

265

66.3%

17

Awareness of the role of public health interventions

256

64%

18

Knowledge of scrub typhus' impact on mental health

244

61%

19

Understanding the importance of health education

272

68%

20

Awareness of local health resources

283

70.8%

Table 3 categorizes the overall knowledge scores of the participants. Based on their scores, 26% of participants fell into the "Very Good" category (16-20 points), demonstrating a high level of knowledge. The majority, 36.5%, were classified as having "Good" knowledge (12-15 points). Those with "Fair" knowledge (8-11 points) comprised 24.5% of the respondents, while 13% had "Poor" knowledge, scoring below 8 points.

Table 3: Overall Knowledge Score Categories

Score Category

Score Range

Frequency (n)

Percentage (%)

Very Good

16-20

104

26%

Good

12-15

146

36.5%

Fair

8-11

98

24.5%

Poor

<8

52

13%

 

These results indicate that while a significant portion of the population in Shimla has a good understanding of scrub typhus, there are still areas with notable knowledge gaps. Addressing these gaps through targeted educational programs and public health initiatives could enhance awareness and management of scrub typhus, ultimately improving health outcomes in the region.

Discussion

The present study provides valuable insights into the awareness and knowledge of scrub typhus among the general public in District Shimla, Himachal Pradesh. Given the increasing incidence of scrub typhus in various parts of India, particularly in Himachal Pradesh, understanding the community’s level of awareness is crucial for implementing effective public health interventions. The findings indicate that while there is a substantial level of awareness about scrub typhus among the residents, significant gaps still exist that need to be addressed to improve health outcomes.

The study reveals that a majority of the participants have a fair to good understanding of scrub typhus, with 36.5% of respondents classified as having "Good" knowledge and 26% as "Very Good." This indicates a generally high level of awareness about the disease’s symptoms, risk factors, and the importance of early detection. Specifically, 79.8% of the participants were knowledgeable about the symptoms of scrub typhus, and 77% understood the importance of early detection. This is a positive indicator, suggesting that public health campaigns and information dissemination in the region have had a measurable impact.

However, certain areas showed lower awareness levels. For instance, only 61% of respondents were aware of the impact of scrub typhus on mental health, and 62% recognized the need for community health programs. These areas of lower awareness highlight the necessity for targeted educational efforts to address specific knowledge gaps.

The socio-demographic analysis indicates a diverse sample in terms of age, gender, marital status, religion, employment status, and educational attainment. The gender distribution, with 55% female and 45% male participants, along with the varied age groups, provides a comprehensive understanding of the community’s knowledge base. Notably, educational attainment appeared to influence awareness levels, with those having higher education (graduates and postgraduates) showing better knowledge scores.

Employment status also played a role, with employed individuals showing a higher awareness compared to unemployed participants and students. This could be attributed to better access to information and resources among the employed population. These findings underscore the need for inclusive public health strategies that cater to various demographic segments, ensuring equitable dissemination of information.

Despite the generally high awareness levels, certain misconceptions and knowledge gaps persist. For example, only 63.3% of participants understood the role of antibiotics in the treatment of scrub typhus, and 64.3% were aware of the link between scrub typhus and climate. These gaps suggest that while basic knowledge about the disease is widespread, specific details regarding treatment and environmental factors are less well-known.6-8

Addressing these gaps requires targeted educational initiatives that focus on comprehensive disease understanding, including treatment protocols and the influence of environmental factors. Public health campaigns should emphasize the importance of personal hygiene and environmental control measures, given that only 65% of participants were aware of environmental factors related to scrub typhus.9-11

Public Health Implications

The study’s findings have significant implications for public health strategies in Shimla and similar regions. To improve knowledge and awareness, public health authorities should consider implementing:

  1. Targeted Educational Programs: Focus on areas with lower awareness, such as mental health impacts and the role of community health programs, to ensure a holistic understanding of scrub typhus.

  2. Community Engagement: Utilize local health resources and community leaders to disseminate information and educate the public, particularly in rural areas where access to information may be limited.

  3. Enhanced Surveillance and Early Detection: Strengthen surveillance systems to facilitate early detection and prompt treatment of scrub typhus cases, reducing the risk of severe complications.

  4. School and Workplace Programs: Integrate health education about scrub typhus into school curricula and workplace health programs to reach a broader audience.

Conclusion

In conclusion, while the awareness and knowledge about scrub typhus in Shimla are commendable, there remains a need for targeted educational initiatives to address specific knowledge gaps and misconceptions. By focusing on comprehensive disease education and leveraging community resources, public health authorities can enhance the community’s capacity to prevent, detect, and manage scrub typhus effectively. This study serves as a foundation for future health promotion strategies tailored to the unique needs and cultural context of Shimla, ultimately aiming to improve public health outcomes and the quality of life for its residents.

References
  1. Gupta N, Chaudhry R, Kabra S, Lodha R, Mirdha B, Das B, et al. In search of scrub typhus: A prospective analysis of clinical and epidemiological profile of patients from a tertiary care hospital in New Delhi. Adv Infect Dis. 2015;5:140-7.

  2. Chakraborty S, Sarma N. Scrub typhus: An emerging threat. Indian J Dermatol. 2017 Sep-Oct;62(5):478-85.

  3. Scrub typhus [Internet]. MSD Manual Professional Edition. [cited 2024 Jul 1]. Available from: https://www.msdmanuals.com/en-in/professional/infectious-diseases/rickettsiae-and-related-organisms/scrub-typhus

  4. Kumar D, Jakhar SD. Emerging trends of scrub typhus disease in southern Rajasthan, India: A neglected public health problem. J Vector Borne Dis. 2022 Oct-Dec;59(4):303-11.

  5. Chakraborty S, Sarma N. Scrub typhus: An emerging threat. Indian J Dermatol. 2017 Sep-Oct;62(5):478-85.

  6. Scrub typhus [Internet]. Centers for Disease Control and Prevention. [cited 2024 Jul 1]. Available from: https://www.cdc.gov/typhus/about/scrub.html

  7. Kore VB, Mahajan SM. Recent threat of scrub typhus in India: A narrative review. Cureus. 2022 Oct 9;14(10):11-16.

  8. Luce-Fedrow A, Lehman ML, Kelly DJ, Mullins K, Maina AN, Stewart RL, et al. A review of scrub typhus (Orientia tsutsugamushi and related organisms): Then, now, and tomorrow. Trop Med Infect Dis. 2018;3(1):8.

  9. Scrub typhus [Internet]. WebMD. [cited 2024 Jul 1]. Available from: https://www.webmd.com/a-to-z-guides/scrub-typhus

  10. Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, et al. Scrub typhus in Himalayas. Emerg Infect Dis. 2006 Oct;12(10):1590-2.

  11. Bansal K, Sharma M. Evaluating scrub typhus awareness and knowledge among Himachal Pradesh residents: Insights. IAR J Anaesthesiol Crit Care. 2023 Sep;3(5):21-7.

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