Be alert to monsoon diseases

by Dr. K. Sreekanthan

Monsoon brings with it the much awaited relief from the long spell of sultry, scorching summer. However the cooling showers bring with them an increased susceptibility to a lot of diseases that are peculiar to the monsoon. It is time we get our safeguards ready and gear ourselves up to face monsoon in its full glory.

In Kerala the south- west monsoon known as "Edavappathy/Kalavarsham" usually begins in the first week of June. But it can be late or sometimes earlier.

This year the monsoon has already begun as a continuation of the summer rainfall. Along with the rainfall there is a sudden increase in the occurrence of viral influenza disease with fever, cold and cough. Last year there was an upsurge of Dengue fever.

Diseases that are spread during monsoon may be water borne, air-borne or vector-borne.

These include the water-borne gastro intestinal infections like Typhoid fever, acute diarrhoeal diseases like cholera and non-cholera gastroenteritis, dysentery, jaundice due to hepatitis A and E, Air borne diseases like influenza, mosquito borne disease like Dengue fever, Malaria Japanese encephalitis. Other diseases are Leptospirosis (Weils Disease*- Rat fever*), Conjunctivitis etc.

Contamination of water due to lower levels and unhygienic conditions in cities are very often the cause of many monsoon ailments. Skin conditions,Asthma and arthritis also aggravate because of excess humidity.

These and many other disease that are more commonly found in the monsoon because the first few rain showers bring along with them obnoxious gases,as well as the air-born germs ,thus accumulating in the lakes and other areas , causing contamination of water. In severe monsoon the drain pipes clog and overflow, sometimes mixing with the water pipes and causing diseases. Even getting wet in the rains can give rise to cold, coughs and fevers as well as body and joint pain. Sudden change in temperature from extreme heat to cold can precipitate viral infection. Collection of water in pot holes and stagnation of water as breeding grounds for mosquitoes which spread diseases like Dengue fever and malaria.The water get contaminated with rat urine containing the microorganisms.

Weeds enclosed ponds and water storages should be viewed only with caution, as they become favourable dwellings for rats because of its advantageous shelter providing characteristics. Sunlight is prevented from passing down in total, thereby helping the disease germs to flourish uninterruptedly from the sharp rays of the sun. In such positive conditions the germs can sustain even for weeks.

The persons who come into physical contact with such water turn out to be victims of disease like leptospirosis. The germs enter their bodies even through minor cuts and wounds and mucous membranes of eyes or oral cavity on immersion or taking bath.

Climatic variations are also yet another cause of disease spread. The sudden onset of monsoon after recession of an extended hot summer diminishes the normal health status of an average individual forcing him prone to diseases. Especially people of extremes of age are more prone. Patients suffering from chronic ailments like Diabetes mellitus, small lung ailments or heart diseases, chronic rheumatism are more vulnerable.

Nevertheless, an important point to be mentioned here is that even in spite of rainfall there is acute scarcity of good drinking water in many parts of the state. This will lead to consumption of available source of water which is not germ free. The following are a few safeguards that one must follow in order to keep all diseases and infections at bay. During monsoon intestinal functions along with the digestive system become weak, and make the body highly susceptible to any kind of infection.

Therefore always eat light food and avoid as far as possible too much spicy and fried foods. In order to prevent water-borne diseases, do not drink water which is not properly boiled and stored. Drinking water should be boiled and properly filtered.

Avoid consuming food that is exposed to the surroundings for quite a long time, since food that is exposed for along time are contaminated by germs, which if enter the body, may cause various infections. Flies are the most common carriers of germs that mostly cause contamination.

Therefore remember to cook the vegetables well and steam them properly to kill the germ content in them, if any.Diabetic patients need to take extra care of their feet during monsoon season.

These patients should take specific care as not to walk bare-foot since the soil on which they walk is a reservoir of all types of germs. Asthma patients also need to take special care during monsoon as they should ensure that there is no accumulation and seepage of water from the vicinity of their residence since that will cause severe health problems. They should also ensure that fungus does not grow in the wooden furniture, and in other articles like shoes and leather bags.

Prohibit mosquito - breeding since they are also carriers of deadly germs. Do not let water accumulate in your surroundings.

Put a few drops of kerosene or Phenyl in the stagnant water to check the undesired mosquito breeding. Mosquito net should be used wherever possible.

Apart from naturally occurring diseases described above, electric injury due to leakage of current, water dripping onto live electric wiring, electrocution is also common.

It would be wise to give a thorough checkup to the wirings, switches, plugs, and the positioning of the wires around the house. Furthermore do not forget the electrical appliances. In case of any fault attend to them at the earliest.

Also take care of your children who love to splash through water logged streets, this could be dangerous. Water logging conceals a lot of rubbish filling over from dustbins, drains and manholes.

It often contains glass pieces, stone chips slivers of wood and other substances. These can inflict serious injuries on tender bare feet.

Thus a little effort on your part coupled with care and caution can really help you enjoy this monsoon to its fullest. Be extra alert and observe these safety guidelines.

Psychological disorders after a child birth

Dr. R.A.R. Perera

Consultant Clinical Psychologist.

Postnatal psychology deals with mental illness associated with childbearing, and postnatal disorders. Postnatal disorders are divided in to three groups - postnatal blues, puerperal psychosis and postnatal depression.

Post natal blues - In the first few days after childbirth, 60-70% of women experience feelings of anxiety, lack of confidence, unpredictable mood swings, with usefulness, difficulty concentrating and a general feeling of confusion. The peak incidence is on the fourth or fifth day and in general, these feelings last for 2-3 days. Although transient, these symptoms cause distress to the mother who can be compounded by a lack of understanding and support from those around her. Fortunately there has been growing recognition of the problem, both by professionals and by women and their families. A number of factors suggest there are biological causes for this problem. These include the nature and timing of the blues and an increased risk in women with a history of premenstrual syndrome. Social class, chronic stresses and life events do not seem to be related to the blues. The only social factors that may have protective effects are supportive and social relationships, primarily with the family and the spouse. There is no relationship with a difficult delivery or being in hospital.

Treatment:- Understanding and support from the professionals, family and friends. Medication is not used in this common condition.

Puerperal psychosis:- The most severe but least common among postnatal psychological disorders; it results in one admission in 500 births. It is an affective disorder similar to manic depressive psychosis. There is pronounced disturbance of mood, which can be either low or high or fluctuating between low and high. Delusions (false beliefs) and or hallucinations (hearing or seeing things which are not real) are also present. In depression, a woman may believe herself to be bad or evil or hear voices telling her that terrible things are going to happen to her or the baby or that she should harm herself. In mania, she may believe that she has special powers. Associated symptoms include sleep or appetite disturbances, impaired concentration, changes in activity levels, impaired functioning or (as if people are plotting against her) persecutory ideas.

Puerperal psychosis usually begins in the first week after delivery, with the incidence dropping sharply over the next two weeks.

* Predisposing factors:-

A previous or family history of psychosis, first pregnancy, perinatal death, alcohol and drug abuse, poor marital relationship and poor social support. Most of these factors can be identified antenataly and used to predict a high risk (50-60%) of psychosis, which can assist in planning support services for the puerperium. The severity of the psychosis leads to easy diagnosis and a Psychologist or a psychiatrist should immediately see them.

Treatment:- Antipsychotic and depressant treatment. The risk of relapse is about 50%, which can be puerperal (in another child birth), non-puerperal or sometimes associated with menstrual periods.

Post natal depression

Postnatal depression is the most common major complication (physical or psychological) of the postnatal (after a child birth) period. The prevalence of major depression in the first 3 months postpartum is 10-15%; it peaks at about 4-6 weeks. The symptoms are - low mood, low interest, hopelessness, impaired concentration, loss of appetite, difficulty in sleeping, impaired functioning, sexual difficulties. She is usually able to look after the basic physical needs of the baby. Many of these features occur in the normal puerperium (after child birth) as a result of the physical and psychological demands of having a new baby. Postnatal depression is differentiated by the pattern of symptoms and the severity. In addition to the mother's suffering, there is an impact on the spouse, family and the development of the child. Social class, parity nor adverse obstetric factors appear to influence the incidence of postnatal depression. The two social factors that are consistently associated with an increase risk are poor quality of marital relationship and inadequate social support. Most cases of postnatal depression go undetected and diagnostic tools have been developed to assist diagnosis (Edinburgh postnatal depression scale).

General practitioners, health workers and midwives use it. In some countries there are programs to screen all women at 6 weeks postpartum (after a child birth).

Treatment:- Women with non-psychotic depression seldom requires admission. Treatment is based on the same principles as depression occurring at any other time, but consideration should be given to the mother's situation. Less sedative antidepressants should be prescribed. If the woman is breast-feeding, the choice of psychotropic medication is restricted. Counselling is also important.

Hormones:- Up to 10% of cases of postnatal depression is associated with postpartum autoimmune thyroid disease. Low progesterone levels also can cause it.

Social support:- Encouraging women to develop and use supportive networks are an important preventive and therapeutic measure. Selfhelp organisations; health visitors and general practitioners can help.

The mother should be encouraged to develop her own source of support rather than attempt provides direct support.

In Sri Lanka the parents of these new mothers and the midwives who visit these new mothers generally manage these conditions. Adequate training of these midwives and the primary care physicians (General practitioners) is an important factor in reducing the social issues associated in this important condition.