Dengue, traditionally seen as an urban issue due to factors like overcrowding and stagnant water, is increasingly impacting rural Telangana. A recent spike in cases challenges the urban-only narrative, as poor sanitation, inadequate healthcare, and climate change contribute to its spread, highlighting the need for broader public health strategies.
Though cases of seasonal diseases were not frequently reported at the PHCs in rural Telangana, fever surveys have been mandated by officials.
Even as urban Telangana is witnessing a surge in monsoon-related fever cases, the state’s rural areas are presenting a different picture.
Compared to rural areas, urban and peri-urban areas have been reporting more cases of seasonal diseases in August. At the 100-bed Government Area Hospital in Jogipet, six patients have been admitted with dengue.
However, around 8 am on Thursday, 29 August, four out of the six beds in the emergency ward were occupied by patients suffering from fever and weakness.
By noon, a long queue of patients and those accompanying them have formed outside the consulting rooms in the outpatient department. The scene at Jogipet, however, contrasted with those at a couple of nearby public health centres.
Picture in contrast
The medical officer was sitting on a plastic chair at a small table in the hallway of the Ayushman Arogya Mandir, previously the Primary Health Centre (PHC) at Talelma village in the Sangareddy district around 10.15 on Thursday.
“People here know me, and I know them,” Dr Satyanarayana told. “I usually sit there, see them, and sometimes chat about their lives. Today, the number of patients is less. Only eight patients have come, and there were just two cases of fever,” he added.
After the outpatient department opened at 9 am at the Area Hospital in Jogipet patients started arriving in large numbers. However, just 12 km away at the Talelma PHC, the only sounds echoing through the hospital were the chatter of a nurse and a pharmacy staff member.
“Dengue is an urban disease. I say this because, even though we sent a few samples for testing over the past month, none came back positive. There are mosquitoes here, which sometimes lead to viral fever cases, but we don’t have the dengue-causing mosquitoes in rural areas,” the doctor explained.
“There’s no open drainage here, and even when it rains, the water flows into the fields rather than collecting in potholes where mosquitoes could breed. The rural environment helps protect people from these seasonal diseases,” Dr Satyanarayana added.
Similarly, at the Gadi Peddapur PHC in Medak district, also 12 km from Area Hospital, Jogipet, there was no rush even at noon. On Thursday, the medical officer of the PHC was on leave.
“We serve a population of 9,114 people and typically see 50-70 OPD cases and five-seven IP cases daily. If any serious cases arise, they are transferred to advanced centers,” officials at the PHC told.
They added that the only serious seasonal disease the PHC had encountered recently was a patient with typhoid. “The person had travelled from Hyderabad to the village and came to us within a day. So that case originated outside the area,” the official explained.
Influx of patient at AH
The influx of patients at the Area Hospital was evident as soon as the OPD registration doors opened. By 12:30 pm., a long queue of patients had formed outside the OPD.
“These days, we’re registering around 450-500 cases at the OPD, with 220-250 of them being fever cases. Compared to a few months ago, the number of patients coming to the hospital has significantly increased,” the operator at the registration counter told.
Inside each doctor’s cabin, two doctors sat on one side of the table while patients stood on the other side, explaining their symptoms. There were no chairs or benches for patients. They stood next to doctors. Each patient spent a maximum of two minutes with the doctors.
Patients suffering from high fever were sent to the hospital’s emergency ward. As more fever patients arrived at the emergency ward, the crowd at the entrance increased. The nurse had to request the security personnel to allow patients in one by one.
“Patients who have been suffering from fever for the last four days are being sent to the emergency ward. Sometimes, the OPD doctors send patients here for admission, or after examining them in the emergency ward, if we feel they need a few days of care, we admit them,” a doctor said.
He added that fever was usually not considered an emergency case, but right now, most cases in the emergency ward were related to fever.
The 100-bed hospital has 53 beds reserved for admissions, with the rest allocated for the emergency ward, ICU, labour, and isolation wards.
However, with all admission beds occupied, the nurse at the IP department admitted new patients to the ICU and isolation wards as well.
“Most cases are related to fever, and doctors often send these patients here for admission. If a patient continues to have a high fever even after a day or two, we send their samples to the diagnostic hub at Sangareddy Government Hospital,” the hospital superintendent told.
“While most patients recover within a few days under our care, a few cases persist. We’ve sent around 200 samples to the hub, and 31 have tested positive for dengue. No cases of chikungunya or malaria have been reported here,” the official said.
The superintendent added that the hospital was equipped with Rapid Antigen Test kits, and if a case was confirmed, the samples were sent to the diagnostic hub for ELISA testing.
“Even though we’re seeing high fever cases due to dengue, most of the patients’ platelet counts have not dropped below 100,000,” he noted.
Mahesh, a patient’s relative, mentioned that people prefer the Area Hospital when their condition becomes unmanageable. “Many villagers can’t afford private hospitals in Sangareddy, so this hospital is the only option for most of us from nearby villages who want good care. But not all services are available here—they provide first aid and then refer us to the government general hospital in Sangareddy. The hospital doesn’t even have a wheelchair to transport patients from the emergency room to the ambulance,” Mahesh explained.
At the dispensary, the pharmacist shared that most medicines dispensed recently were for fever. “Paracetamol, cetirizine, diclofenac—these are the common medicines we give to patients. I’m providing paracetamol to about 90 percent of the patients who come to the counter,” the pharmacist said.
He also mentioned that there was no shortage of medicine at the hospital, and supplies were always available.
PHCs observation
Even though cases of seasonal diseases were not frequently reported at the PHCs, the hospital was required to conduct fever surveys as mandated by the state government. ASHA and ANM workers carry out the surveys in local areas.
“We are conducting the surveys, with ASHA and ANM workers visiting around 100 houses daily. Very few cases of fever—just one or two—are coming to their notice. If patients have a moderate fever, these workers provide them with paracetamol. If the fever is high, they are advised to visit the hospital,” Dr Satyanarayana said.
The PHC staff also mentioned that their primary duty as medical officials at the centers was to implement state government or National Health Mission (NHM) programmes. “Every Monday and Friday, we bring pregnant women for checkups. These two days are also dedicated to ANC checkups. Wednesday is vaccination day,” said a health worker at Gadi Peddapur PHC.
He added that most PHCs operate from 9 am to 4 pm, and in case of emergencies, patients were often referred to advanced centers.
“This PHC was set up in 2002, so it’s an older facility. Now, with the availability of 108 ambulance services, better roads, and improved connectivity to nearby towns, people prefer to go there,” the health worker explained.
Dr Satyanarayana noted that the most common case at the PHC was people experiencing fatigue. “Due to anemia and low iron levels, many people feel weak, and we provide them with iron tablets,” he said.
When asked about the availability of medicines, he confirmed that basic medicines were always in stock. “Sometimes, antibiotics run out and take time to be replenished. But most importantly, we need anti-rabies and antivenom injections,” Dr Satyanarayana emphasised.
The health worker at the Gadi Peddapur PHC echoed the same concern. “Cases of dog bites have increased significantly, and these two injections are essential for PHCs. We need more of them because the number of cases has risen. Also, this is the monsoon season, so snakebite cases are expected to increase,” he said.
He also highlighted a unique aspect of handling poisoning cases. “This area has a lot of cotton crops, and large quantities of insecticides are used to protect the plants. Accidental poisoning cases occur frequently, and we need proper guidelines from the health department to manage these situations,” the health worker added.
Monitoring the situation
While cases of seasonal diseases were high at tertiary care centers and moderately high at secondary care centers, the PHCs were not reporting a significant number of cases.
Amid the rising fever cases across the state, Health Minister Damodar Rajanarasimha held a review meeting on Thursday to discuss seasonal diseases and dengue with MHOs from all districts. He urged them to remain vigilant against viral diseases.
The minister instructed the officials to utilize Rapid Antigen Tests to confirm dengue cases, rather than relying solely on the Enzyme-Linked Immunosorbent Assay (ELISA) test.
Rajanarasimha also directed the officials to identify high-risk areas where seasonal diseases and dengue cases have been reported and to take preventive measures accordingly. He emphasised the importance of submitting daily reports on seasonal diseases to the control room, established as part of the seasonal disease prevention efforts, by 6 pm.
The minister assured that all government hospitals would be equipped to conduct the necessary tests, including blood tests, essential medicines, staff, and doctors for diagnosing dengue and other seasonal diseases.
He also instructed officials to conduct weekly reviews with various government departments, including urban municipal corporations, municipal bodies, village panchayats, irrigation, and education departments, and to submit a report on dengue prevention to the district collector. #hydkhabar
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