Guidelines for Epidemic management in Homoeopathy

Strategical approach for finding a genus epidemicus and guidelines for epidemic management including Constitution of the epidemic control group in Homoeopathy

Authored by:
Dr. Anand.P.R, B.H.M.S, M.D, M.C.A                    

Co-authored by:
Dr. Dinesh.R.S, B.H.M.S, MBBS, M.D
Dr. Sreejith.S, B.H.M.S, M.D
Dr. Mridula Gopinathan, B.H.M.S, M.D 

An epidemic (epi = upon, demos = people) is the “unusual” occurrence in a community or region of disease, specific health related behavior or other related event, clearly in excess of the “expected occurrence”

The term ‘expected occurrence’ is one of the key works in the definition as in one locality where no cases of one particular disease is reported even one case would be a ‘potential ‘epidemic.  Where as another locality where the hundred of cases of that particular disease is endemically prevalent it requires lot many cases of it to be considered as an epidemic. An arbitrary limit of two standard error from the endemic frequency is used to define the epidemic threshold for common disease. 

Hahnemann’s Definition:-
Epidemics are diseases of such kind that attack many people and they present with very similar suffering from the same causes. These diseases generally become infection when they prevail among thickly congregated masses of human beings. Thence arise fevers, in each instance of a peculiar nature because the cases of disease have identical origin, they setup in all those the affect an identical morbid process, which when left to itself terminates in a moderate period of time in death or recovery

How to know if an epidemic is prevalent or not in the community?
Statistically speaking an epidemic is said to occur if the prevalence of a particular disease at a particular time is to standard error above the endemic prevalence rate. For this records case incident rate for different diseases should be kept in different Govt. dispensaries and private clinics and hospitals. As this becomes difficult we can rely basically on other sources of information like.

1. Epidemic assessment cell of the Government.
2. Epidemic control cell of other system of medicine
3. Media reports
4. Reports from medical officers working in peripheral units

Scope for expansion
A computer network based patient data archiving can be done and provision of daily updating of data is to be made. Information regarding epidemic outbreak can be assed by latest technique like Data mining.

If an epidemic is identified in locality, whom to report to?
A prompt and timely reporting is as important as the identification of an epidemic. A prompt telephonic report should be made to the epidemic control cell with all the identifying details. It should be followed up with a proper written report.

Significance of homoeopathy in epidemics

In a country as large as ours, the occurrence of epidemics is not infrequent and they usually spread like wild-fire creating a chaos. And it is into this chaos that homoeopathy hopes to restore order. When there arises situations where the cause of the disease appears to be an enigma and every other system of medicine is clueless regarding what preventive/curative medicine is to be given, homoeopathy has been able to solve the problem. Even when, during the course of an epidemic, there appears to be a change in strain of the infective organism and there is very little time to create a new drug, homoeopathy has been able to overcome the crisis.

This is possible not because there is a panacea for every disease in homoeopathy; but unlike the commonly used medicines which are directed towards the destruction of the infective organisms, homoeopathic medicines aim to improve the immune system of the individual. Here the basis of selection is not dependent upon the nature of the organism but on the signs and symptoms of the diseased individual.

The age old adage “Prevention is better than cure” holds in good stead in times of epidemic. When few cases (5 or 6) of the epidemic disease are studied carefully in all their aspects, a single medicine can be selected which will correspond with the characteristic symptoms of the disease as well as the patient. Homoeopathy gives importance to not merely the symptoms of the disease but also the peculiar symptoms exhibited by the patients which is why even when the disease is the same the medicine required may vary for different epidemics. The climatic conditions during the time of epidemic also plays a significant role.

In epidemics of such nature that are transmitted only through vectors, the most important preventive step to be taken is vector control. However due to practical problems such as large population, poverty , poor hygiene and lack of manpower this becomes a long drawn procedure which should be  nevertheless carried out even though it does not produce immediate relief to the growing concerns of increasing epidemic casualties. Hence the best solution is to administer the preventive medicines in the fastest and the most extensive method.

Nine reasons why homoeopathic medicines are the best option in any epidemic: –

• Easily administered, the medicines are palatable and hence easily administered.
• Economical viability – From the consumer point of view the cost of homoeopathic medicines is minimal.
• Easy dispensability (Medication, packing and distribution) – The homoeopathic medicines though packaged in dilutions, are dispensed by medicating them in globules which makes transport, distribution and administration (intake of medicine) easy. The practical problems seen while administrating vaccinations such as fear of injections, risk of use of infected needles, immunization of infants and pregnant women etc. are overcome.
• Easy instructions – Since immunization involves every section of the society (including the educated and uneducated classes) the instructions must be very simple to follow which is how it is with homoeopathic medicines.
• No side effects after drug administration.
• Criteria of the beneficiaries –All age groups are included in the immunization programme from infants to persons in geriatric category. Those undergoing Allopathic or Ayurvedic medication can take the preventive medicine as there is no particular interaction between the medicines.
• Action of medicine – Contrary to common belief that homoeopathic medicines are slow in action, they are in fact rapid in their action. In case of epidemic disease of a virulent nature, the immunity rendered to healthy persons or uninfected persons is immediate, provided the dose taken is accurate.
• Change in the nature of disease – During an epidemic many a times it has been observed that a mutation of the infective organism has resulted in a change in the nature of the epidemic thus requiring an exhaustive research into finding another vaccine. But these attempts pose many practical difficulties and hence many casualties. Since homoeopathic medicines aim to boost the individual’s own immune system, genetic mutation will not be a deterrent in finding a correct homoeopathic solution to the epidemic.
• Unidentified cause- In case of epidemics where the infective organism is not found or if found, homoeopathy can offer preventive measures as it relies on the signs and symptoms characteristic of the disease on not on the identification of organism per se.

Nevertheless it is hoped that this report will shed some light upon the shroud of ignorance surrounding homoeopathy so that the Ministry of Health would in future show greater confidence in Homoeopathy and encourage all the systems to combine their efforts in combating future epidemics.

Genus epidemicus the views presented in the literature

Organon of medicine 6^th edition

• 100
• It is quite immaterial whether or not something similar has ever appeared in the world before under the same or any other name.
• There is no difference in the mode of examination or of treatment even if the disease is novel and peculiar.
• The physician must regard the pure picture of every prevailing disease as if it were something new and unknown and investigate it thoroughly for itself, never considering that the case of disease before him is already wholly or partially known, always carefully examining it in all phases.
• Every prevailing disease is in many respects a phenomenon of a unique character, differing vastly from all previous epidemics. Exceptions are those epidemics that result from a contagious principle that always remain the same, such as small pox, measles, & c.

Questions to be answered

1. Which are the diseases that have a fixed character in addition to small pox and measles?
2. Can we find out a universally acceptable genus epidemicus for diseases that have a fixed character so that we can use them irrespective of time, seasons and localities? We can save time and energy in investigating such diseases.

101

• We may not obtain knowledge of the complete picture of an epidemic disease from the first case itself. Only by a close observation of several cases we can become conversant with the totality of its signs and symptoms.
• However, the carefully observing physician can, from the examination of even the first and second patients, often arrive at characteristic portrait of it, and even succeed in finding a suitable, homoeopathically adapted remedy for it.

Questions to be answered

1. How many cases are to be selected for finding out the totality of signs and symptoms of an epidemic disease?
2. Is there any self-contradiction in this aphorism?

102

• The sketch of the disease picture becomes ever more and more complete after writing down the symptoms of several cases of this kind. It will become more significant (more characteristic) and including more of the peculiarities of this collective disease. The general symptoms (e.g. loss of appetite, sleeplessness etc.) become precisely defined as to their peculiarities. The more marked and special symptoms which are peculiar to but few diseases and of rarer occurrence, at least in the same combination, become more prominent and constitute what is characteristic of this malady.
• All those affected with the disease prevailing at a given time have certainly contracted it from one and the same source and hence are suffering from the same disease.
• The whole extent of such disease and the totality of its symptoms cannot be learned from one single patient, but it is only to be perfectly deduced and ascertained from the sufferings of several patients of different constitutions.
• The knowledge obtained by a complete survey of the morbid picture is essential for enabling us to choose the most suitable homoeopathic remedy for the array of symptoms. 

The epidemic control Group
As health is a state concern in India, it is necessary for all the states in the country to constitute a State Epidemic Control cell for Homoeopathy. 

Aim of the group.

To manage all epidemic control activities

1. The epidemic control group can itself identify outbreaks of the epidemics
2. The epidemic control group can predict the time and probable locality of outbreak of epidemic using prediction indicators
3. The epidemic control Group can take all measures to counter a current epidemic a\ or a predicted outbreak of a epidemic (including emergency stocking of medicines)
4. Once an epidemic is identified. The epidemic control group authorizes certain nodal medical officers to take the case reports of the positively identified and diagnosed patients (positive lab reports and immunological studies should be stressed upon)
5. These reports along with the impression of the nodal medical officer are sent to the ‘genus epidemics’ selection unit in the epidemic control cell.

Constitution of the epidemic control group: – (HIGH POWER COMMITTEE)

As epidemics create serious health social economic problems, it requires very serious contemplation as to the planning and strategic control. So the most senior health authorities should be involved in the group formulation.

• The director of homeopathic medical education.
• The director of homoeopathic medical services.
• The Principals of Govt. Homoeopathic medical colleges in the state.
• Coordinator Homoeopathic Epidemic control group.

The ‘genus epidemics’ finding Group –constitution (STATE LEVEL EXPERT GROUP)

• The director of Homoeopathic medical education.
• The director of Homoeopathic health service.
• Three subject experts.
• Heads of Social and Preventive departments of the Government Homeopathic Medical Colleges of the state.
• Representative of medical officer associations.
• Representation of different association of homoeopathic doctors.

Once ‘genus Epidemics’ is found out an implementation group should be made. A chief project implementation officer is identified for from the epidemic control group. He is given the full authority and responsibility to deal with all matters concerning the epidemic.

Members of the epidemic control project implementation group

• Chief project implementation officer.
• Nodal officer for wide area where epidemic out break is there.
• homoeopathic medical officer in the locality.
• Representatives of the different homoeopathic doctor organization.
• Representation of local governing bodies.
• Representative of political social welfare organization.

The task force shall be constituted from

• Homeopathic medical officers (Both Govt. and private) in the locality.
• The peripheral health workers.
  1. Junior health nurse.
  2. Junior health workers.
• The task force of local governing bodies.
• The task force of social welfare organization & clubs.
• The task force of political organizations.

The communication between local implementation sites to central strategical control unit

All implementation details and day today works schedules and feedbacks are to be dealt with by the nodal officer

Biweekly reports are to be made to the chief project implementation officer

The ‘chief project implementation officer’ will make weekly report to the epidemic control cell (which would meet in each week to reevaluate the project weekly)

Other duties to the chief project implementation officer

• To split the areas for easy work coordination to coordination different units so the redundancy of work coordination is not there.
• To check out if enough quantity of medicines and sundries are available in the regular supplying units in the Govt. health machinery.
• Check out how much further medicines can be manufactured and supplied by regular supplying units.
• Identifying excess stock of epidemic control medicines lying unused in areas where epidemic is not prevalent including Govt. dispensaries and medical colleges.
• Accommodating facilities for transport of these medicines and sundries.
• To arrange for finance to conduct all these activities.
• It is always better to procure already medicated and filled bottles of medicines from the manufacturing units. Using the student workforce from the Govt. Homoeopathic medical college should be one be done as the last viable option.
• Proper record keeping.
• Proper statistical study of available data for which a medical statistician’s help can used

The media mobilization: –

The media also help a also in the mobilization of the effort and implementation of the project

The media approach can be basically divided into two

• The mass media
• The local campaigning

The use of mass media for awareness can be done due to

• Ease in implementation
• The greater geographic area of approach
• Greater appeal

But using mass media can cause undue alarm and panic and these should be avoided

Local Campaigning: – Can be done by pamphlets given in the behalf of the health authorities or local social welfare bodies or using mike announcement done with local help

Classes and training programs for the implementation group and workforce: –

• The epidemic control cell representative will take class to the implementation group who will take class for the workforce
• The nature of epidemics should be taught
• If any vectors are involved the vector control measures should be taught
  1. Larval measures
  2. Adults
• Training for how to fill Performa’s and checklists
  1. Performa for calculating the prevalence rate of the epidemic before delivering the preventives
  2. Performa for identifying the risk factors in the environment for the outbreak of the epidemic.
  3. Performa for evaluating the effectiveness in the post epidemic evaluation & assessment

The training for doctors to deal with cases of epidemic reported to him

• Training to identify the symptoms of the disease.
• Training for disease diagnosis.
• Training how to use flow charts for quick case taking.
• Training how to use flowcharts for quick remedy selection.

Selection of the research group: – 

Proper statistical data worked out during an epidemic became a good guideline for further outbreak of similar epidemic.

If a number of areas are involved in the epidemic or the preventive is decided to be delivered to a wide area there a research group should be selected.

The members of the research group:

• The director of homoeopathic medical education
• One subject expert
• One medical statistician
• PG representative from homoeopathic medical colleges

Their Duties would be: 

• Selection of an area with maximum prevalence rate.
• Banding of the area.
• Randomized control study and sample definitions.
• Implementation of the research problem.
• Creating Performa’s –
  1. For case taking.
  2. For calculation of prevalence rate.
  3. For retrospective study.
  4. To know the prevalence rate offer the preventive has been given.
• Data rearrangement.
• Statistical tabulation.
• Hypothesis proving
• Projection of the study inferences in one area to cover all areas

10) Study of data from all sources even data from sites different from the area selected for research study

Post epidemic evaluation & assessment : –

The research group will provide the post epidemic evaluation report to the ‘epidemic control group’ or the ‘chief epidemic control officer’

The report will contain all the details regarding the disease, the nature of outbreak, the risk factors which were involved in the epidemic outbreak, the medicine that came out as genus epidemicus, why it was selected as genus epidemicus, the area to which the preventive was provided, the number of persons to which preventive was given, the impression of the research team as to effectiveness of the preventive

After proper suggestion this ‘report’ is to be 1^st published in homoeopathic and other medical journals.

After this the report should be provided to the media so they can create a public awareness as to the role of homoeopathy in management of epidemics

The Study of the economic impact of the epidemic : –
The economic impact of the epidemic can be easily assessed by adding a column in the retrospective study & post preventive assessment Performa.  By this the total expense for each caser from the start to the end of the disease can be assessed including money lost due to absenteeism of both the case and relative multiplying this with the expected case rate will give economic impact in term of cases

If the total expense for delivery of the preventives is added, it gives the total economic impact

A provision should be made in the next five-year plan to deal with future expenses for countering epidemics.

PROSPECTIVE STUDY PERFORMA FOR STUDYING THE PREVALENCE RATE OF AN EPIDEMIC

Name                                                               :

Age                                                                  :

Occupation                                                      :

Residential Address                                         :

Occupation Address                                        :

Religion:                                                          Caste:

Family Income:                                                Annual Income:

Educational studies:

Economic States

Immunized                                                      : Complete/Incomplete/unimmunized

Name of school/working Unit                          :

Place of School/Working Unit                         :

Playground/social gathering                             : (library /Theaters/Parks)

Risk Factors in home( within 500m)

• Sewage disposal area
• Rain water collection
• Contaminated water ( river, ponds, lakes)
• Gardens/estates/forest area
• Any unwanted food or rubbish waste
• Miscellaneous

Risk Factors in school/office surroundings( within 50m)

• ontaminated/waste water
• Gardens/estates/forest area
• Rain water collection
• Any unwanted food or rubbish waste
• Miscellaneous

Type of house  : hatched /tiled /terrace

Construction of the houses

Maintenance of sanitary disposal

Screening for windows/doors

Domestic habits

Washing & cleaning food items                 :

Covered/uncovered food

Usage of mosquito repellents/net               :

Personal hygiene                                        :

Clinical Features

Date of onset:                                                           Duration                      Pulse

Temp                           B.P

Change in the occupational behavior/practices in the surroundings

Change in the surrounding environment          :

Nature of water supply                                    :

Latrine/septic tank/ leech pit                            :

Well (protected/unprotected)                           :

PERFORMA FOR CASE TAKING

Reporting center:                               Date: 

Geography:

1. Geographical location: Kara, ward, village, panchayat/ municipality/ corporation, block, taluk, district.
2. Location Map
3. Climatic condition
4. Demographic status: Population – male, female, child population, IMR, MMR etc.
5. Health resources available.
6. Epidemic history: report occurrence or prevalence or recent epidemics in the geographic area.

Case taking proper: 

• Name
• Age
• Sex
• Religion
• Residential address
• Phone
• Resident / migrant / traveler
• Financial status
• Social class – APL/BPL
• Personal contacts- at home, work, school, other places.
• Attended special events/ parties/ melas – ingestion of contaminated food, water.
• Recent inoculations and hospital visits.
• Living surroundings – slum, hilly, marshy, urban, costal, rural etc.
• Health status prior to the epidemic.
• Clinical features   date   location    sensation/ethiology        modalities    concomitants
  Fever
• Myalgia
• Headache
• Arthralgia
• Retrobulbar pain
• Bleeding manifestation
• Petechia/purpura
• Echimosis
• Hematemesis
• Malena
• Abdominal pain
• Vomiting
• Others

Generals

• Appetite                                                           Thirst
• Bowels                                                             Urine
• Perspiration                                                   Sleep/covering
• Mind

General examination

• Pallor                                                               Icteric
• Cynosis                                                            Clubbing
• Lymphadenopathy                                       Odema
• Tourniquet test

Local examinations (and systemic findings)

• Psychic expressions:
• Laboratory findings
• HB
• PCV
• Platelet count
• TC/DC                                                                   P          L          E
• IgM Antibody levels
• Stool occult blood
• Urine relevant findings
• Others

Any treatment taken for present febrile illness :    Yes/no

• Predominant miasmatic expression
• Symptoms of miasmatic expression
• Febrile illness in recent past (2 months)
• Afebrile days in present illness if any

Dengue fever in home/neighborhood /relatives/school/office

• Name/age/sex
• Address
• Details of admissions
• Discharged/Death
• Economic liability to the family Rs
• Other Related information’s

PERFORMA FOR STUDYING THE EFFECT OF HOMOEOPATHIC PREVENTIVE MEDICINE IN AN EPIDEMIC

RESTROSPECTIVE STUDY

• Name
• Age
• Sex
• Occupation
• Residential address
• Occupational address
• Number of family members
• Family income
• Educational status
• Birth order
• Environment/surroundings

Risk factors

1. Homoeopathic preventive taken Yes/No
2. Have you taken the medicine in the prescribed dose   Yes/No
3. Have you taken any other medicine in between Yes/No

If yes, specify – homoeopathy, allopathy, ayurveda, others

4. Whether you under any chronic medications Yes/No

If yes, specify – homoeopathy, allopathy, ayurveda, others

5. Have you developed symptoms of the epidemic after taking

homoepathic preventive medicine                                                             Yes/No

6. After how many days did you develop the symptoms- 1-7, 8-14, 15-28
7. How many days did the symptoms last 1-7, 8-14, 15-28
8. What were the symptoms?

9. Have you undergone in-patient treatment? Yes/No

If yes, specify – homoeopathy, allopathy, ayurveda, others

10.How long did the In-patient treatment last        1-7, 8-14, 15-28

11. Was any labororatary investigation done? Yes/No
12. How long did the treatment last 1-7, 8-14, 15-28
13. How many working days were lost 1-7, 8-14, 15-28
14. How much did the epidemic treatment cost <500, >500, > 1000
15. What was the treatment result? Cured, complications, death.
16. If no treatment was taken for the epidemic what is the result

Cured, complications, death.

17. Signature head of family

• survey no: Place,  Date, time.
• Signature of the surveyor
• Signature of the team lead
• Signature of the data reviewer

SURVEILLANCE
Genus epidemicus is found to be effective in preventive intervention using homoeopathic principles in various diseases having epidemic potential. For effective management of an epidemic early detection of cases is necessary and for this surveillance is mandatory. The success of a surveillance program depends on the effectiveness of its reporting units. Reporting units should be established so as to identify, diagnose, treat, and rehabilitate potential cases of epidemics. This network of reporting units will comprise the basic framework of the surveillance system. An adequate number of reporting units should be identified in each district. The goal should be a minimum of one reporting unit per one million populations.

Network of epidemic reporting units
The reporting units should comprise of all health facilities including government dispensaries, community health centers, private clinics and hospitals who are likely to see cases of epidemic. They must be listed and enrolled as reporting units.

Initial identification and reporting of epidemic cases
A ‘nodal officer’ is to be identified in each reporting unit. He will be responsible for identifying and reporting all cases of the epidemic to the District Epidemic Officer (through telephone or fax). Verbal reports are to be followed by written ones. All such epidemic cases should be recorded in the case recording format by the DEO and then sent to the Chief project implementation officer in charge of the concerned epidemic.

Initial investigation of an epidemic
All reported cases of particular epidemic should be investigated by the nodal officer within forty eight hours after notification (at least 30 cases). The nodal officer should initiate appropriate action by filling the proper lab request forms, make shipment of specimens to the lab and these details are to be sent to the District Epidemic Officer.

Reporting should be done twice a week by the nodal officer to the higher center if an epidemic is identified.

Active surveillance:
When very few cases of imminent epidemic potential is identified active surveillance should be instigated. The nodal officer should make active surveillances by visiting hospitals and private clinics and checking out the case register data for cases of the epidemic.

Key for a successful surveillance program: The reporting system cover key hospital and clinic and must have one reporting source for every geo political unit Weekly reporting of the epidemic is critical Zero case reporting of should be built into the reporting system for rate and serious epidemic diseases. The reporting system must be constantly monitored and revitalized. Immediate response to reports of epidemic diseases must be done with in 48 hrs Corporation of from private medical community is essential for all surveillance efforts. Feed back to all participants of surveillance system is essential.

Nodal officers will lead to make special effort to meet personally with busy hospital staff and private practitioners to obtain their corporation continued involvement in reporting case of epidemic potential. Regular meeting should be scheduled at least once in 3 month between the nodal officer and reporting units.

Case investigation During Epidemic outbreak

Case investigation:
Each reported cases of the epidemic should be investigated with in 48 Hrs and the case investigation form is to be completed. The nodal officer should visit the home of each patient at the earliest to ascertain all the symptomatology in the case record form so that the genus epidemic group can utilize these data for finding the genus epidemic. The nodal officer should also identify the potential sources of infection and also the factors contributing as risk factors for the epidemic from and environment study

All the investigation should be carried by the nodal officer in each case and should be cooperated by the DEO and higher authority

STATISTICAL STUDY OF THE SURVEY RESULT EFFICACY OF  HOMOEOPATHIC MEDICINES IN EPIDEMICS

Most of the homoeopaths are not oriented with statistical methods. This article aims to give a overview of how to do the post epidemic statistical study after the homoeopathic preventive measures have been delivered.

We will discuss how the study can be done using an actual study conducted by Dr.Anand.P.R, Dr. Dinesh.R.S, Dr. Sreejith.S and Prof. Hameed Labba (Head of dept. of statistics at University College, Thiruvananthapuram) et.al for the Govt of Kerala and Govt. Homoeopathic Medical college, Thiruvananthapuram.

SURVEY RESULTS ON THE EFFICACY OF HOMOEOPATHIC PREVENTIVE MEDICINE FOR DENGUE AND VIRAL FEVER – 2003.

Aims and objectives

1. To asses the efficacy of Homoeopathic medicine in the prevention of Dengue and viral fever outbreak in Thiruvananthapuram and Kollam districts of Kerala in 2003.
2. To determine the magnitude of incidence, clinical features, mortality, social and economic impact of the dengue epidemic.

Materials and methods

After detailed analysis of the Dengue cases in Thiruvananthapuram and Kollam districts of Kerala, the Genus Epidemics Eupatorium Perfoliatum was selected. The 200^th centesimal potency of this medicine was given in 15 doses (3 doses daily for 5 consecutive days). The distribution was done by the Homoeopathic medical students, the NGO’s and Residential associations. The efficacy study was conducted one month after the distribution of the preventive medicine.

STUDY POPULATION                                   –  50 lakhs

METHOD OF SAMPLING                  – Stratified Area Sampling

NATURE OF STUDY                          – Single blind retrospective analysis

STATISTICAL TEST — USED                –  Chi square test

TOTAL NO. OF PEOPLE WHO HAVE TAKEN HOMOEOPATHIC PREVENTIVE MEDICINE   – 20 lakhs (from 670 requests from residential   associations)

Among the 670 residential associations, 67 residential associations were selection from different areas (rural, urban, coastal areas, offices, schools etc) according to statistical methods (Snedecor’s table of random digits). Again 50 families were selected from each area on the basis of systematic sampling.

Thus we selected 15 x 67 = 1005 samples (families). We surveyed the 1005 families frequently. After 3 weeks of survey we received the following data –

	Taken	Not taken	Total
Infected	123  (a)	44   (b)	167   (a+b)
NOT INFECTED	746  ( c)	92   (d)	838   (c+d)
Total	869 (a+c)	136 (b+d)	1005 (n)

Hypothesis

H₀ – the homoeopathic preventive medicine and the attack of viral fever are independent; the medicine is not effective in preventing the disease

H₁ – the homoeopathic preventive medicine has effect on the attack of viral fever; they are not independent

	Taken	Not taken	Total
Infected	a	b	a+b
NOT INFECTED	c	d	c+d
Total	a+c	b+d	n = a+b+c+d

Statistical test (chi – square test)
For testing the null hypothesis, we are using the χ² test for independence. We put the two attributes in two rows and two columns – 2 x 2 contingency table.

Now,

χ²            =                 (ad – bc)² n

(a+b) (b+d) (c+d) (a+b)

Here α = 0.05 (Significance level)

df         = (r-1) (c-1)

= (2-1) (2-1)

=  1

Now     χ² = [ (123 x 92) – (44 x 746)]² x 1005

869 x 136 x 838 x 167

= ( 11316 – 32824)² x 1005

869 x 136 x 838 x 167

= 28.109 

χ_α ² = 3.841 ( Table value , α = 0.05, df = 1)

If the calculated value (χ²) is greater than the table value (χ_α ²) we can reject the H₀ , the null hypothesis.

Here χ² > χ_α ². i.e, calculated value is greater than table value.

So we can reject the hypothesis H_0, i.e., the medicine and the attacks of viral fever are independent. 

That is, the homoeopathic preventive medicine is effective to prevent Dengue and other viral fever.

To check the effectiveness of the homoeopathic preventive medicines

No Dengue fevers were reported from these areas during the survey

The percentage of the infected persons who have taken the preventive medicine (Out of 1005 samples, 869 samples consumed medicine)

= 123 x 100 = 14% (taken)

869

The percentage of non- infected persons who have taken the preventive medicine

= 746 x 100 = 86%

869

From these results we can conclude that the homoeopathic medicine is highly effective in preventing viral fever.

Similar studies were done by Dr. Dinesh. R.S and Dr.Joby. J in 2005 epidemic and by Dr. Dinesh.R.S and Dr. Rejikumar et.al in 2006. A study on the prophylactic Efficacy of Homoeopathic Preventive Medicine against Chikugunya fever by Dr. Rejikumar et al showed 82.19 % efficacy for the 200^th potency of Eup perfoliatum in the control of Chikugunya fever. This study was coordinated and verified by Dr. S. Sajith Kumar, M.D, Asst Proff, Dept of Community Medicine, Medical College, Thiruvananthapuram.

The Govt of Kerala has formulated a Rapid Action Epidemic Control Cell Homoeopathy (RAECH) under the Department of Homoeopathy after going through all these reports. It is the sincere wish of the authors that the other state governments in India would also take up similar ventures.

BIBILOGRAPHY 

1. Mahajan- Medical Statistics.
2. Kothari – Research Methodology.
3. Who – Report On Acute Flacid Paralysis Survillence
4. Park And Park – Social And Preventive Medicine
5. Hahneman Samuel – Organon Of Medicine
6. Hahneman Samuel – Lesser Writings
7. C Tripathi And P N Reddy – Principles Of Management