Response of the health system in Nipah outbreak in Ernakulam district: A qualitative analysis

BACKGROUND: Nipah is an emerging zoonotic disease that is transmitted through contaminated food or directly between people. Recently, Nipah virus infection was confirmed in Kochi, Kerala, making it the fourth outbreak reported in India. However, due to its good epidemic response, the health system of Kerala was able to control it in a timely manner. OBJECTIVE: To qualitatively analyse the response of the health system of Kerala in controlling the Nipah outbreak (2019) by identifying the enabling factors and the challenges faced by it. METHODS: A qualitative study was conducted using grounded theory approach. Key informant interviews were conducted till data saturation was reached. The audio recorded data was translated, transcribed and was manually coded and thematically analysed. RESULTS: The major enablers for its apt response were identified to be effective communication, good line of control, effective division of work, intersectorial coordination, strong leadership, political commitment, resilient public private partnership and support groups, past experiences in disaster management, quick procurement of medicines and availability of lab facilities. On the other hand, the challenges identified were initial confusions, lack of standard operating procedures/guidelines for epidemic management, complacency, lack of effective zoonotic surveillance, media management and community participation. CONCLUSION: This study attributes the success of the outbreak response to the strong leadership and political commitment. In order to prevent recurrences in the future, there is a need to build a resilient health system through capacity building and further strengthening of the surveillance system.