Acute appendicitis and acute cholecystitis are two common surgical emergencies that require immediate medical attention. Both conditions can result in severe complications if left untreated, making them a significant public health concern [1-2]. This study aims to investigate the causes, symptoms, and treatment options for acute appendicitis and acute cholecystitis among patients attending the outpatient department of Civil Hospital, Manali, situated in the picturesque District Kullu, Himachal Pradesh.

Acute appendicitis is characterized by the inflammation of the vermiform appendix, a small, finger-like projection located at the junction of the small and large intestines. It remains one of the most frequent causes of acute abdominal pain worldwide, often necessitating surgical intervention. In contrast, acute cholecystitis is the inflammation of the gallbladder, primarily caused by gallstones obstructing the cystic duct. Both conditions exhibit overlapping clinical symptoms, such as abdominal pain, nausea, and vomiting, making accurate diagnosis a challenging task for healthcare providers [3-6].

Manali, a prominent hill station in Himachal Pradesh, attracts a large number of tourists throughout the year. The surge in tourist footfall can potentially expose the local population to various health risks, including the increased incidence of acute appendicitis and acute cholecystitis. The burden of these surgical emergencies can significantly impact the healthcare infrastructure and resources of the region.

This research is conducted with the primary objectives of understanding the causative factors of acute appendicitis   and acute cholecystitis among the  residents and tourists of Manali, as well as identifying the common symptoms that lead patients to seek medical attention. Furthermore, the study seeks to assess the treatment options provided to patients in the outpatient department of Civil Hospital, considering the unique geographical and demographic characteristics of the region.

The outcomes of this research will contribute valuable insights to healthcare professionals, policymakers, and stakeholders by shedding light on the local epidemiology and management of acute appendicitis and acute cholecystitis in the context of Manali, Himachal Pradesh. It is crucial to develop a better understanding of these conditions to enhance the delivery of healthcare services and reduce the potential complications and economic burden associated with them.

Objectives of the Study

To evaluate the causes, symptoms, and treatment options for acute appendicitis and acute cholecystitis among patients attending the outpatient department of Civil Hospital, Manali, District Kullu, Himachal Pradesh.

Research Methodology

• Research Approach: Descriptive

• Research Design: Hospital based cross-sectional survey design

• Setting of the study: OPD in Civil Hospital, Manali, District Kullu Himachal Pradesh

• Study duration: between July 2023- September 2023

• Study population:  Patients aged above 30 years came to OPD 

• Sample size: 400 patients, assuming 50% have adequate knowledge regarding acute appendicitis and acute cholecystitis, 5% absolute error, 95% confidence level, and 5% non-response rate.

• Sampling Technique: convenience  Sampling technique

• Sampling criteria: first five patients who came to OPD were selected everyday till the completion of sample size after explaining the purpose of the study.

Informed consent was taken from them and confidentiality of the selected participants was also maintained

• Inclusive Criteria: Patients who were willing to participate in the study

• Exclusion Criteria:  Patients who were not willing to participate in the study

Description of Tool

• Demographic data survey instrument: The demographic form elicited information on participants’ background: age, marital status, religion, employment, education, family’s monthly income etc

• Questionnaire: The questionnaire contains 20 structured knowledge related questions having three options (yes, no, don’t know).  The participants have to choose right one. 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 by  under the guidance of supervisors and patients were given 30 minutes time to complete that questionnaire and collected at the end of the prescribed time

• Data analysis with Epi Info V7 Software with appropriate statistical test in terms of frequencies, percentage

The goal of the current study was to assess the awareness about acute appendicitis and acute cholecystitis among patients attending outpatient department of Civil Hospital, Manali, District Kullu, Himachal Pradesh.

A total of 400 respondents including 275 (68.75%) Male patients and 125 (41.25%)  female  patients  were participated in the study. Among the total, 143 (35.75%) were from urban area and 257 (64.25%) were from rural area.

In the present study 21.5% (86)  participants had very good knowledge (16-20 marks) towards acute appendicitis and acute cholecystitis , 35.5% (142) had good knowledge (12-15 marks), 30.75% (123) had fair knowledge  (8-11 marks) and 12.25% (49) having poor knowledge  (<8 marks).

Table 1: Knowledge Regarding Acute Appendicitis and Acute Cholecystitis among Study Participants

Table 2: Knowledge Score Regarding Acute Appendicitis and Acute Cholecystitis among Study Participants

The findings of this study provide valuable insights into the awareness, knowledge, and understanding of acute appendicitis and acute cholecystitis among patients attending the outpatient department (OPD) of Civil Hospital, Manali, District Kullu, Himachal Pradesh. Acute appendicitis and acute cholecystitis are significant surgical emergencies, and early recognition and appropriate management are essential in preventing complications. The study aimed to assess the knowledge levels of the study population regarding these conditions and explore the implications for healthcare delivery in this unique region.

The study included 400 participants, with a higher proportion of male patients (68.75%) compared to female patients (31.25%). Interestingly, a considerable proportion of the participants came from rural areas (64.25%) compared to urban areas (35.75%). This demographic distribution reflects the diverse population seeking medical care at Civil Hospital, a healthcare facility situated in the vicinity of a popular tourist destination.

The study assessed the knowledge of participants by evaluating their responses to 20 structured questions related to acute appendicitis and acute cholecystitis. The results revealed a range of knowledge levels among the participants. Approximately 21.5% demonstrated a "very good" level of knowledge, scoring between 16-20 marks, while 35.5% had a "good" level of knowledge (12-15 marks). Moreover, 30.75% had a "fair" level of knowledge (8-11 marks), and 12.25% had "poor" knowledge (less than 8 marks). These findings indicate that there is a considerable variation in the awareness and understanding of these conditions within the study population.

Comparing these findings to other studies conducted in India and worldwide, it is evident that knowledge levels regarding acute appendicitis and acute cholecystitis vary widely.7-12 in a study by Singal et al. on acute appendicitis in an Indian setting, they found that awareness and understanding of the condition were low among patients. Similarly, Sharma D reported a lack of awareness about acute cholecystitis in North India. These findings align with the observation that a significant proportion of participants in our study exhibited only fair or poor knowledge regarding these conditions.

The role of education and awareness campaigns cannot be underestimated. Efforts to increase public knowledge about the early signs and symptoms of these surgical emergencies are crucial to ensuring timely medical intervention, reducing complications, and improving patient outcomes. This is especially pertinent in regions like Himachal Pradesh, where a substantial number of tourists visit throughout the year and may face challenges related to healthcare access and information.

Implications for Healthcare Delivery

These findings have important implications for healthcare providers and policymakers in Himachal Pradesh. Recognizing the lower levels of knowledge about acute appendicitis and acute cholecystitis, healthcare facilities, including Civil Hospital in Manali, should prioritize health education programs aimed at increasing public awareness. These programs could include community outreach initiatives, information dissemination through local media, and the provision of educational materials in healthcare settings.

Moreover, given the unique geographic and demographic characteristics of Himachal Pradesh, healthcare facilities must tailor their approaches to meet the needs of both the local population and the transient tourist population. Efficient and timely diagnosis and management are critical in these surgical emergencies, and measures should be taken to reduce delays in seeking medical attention.

In conclusion, this study highlights the varied knowledge levels among patients attending the OPD of Civil Hospital, Manali, regarding acute appendicitis and acute cholecystitis. It emphasizes the need for targeted educational interventions to increase awareness and understanding of these conditions, ultimately improving healthcare delivery and patient outcomes in this picturesque region.

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