Malaria Control in India Part II

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Malaria Control in India Part II Powered By Docstoc
					Mosquito Breeding Habitats in
       SSP in Gujarat
   Relationship of Poverty with Malaria in the Indian
   States Below Poverty Line in 1999-2000

                     Total
                                          % Malaria                    % P. vivax
                    malaria
                                          cases in                     cases
                     cases
                                          BPL states                   in BPL
                    in India
                                                                        states
         % NAMP
                                                                                    Total        % P.falci-
                                    Total                 Total
           population                                                               P. falci-    parum
                                    malaria               P. vivax
       in BPL states                                                                parum        cases
                                     cases                 cases
         at risk of                                                                 cases        in BPL
                                     in BPL               in India
          malaria                                                                   in India     states
                                    states
Year
1965      28.99           99,667    29,576      29.67      73,504       29.24        26,163         30.89
1970      50.35           694,017   199,743      28.78     593,902      26.08       100,115          44.98
1975      50.01         5,166,142   1,843,681     35.68    4,436,891    29.70       729,251          72.09
1980      49.82         2,898,140   1,055,750     36.42    2,310,129    26.47       588,011          75.51
1985      49.86         1,864,380   940,788      50.46     1,319,375    39.11       545,005          77.94
1990      50.15         2,018,783   804,148     39.83      1,266,665    27.40       752,118          60.75
1995      48.47         2,296,008   1,465,078    50.06     1,503,877    37.25       792,131          70.24
2000      52.59         2,019,065   1,404,737    69.57      971,149      49.28       1,047,916      88.37
          Malaria and Poverty

• Malaria-wheels within
  wheels
• Malaria- a development
  issue
• Malaria control should
  rely on poverty
  alleviation for human
  development, social
  security & sustainable
  environment
                Dense Forests
                were replaced by
                coffee plantations.
                An. fluviatilis
                transmitted
                malaria
                disappeared.
                Malnad is healthy.


                Malnad
                50,000 Sq Km
                Area

MALNAD REGION, INDIA
          MALARIA IN PUNJAB
   Malaria epidemic in Punjab in 1908 caused
    300,000 deaths in 20 million populations
    over a period of three years.
   Malaria in Punjab flares up after July-
    August rains. The malaria mortality figures
    of Punjab from 1867-1943 revealed that in
    77-years majority of malaria peaks were
    followed by 8-year cycle.
   The relationship of rainfall with malaria was
    investigated and epidemic forecasting
    methods were developed in Punjab.
   Irrigation changed the malaria
    epidemiology and the region was converted
    to endemic malaria.
Rice Cultivation and Malaria in Punjab

        % Share of Cropped Area
        1970-73     7.6%
        1996-98     28.4%
Bioenvironmental Malaria control at
 the Indian Oils Ltd. Mathura, U.P.
Bioenvironmental Malaria Control in BHEL
     and IDPL, Hardwar, Uttranchal
Malaria Outbreak in Bargi Dam
area in Narayanganj PHC, M.P.




          Dam impounded

   D Dam completed
   a
   m
   Malaria Control in Karnataka in
   Partnership with PHC System
• Major silk producing region. Farmers
  unwilling to allow the use of DDT
• High malaria incidence and deaths
• Major Breeding habitats of An. culicifacies
  – Wells: Species A (Vector Species)
  – Streams: Species B (Non-Vector Species)
  – All wells mapped and fishes released
  – Malaria cases declined sharply
Impact of Fishes on Malaria

 Malaria cases




Population 38000 in
   93 villages
                      Malaria cases
Rise of malaria in DDT sprayed villages. In 1998
   fishes were released in problem villages.




                               Fishes released

     Malaria Cases


        Population 52554
       38 problem villages
 Impact of SP spraying (1996-98) on Malaria. In
2002 fishes were released to control mosquitoes



    Malaria cases

                                            Fishes
      SP Spraying             No Spraying




    Population in 4 PHCs
         1.3 million
       SITUATION ANALYSIS OF BETUL
        DISTRICT, MADHYA PRADESH
                                       Chloroquine Total     P.
Year    DDT sprayed in mt   %                      malaria   falciparum
                                       Tablets in
        against 200   mt    Coverage
                                       Lakhs       cases     cases
1990                                                 496         91

1991                                                 949        281

1992         4.00             2.0        5.00       805        196
1993          1.60            0.8         5.10       626        213

1994          4.90            3.0         5.40       1503       602

1995          2.30            1.0         6.20       1820       739

1996          7.40            3.5         7.70       2290       662

1997          9.90            5.0         9.80       5279       1764

1998          14.9            7.5         9.60       8872       3340

1999          10.2            5.0         13.88     14133       3919

2000         18.0             9.0        20.30      16764      7126
Bioenvironmental Control of Malaria in
   Betul District, Madhya Pradesh
   Results of Monitoring Malaria
    Incidence in Betul District
      Impact of Fishes on Malaria
(Rise in 2000 was due to epidemic in adjacent villages)




    Malaria cases




     Population 85672 in
        160 villages
Impact of Bioenvironmental Interventions
 in 100 million population in Maharashtra


              Interventions Started in 1997



                             Total Malaria Cases
       P. falciparum Cases
Impact of Fishes on Malaria

 Malaria cases




Population 38000 in
   93 villages
                      Malaria cases
Impact of Bioenvironmental Interventions
 in 100 million population in Maharashtra


              Interventions Started in 1997



                             Total Malaria Cases
       P. falciparum Cases
Editorial
World Health. 51st Year, No.3, May-June 1998
United against malaria

“WHO’s Global Malaria Eradication
Campaign achieved some notable
successes but it also proved that, without a
much more flexible and variable strategy
combined with poverty reduction, self
reliance and sound environmental
management, the war against this disease
could not be won.”

                    Dr. Hiroshima Nakajima
                   Director General of WHO
  Dr. Halfdan Mahler, Former
Director-General, World Health
Organization who initiated the
    imaginative Small Pox
 Eradication Programme said

“All countries benefit from the
 fruits of India’s TB research
  -all countries except India”
Health Catastrophe of 21stCentury-
     Future Impact of Malaria

    Malaria problem will prove a great
      hindrance to socio-economic
   development in the fields of health,
education, land exploitation, mining, road
 construction, agriculture, tourism et al.
  leading to greater poverty and under-
              development
SHARPENED OLD TOOLS AND
UTILIZATION OF NEW TOOLS
  AND STRATEGIES WILL
 PRODUCE MORE FOCUSED
AND SUSTAINABLE MALARIA
         CONTROL
  New Tools in Malaria Control
           • MALARIA DIAGNOSIS
• Dipstick/pLDH tests
               • TREATMENT
     • Artemisinin & Drug Combination
              • ENVIRONMENT
        • Health Impact Assessment
            • VECTOR CONTROL
• Situation specific based on stratification,
  An. Sibling species, Bioenvironmental
  Methods, Treated Bed Nets, Bacillus
  thuringiensis, Neem Based Repellents,
  Selective Spraying
 POVERTY ALLEVIATION
   STRATEGIES WILL
REDUCE POPULATION AT
 THE RISK OF MALARIA
  BETTER QUALITY AND
 COVERAGE OF HEALTH
SERVICES WILL ACHIEVE
EFFECTIVE MANAGEMENT
      OF MALARIA
   DEFORESTATION WILL
DISLODGE HIGHLY EFFICIENT
   VECTORS OF MALARIA
  Example: Anopheles dirus
HEALTH IMPACT ASSESSMENT
 WILL BECOME MANDATORY
  AND THIS WILL REDUCE
 RECEPTIVITY TO MALARIA
 ENHANCED COMMUNITY
 AWARENESS WILL HELP
IN MALARIA PREVENTION
    AND EARLY CASE
DETECTION AND PROMPT
      TREATMENT
  NEW DIAGNOSTICS,
    DRUGS, DRUG
 COMBINATIONS WILL
REDUCE MALARIA FROM
   EVEN THE MOST
 DIFFICULT TERRAINS
         ACKNOWLEDGEMENTS

      Late Professor V.Ramalingaswami, FRS
           Professor M.G.K. Menon, FRS


   THE INDIAN COUNCIL OF MEDICAL RESEARCH
    THE NATIONAL ANTI MALARIA PROGRAMME
HEALTH DEPARTMENTS OF THE STATE GOVERNMENTS

       SCIENTISTS AND TECHNICAL STAFF
       OF THE MALARIA RESEARCH CENTRE
            AND ITS FIELD STATIONS

         NATIONAL AND INTERNATIONAL
         COLLABORATING INSTITUTIONS
                                                                       19

                                                                                                    20

                                                                                                           20
Rise of malaria in DDT sprayed villages. In 1998
   fishes were released in problem villages.

10000
 9000
 8000
 7000
 6000                                             Fishes released
 5000
 4000   Malaria Cases
 3000                    DDT (PHC Gudibanda)

 2000
 1000       Population 52554
           38 problem villages
    0
        1993   1994   1995   1996   1997   1998   1999   2000   2001   2002
  Impact of SP spraying (1996-98) on Malaria. In
 2002 fishes were released to control mosquitoes

90000
80000
        Malaria cases
70000
60000
                                                                          Fishes
50000      SP Spraying                             No Spraying
40000
                                Four PHCs
30000
20000
        Population in 4 PHCs
10000
             1.3 million
    0
        1993   1994   1995   1996   1997    1998     1999   2000   2001     2002
       SITUATION ANALYSIS OF BETUL
        DISTRICT, MADHYA PRADESH
                                       Chloroquine Total     P.
Year    DDT sprayed in mt   %                      malaria   falciparum
                                       Tablets in
        against 200   mt    Coverage
                                       Lakhs       cases     cases
1990                                                 496         91

1991                                                 949        281

1992         4.00             2.0        5.00       805        196
1993          1.60            0.8         5.10       626        213

1994          4.90            3.0         5.40       1503       602

1995          2.30            1.0         6.20       1820       739

1996          7.40            3.5         7.70       2290       662

1997          9.90            5.0         9.80       5279       1764

1998          14.9            7.5         9.60       8872       3340

1999          10.2            5.0         13.88     14133       3919

2000         18.0             9.0        20.30      16764      7126
        Bioenvironmental Control of Malaria in
           Betul District, Madhya Pradesh
               Results of Monitoring Malaria
                Incidence in Betul District
20000    600
18000    500

16000    400
                       Malaria cases
         300
14000    200
                       Pf cases


12000    100

10000      0
                                               Malaria cases

         Ju 002
            ov 0




                      2
          O 02
         M 001




                      3
            ov 1
                     0




                     1
         M 00




           pr 1
         Se 01




 8000
                   00




                   00

                   00
                   00
                   00




                   00

                  00




                   0
                  0




                  0




                  2
               ,2




               ,2
               ,2
               ,2




               ,2
               ,2
               ,2




               ,2
               ,2




               ,2
               ,2




              il,
             ct




             ct
            pt




            ne
            ar




            ar
            ec




            ec
           ay
          O




         M
          D




          D
          N




          N




         A
 6000
 4000
                                               Pf cases
 2000
    0
     86
     87
     88
     89
     90
     91
     92
     93
     94
     95
     96
     97
     98
     99
     00
     01
     02
   19
   19
   19
   19
   19
   19
   19
   19
   19
   19
   19
   19
   19
   19
   20
   20
   20
           Impact of Fishes on Malaria
   (Rise in 2000 was due to epidemic in adjacent villages)


12000

10000

 8000
        Malaria cases
 6000
                                    PHCs Banavara and Kanakatte

 4000

 2000    Population 85672 in
            160 villages
    0
        1993   1994   1995   1996     1997   1998    1999   2000   2001   2002
Impact of Bioenvironmental Interventions
 in 100 million population in Maharashtra

  250000
                   Interventions Started in 1997
  200000      204969

                       165985
  150000
                                137712

  100000
                                   Total Malaria Cases
                                         81406
           P. falciparum Cases                   56043
  50000
                                                         35568
                                                                 19897
      0
            1997   1998    1999     2000     2001    2002    2003
              Impact of Fishes on Malaria

1600          Malaria cases
1400

1200
                Gambusia (PHC Kamasamudram)
1000

 800

 600

 400

 200      Population 38000 in
             93 villages
                                                       Malaria cases
   0
       1993    1994   1995    1996   1997     1998   1999   2000   2001   2002
Impact of Bioenvironmental Interventions
 in 100 million population in Maharashtra

  250000
                   Interventions Started in 1997
  200000      204969

                       165985
  150000
                                137712

  100000
                                   Total Malaria Cases
                                         81406
           P. falciparum Cases                   56043
  50000
                                                         35568
                                                                 19897
      0
            1997   1998    1999     2000     2001    2002    2003
Editorial
World Health. 51st Year, No.3, May-June 1998
United against malaria

“WHO’s Global Malaria Eradication
Campaign achieved some notable
successes but it also proved that, without a
much more flexible and variable strategy
combined with poverty reduction, self
reliance and sound environmental
management, the war against this disease
could not be won.”

                    Dr. Hiroshima Nakajima
                   Director General of WHO
  Dr. Halfdan Mahler, Former
Director-General, World Health
Organization who initiated the
    imaginative Small Pox
 Eradication Programme said

“All countries benefit from the
 fruits of India’s TB research
  -all countries except India”
Health Catastrophe of 21stCentury-
     Future Impact of Malaria

    Malaria problem will prove a great
      hindrance to socio-economic
   development in the fields of health,
education, land exploitation, mining, road
 construction, agriculture, tourism et al.
  leading to greater poverty and under-
              development
SHARPENED OLD TOOLS AND
UTILIZATION OF NEW TOOLS
  AND STRATEGIES WILL
 PRODUCE MORE FOCUSED
AND SUSTAINABLE MALARIA
         CONTROL
  New Tools in Malaria Control
           • MALARIA DIAGNOSIS
• Dipstick/pLDH tests
               • TREATMENT
     • Artemisinin & Drug Combination
              • ENVIRONMENT
        • Health Impact Assessment
            • VECTOR CONTROL
• Situation specific based on stratification,
  An. Sibling species, Bioenvironmental
  Methods, Treated Bed Nets, Bacillus
  thuringiensis, Neem Based Repellents,
  Selective Spraying
 POVERTY ALLEVIATION
   STRATEGIES WILL
REDUCE POPULATION AT
 THE RISK OF MALARIA
  BETTER QUALITY AND
 COVERAGE OF HEALTH
SERVICES WILL ACHIEVE
EFFECTIVE MANAGEMENT
      OF MALARIA
   DEFORESTATION WILL
DISLODGE HIGHLY EFFICIENT
   VECTORS OF MALARIA
  Example: Anopheles dirus
HEALTH IMPACT ASSESSMENT
 WILL BECOME MANDATORY
  AND THIS WILL REDUCE
 RECEPTIVITY TO MALARIA
 ENHANCED COMMUNITY
 AWARENESS WILL HELP
IN MALARIA PREVENTION
    AND EARLY CASE
DETECTION AND PROMPT
      TREATMENT
  NEW DIAGNOSTICS,
    DRUGS, DRUG
 COMBINATIONS WILL
REDUCE MALARIA FROM
   EVEN THE MOST
 DIFFICULT TERRAINS
         ACKNOWLEDGEMENTS

      Late Professor V.Ramalingaswami, FRS
           Professor M.G.K. Menon, FRS


   THE INDIAN COUNCIL OF MEDICAL RESEARCH
    THE NATIONAL ANTI MALARIA PROGRAMME
HEALTH DEPARTMENTS OF THE STATE GOVERNMENTS

       SCIENTISTS AND TECHNICAL STAFF
       OF THE MALARIA RESEARCH CENTRE
            AND ITS FIELD STATIONS

         NATIONAL AND INTERNATIONAL
         COLLABORATING INSTITUTIONS

				
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