|
Malaria is one of the
major communicable diseases affecting mankind, caused
by Plasmodium parasite, transmitted by the bite of infective
female Anopheles mosquito. There are four plasmodium
species, P vivzx (Pv), P falciparum (Pf), P malarie
(Pm) and P ovale (Po). |
| |
|
| |
Burden of Disease |
| |
|
| |
Recent estimates indicate that
there are approximately 300-500 million clinical cases
and between 1.5 – 2.7 million deaths occur every
year due to malaria worldwide, 90% of which occur in
tropical Africa, south of the Sahara, mostly caused
by P falciparum (Pf). There are about 100 countries
or territories in the world considered as malarious
and more than 2400 million of the world’s population
are still at risk. Resistance of P falciparum to chloroquine
is now common in practically all malaria endemic countries
in Africa. Resistance to Sulfadoxcine/pyrimethamine
is widespread in South-east Asia and South America.
Mefloquine resistance is now common in the border areas
of Thailand with Cambodia and Myanmar. Resistance of
P vivax to chloroquine has now been reported from Indonesia,
Myanmar, Papua New Guinea and Vanuatu. |
| |
|
| |
Urban and periurban malaria are
on the increase in South Asia and in many states of
Africa. Military conflicts, wars, civil unrest, along
with unfavourable ecological changes, have significantly
contributed ot the malaria epidemics in vulnerable populations
and areas. Another disquieting factor is the re-emergence
of malaria in areas where it had been eradicated or
its increase in countries where it was nearly eradicat4ed. |
| |
|
| |
In India, there are approximately
1.1 million positive cases reported in 2000. P vivax
is the commonest (60-70%) followed by Pf (30-45%), P
malariae species is rarely found and P ovale is not
found in India. P falciparum is a malignant variety
of malaria as 0.5% to 2% may develop complicated malaria,
of which up to 50% are fatal, if timely treatment is
not commenced. All malaria mortality is due to Pf only.
A single dose of chloroquine may save the life by averting
complications. |
| |
|
| |
Economic loss |
| |
|
| |
The estimates of labour
days loss due to malaria amount to 1328.75 million man-days
per year. The total expenditure incurred on morbidity
due to malaria is Rs. 7.18 per capita per annum. The
annual economic loss due to malaria is approximately
Rs. 76,660 million (Sharma et al. 1996). |
| |
|
| |
National Anti-Malaria
Programme |
| |
|
| |
Malaria is one of
the serious public health problems in India. At the
time of independence malaria was contributing 75 million
cases with 0.8 million deaths every year prior to the
launching of National Malaria Control Programme in 1953.
A countrywide comprehensive programme to control malaria
was recommended in 1946 by the Bhore committee report
that was endorsed by the Planning Commission in 1951.
The national programme against malaria has a long history
since that time. |
| |
|
| |
In April 1953, Govt.
of India launched a National Malaria Control Programme
(NMCP) with the following objectives: |
| |
|
| |
1. To bring down malaria
transmission to a level at which it would cease to be
a major public health problem; and
2. Thereafter an achievement was to be maintained by
each state to hold down the malaria transmission at
low level indefinitely.
|
| |
|
| |
Strategies under NMCP
were: |
| |
|
| |
1. Principal operational activities
under the control programme comprised of residual insecticide
spray of human dwelling and cattle sheds;
2. Malaria control teams were organized and directed
by the state anti-malaria organization to carry out
surveys and to monitor the malaria incidence in the
control areas; and
3. Anti-malarial drugs were made available for patients
reporting to an Institution. |
| |
|
| |
Modified Plan
of Operation (MPO) |
| |
|
| |
In 1977 attempts at
malaria eradication were given up and under the review
policy, a Modified Plan of Operation (MPO) was adopted. |
| |
|
| |
Objectives |
| |
|
| |
1. Elimination of
malaria deaths
2. Reduction of malaria morbidity
3. Maintenance of the gains achieved so far by reducing
transmission of malaria |
| |
|
| |
Areas were divided
on the basis of API into two groups and separate strategies
were suggested accordingly. |
| |
|
| |
Urban Malaria
Scheme (UMS) |
| |
|
| |
The proposal of urban
malaria scheme (UMS) was sanctioned in 1971 when it
was realized that urban malaria was a significant problem
and if effective anti-larval measures were not undertaken
in urban areas, the proliferation of malaria cases from
urban to rural might occur in a bigger way. In this
scheme all the towns having more than 40,000 population
and showing more than 2 API in last 3 years are to be
covered. At present 131 towns and cities in 19 states
and union territories are under the UMS. |
| |
|
| |
Malaria Action
Programme |
| |
|
| |
Due to occurrence
of many epidemics of malaria in the country, an expert
committee was formulated to identify epidemiological
parameters for high risk areas. Following areas were
identified: |
| |
|
| |
Problem Area |
| |
|
| |
A. Hardcore areas (Tribal Areas)
B. Epidemic Prone Areas
C. Project Areas
D. Triple Insecticide resistant Areas
E. Urban Areas |
| |
|
| |
Revised Control
Strategy |
| |
|
| |
The expert committee
has considered the revised Global Policy for Malaria
Control of the WHO and suggested strategies for India
according to the problem area. |
| |
|
| |
Enhanced Malaria
Control Project (EMCP) |
| |
|
| |
Enhanced Malaria Control
Project was launched in April 1997 with the assistance
of the World Bank. This is directly benefiting the six
crore Tribal Population of the eight peninsular states
covering 100 districts and 19 urban areas. However,
the population living in other malaria endemic areas
is also benefited, as the strengthening of the components
of IEC, Training and Management Information System have
covered the entire country. |
| |
|
| |
Selection of PHCs
is based on: |
| |
|
| |
i) Annual Parasitic Incidence (API)
is more than 2 for last 3 years;
ii) Pf cases are more than 30% of the malaria cases;
iii) 25% population of the PHC is tribal; and
iv) The area has been reporting deaths due to malaria
and also has the flexibility to direct resources to
any needy areas in case of out break of malaria. |
| |
|
| |
Objectives
of EMCP |
| |
|
| |
1. Effective control of malaria
to bring reduction in malaria morbidity;
2. Prevention of death due to malaria;
3. Consolidation of the gain achieved so far. |
| |
|
| |
Strategies |
| |
|
| |
1. Early case detection and prompt
treatment;
2. Vector control by indoor residual insecticide spray
in rural ares with API of 2 per 100 and above in the
preceding three years with appropriate insecticide and
by recurrent anti-malaria in urban areas;
3. Health Education and community participation. |
| |
|
| |
Components
of EMCP |
| |
|
| |
1. Early case detection and prompt
treatment
2. Selective Vector Control
3. Legislative Measures
4. Personal Protective Measures
5. Epidemic Planning and Rapid Response and Intersectoral
Coordination
6. Institutional and Management capacities strengthening
7. Operation Research
8. Community Participation |
| |
|
| |
Anti-malaria
Drug Policy |
| |
|
| |
The National Anti-malaria
Drug Policy was drafted in 1982 to combat the increasing
level of resistance to chloroquine detected in Pf. However,
there were large scale malaria epidemics reported in
recent times that has generated great concerns. An expert
committee was formulated under the chairmanship of DGHS
to revise the drug treatment policy and the committee
submitted its recommendations: |
| |
|
| |
Insecticide
Policy |
| |
|
| |
DDT should be the
insecticide of choice for residual spray. If resistance
found to DDT then Malathion is the alternative choice.
In case of resistance to both DDT and malathion then
synthetic Pyrethroids is the choice. |
| |
|
| |
Remote Sensing
in Vector Borne Disease Control |
| |
|
| |
Remote Sensing (RS)
technology is a tool for the surveillance of habitat,
densities of vector species and even prediction of the
incidence of disease that must be considered as new
invention in the epidemiology of malaria and vector-borne
diseases. Literal meaning of remote sensing is to sense
any object from a distance. The Human eyes and cameras
also act as a remote sensing devices. However, scientist
of NASA of USA used colour infrared aerial photography
to identify the habitats of a nuisance mosquito, Aedes
sollicitans in 1971. Th principle of RS rests on the
fact that every object absorbs some part of radiation
received from sunlight. Depending upon its physical
and chemical properties, the object absorbs some part
of radiation while the remaining part is reflected in
specific wavelength of the electromagnetic spectrum
(EMS). This reflected energy is channelized through
a telescope to detectors/sensors present on board of
the satellites. The sensors are sensitive to different
bands of EMS. The sensors convert the light energy into
electrical voltages produces two-dimensional discrete
pictures. These are different for different objects
and the satellite pass over a particular part of earth
at the fixed time intervals repeatedly making it possible
to monitor changes in the lad use categories viz. Water
bodies, vegetation, forests, soil mapping, geology,
crop estimation, detection of fire in forest, mines,
oil sleek in sea, etc. Such data is generated in National
Remote Sensing Agency, Hyderabad, In India. A feasibility
study using Satellite data in collaboration with the
Indian Space Research Organization in and around Delhi
was carried out and correlation of changes in the areas
of land use features viz. Water bodies and vegetations
with mosquito density was found significant in some
sites. |