EPIDEMIOLOGY EVOLVVING MALARIA CONTROL STRATEGIES IN INDIA NVBDCP GUIDELINE FOR DIAGNOSIS AND TREATMENT OF MALARIA IN INDIA( 2011)

1. Dr. Priyamadhaba Behera
Junior Resident
MALARIA CONTROL STRATEGIES IN
INDIA 12/04/2013
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2. OUTLINE OF PRESENTATION
• EPIDEMIOLOGY
• EVOLVVING MALARIA CONTROL STRATEGIES IN
INDIA
• NVBDCP
• GUIDELINE FOR DIAGNOSIS AND TREATMENT
OF MALARIA IN INDIA( 2011)

3. The World Malaria Report 2012 :104 malaria-endemic countries
and territories for 2011. Ninety-nine of these countries had on-
going malaria transmission.
Extends up to 40 degree north and 40 degree south of equator
219 million cases of malaria in 2010 and an estimated 660 000
deaths. Africa is the most affected continent: about 90% of all
malaria deaths occur there.
Between 2000 and 2010, malaria mortality rates fell by 26% around
the world. In the WHO African Region the decrease was 33%.
what factors make Africa prone for high transmission? How
malaria transmission of Africa differ from India

4. Malaria is a public health problem in
India
-About 95% population in the country resides in malaria endemic areas and 80% of
malaria reported in the country is confined to areas consisting 20% of population
residing in tribal, hilly, difficult and inaccessible areas
-45-50% cases are p.falciparum cases
How falciparum differs from others and why leads to various complication?

5. Trend of Malaria Cases And Deaths 2001-2010 in India
cases have declined from 2.08 million to 1.49 million during 2001 to 2010.
Pf cases have declined from 1.0 to 0.77 million cases during the same period.
Less than 2000 deaths were reported during all the years with a peak in 2006 when an
epidemic was reported in NE States.
SPR has declined from 2.31 to 1.41 and SFR has declined from 1.11 in 2001 to 0.74 in 2010.

6. 6
India’s contribution to Malaria in SEAR
India contributes to 71% of total malaria cases in the SEAR

9. How bionomics of vector help to control malaria

11. Indicators for
surveillance, prevalence, when ABER is low or fluctuates?

12. MILESTONES
NMCP 1953
SPECTACULAR SUCCESS
NMEP 1958
UMS 1971
RESURGENCE
MPO 1977
MAP 1995

13. EMCP 1997
NAMP 1999
NVBDCP 2004
IMCP 2005

14. NATIONAL MALARIA CONTROL PROGRAMME
1953
OBJECTIVES
• TO BRING DOWN MALARIA TRANSMISSION
• TO HOLD DOWN MALARIA TRANSMISSION AT LOW LEVEL
STRATEGIES
•INDOOR RESIDUAL SPRAY
•TREATMENT OF PATIENTS REPORTING TO HEALTH
ACHIEVEMENTS
•DECLINE IN INCIDENCE FROM 75 MILLION TO ONLY 2 MILLION IN 1958
How current treatment of malaria differs from 1953 ?

15. NATIONAL MALARIA ERADICATION
PROGRAMME1958
OBJECTIVES
TO ERADICATE MALARIA FROM INDIA IN 7 TO 9 YEARS
ACTIVITIES
SPRAYING OPERATION
FORTNIGHTLY ACTIVE CASE DETECTION
RADICAL TREATMENT
INVESTIGATION OF POSITIVE CASES AND REMEDIAL MEASURES
ACHIEVEMENTS
LOWEST EVER INCIDENCE OF 0.1 MILLION IN 1965
NO REPORTED DEATHS DUE TO MALARIA

17. RESURGENCE OF MALARIA 1967 TO
1976
IN 1965-
SUDDEN WITHDRAWAL OF ASSISTANCE AND
INSECTICIDES REGISTANCE ,STEEP RISE IN MALARIA INCIDENCE

18. URBAN MALARIA SCHEME
1971
IN 139 TOWNS IN 19 STATES AND UNION TERRITORIES
OBJECTIVES
a) To prevent deaths due to malaria.
b) Reduction in transmission and morbidity.
NORMS
The towns should have a minimum population of 50,000.
The API should be 2 or above.
The towns should strictly implement the civic by-laws to prevent/eliminate
domestic and peri-domestic breeding places

20. Control Strategies under Urban Malaria Scheme:
-Parasite control
-Vector control
Parasite control: Treatment is done through passive agencies viz. hospitals, dispensaries
both in private & public sectors and private practitioners. In mega cities malaria clinics are
established by each health sector/ malaria control agencies viz. Municipal Corporations,
Railways, Defence services
Vector control comprises of the following components
Source reduction
Use of larvicides
Use of larvivorous fish
Space spray
Minor engineering
Legislative measure
Aerosol Space Spray
Space spraying of pyrethrum extract (2%) in 50 houses in and around every malaria and
dengue positive cases to kill the infective mosquitoes is recommended.
Town –biologist
State-additional director (malaria/filaria)
Central level-director NVBDCP

22. RE-CLASSIFICATION OF ENDEMIC AREAS
BASED ON ANNUAL PARASITE INCIDENCE
API LESS THAN 2 API GREATER THAN 2
MODIFIED PLAN OF OPERATION 1977
OBJECTIVES
PREVENTION OF DEATH DUE TO MALARIA
REDUCTION OF MORBIDITY DUE TO MALARIA
RETENTION OF ACHIEVEMENTS GAINED SO FAR

23. AREAS WITH API > 2
SPRAYING
ENTOMOLOGICAL ASSESSMENT
SURVEILLANCE
TREATMENT OF CASES
DECTRALISATION OF LABORATORY SERVICES AT-PHC
ESTABLISHMENT OF DDCS AND FTDS
AREAS WITH API < 2
FOCAL SPRAYING
SURVEILLANCE AND TREATMENT
FOLLOW UP
EPIDEMIOLOGICAL INVESTIGATION

24. DRUG DISTRIBUTION CENTRE
DISPENSE ANTI MALARIAL DRUGS
FEVER TREATMENT DEPOT
COLLECT BLOOD SLIDES
DISTRIBUTE ANTI MALARIAL DRUGS

25. RESEARCH
MONITORING TEAMS TO IDENTIFY
FALCIPARUM SENSITIVITY TO
CHLOROQUINE
TEAM TO TEST ALTERNATE DRUGS FOR
CHLOROQUINE RESISTANCE
HEALTH EDUCATION

26. P.FALCIPARUM CONTAINMENT 1977
COMPONENT OF MPO
INTRODUCED WITH THE ASSISTANCE OF SWEDISH
INTERNATIONAL DEVELOPMENT AGENCY
TO PREVENT OR CONTROL THE SPREAD OF FALCIPARUM MALARIA
AREAS

27. SURVEILLANCE
AIM
•CASE DETECTION THROUGH LAB SERVICES
•FACILITIES FOR PROPER TREATMENT
ACTIVE
TYPES
PASSIVE
ACTIVE SURVEILLANCE
☻CARRIED OUT BY SURVEILLANCE WORKERS
PASSIVE SURVEILLANCE
SEARCH FOR CASES BY LOCAL HEALTH AGENCIES
CASES THOSE ESCAPED ACTIVE SURVEILLANCE ARE SCREENED

28. MALARIA ACTION PROGRAMME 1995
RESURGENCE OF MALARIA
(RAJSTAN/MANIPUR/NAGALAND/ASSAM/WB/MAHARASHTRA)
EXPERT COMMITTEE 1994
HIGH RISK AREAS IDENTIFIED
FTD MICROSCOPY FACILITY
1000 POPULATION 30,000 POPULATION

29. ELEMENTS
EARLY DIAGNOSIS AND PROMPT TREATMENT
SUSTAINABLE PREVENTIVE MEASURES INCLUDING VECTOR CONTROL
PREVENTION OF EPIDEMICS
REGULAR ASSESSMENT
HIGH RISK AREAS
HIGH API
HIGH PROPORTION OF PF CASES
REPORTED DEATH DUE TO MALARIA
SPR DOUBLED
SPR >5%

30. ENHANCED MALARIA CONTROL PROJECT 1997
•WITH WORLD BANK ASSISTANCE
•1997-2003, EXTN TO 2005
OBJECTIVES
EFFECTIVE CONTROL OF MALARIA
BRING DOWN MALARIA MORBIDITY
PREVENTION OF DEATH DUE TO MALARIA
CONSOLIDATION OF GAIN ACHIVED SO FAR
SELECTION OF PHC-CRITERIA
API>2 FOR LAST 3 YRS
P.FALCIPARUM>30% OF CASES
25% TRBAL POPULATON
DEATH DUE TO MALARIA

31. MAIN COMPONENTS
♣EARLY CASE DETECTION AND TREATMENT
♣SELECTIVE VECTOR CONTROL AND PERSONAL PROTECTION
♣HEALTH EDUCATION AND COMMUNITY PARTICIPATION
PLAN OF ACTION
SYNTHETIC PYRETHROIDS
BED NETS
RAPID DIAGNOSTIC KITS
ARTEETHER INJECTIONS
BLISTER PACKS
FUNS FOR TRAINING

32. NATIONAL ANTI-MALARIA PROGRAMME 1999
NATIONAL VECTOR BORNE DISEASE CONTROL
PROGRAMME 2004
OBJECTIVES
REDUCE MALARIA MORBIDITY AND MORTALITY BY 50%
TARGETS AND INDICATORS
ABER>10%
MBER OF 0.8%
1.2 – 1.8%
API 1.3 OR LESS
25% REDUCTION IN MORBIDITY AND MORTALITY BY 2010
50% REDUCTION IN MORBIDITY AND MORTALITY BY 2012

33. NATIONAL VECTOR BORNE
DISEASE CONTROL PROGRAMME

34. Launched in year 2003-04
Major vector borne diseases-
• Malaria
• Filaria
• Kala-azar
• Japanese Encephalitis
• Dengue / Dengue Hemorrhagic fevers
• Chikungunya

35. Mission statement
• Integrated accelerated action towards
– reducing mortality on account of Malaria, Dengue
and JE by half
– Elimination of Kala-azar by 2010
– elimination of lymphatic filariasis by year 2015.
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40. INTENSIFIED MALARIA CONTROL
PROJECT
Launched in july 2005 with assistance of global fund for AIDS,TB
and malaria in NE states,Odisha,jharkhand and WB
OBJECTIVES:
1-Increase access rapid diagnosis and treatment through
community participation
2-reduce transmission by used of insecticide treated bednets
and larvivorous fish
3-Enhance awareness about malaria control
4-To promote community,NGO,private sector participation

42. Blood collected with sterile technique

43. Making the smears

44. Making of Thick smear

45. Thin and Thick smear

46. Appearance of Thick and Thin
Smears

49. Specific antimalarial treatment of
severe malaria
Severe malaria is an emergency and treatment should be given
promptly. Parenteral artemisinin derivatives or quinine should
be used irrespective of chloroquine sensitivity.
• Artesunate: 2.4 mg/kg body weight i.v. or i.m. given on
admission (time=0), then at 12 hours and 24 hours, then
once a day (Care should be taken to dilute artesunate powder in 5% Sodium bi-
carbonate provided in the pack).
• Intravenous preparations should be preferred over intramuscular preparations.
Parenteral treatment should be given for minimum of 24 hours once started. In
first trimester of pregnancy, parenteral quinine is the drug of choice.
• Other drugs used are arteether , artemether, quinine ( along with
doxycycline/clindamycin)

50. chemoprophylaxis
Chemoprophylaxis is recommended travellers, migrant
labourers and military personnel exposed to malaria in highly endemic
areas. Use of personal protection measures like insecticide-treated
bednets should be encouraged for pregnant women and other
vulnerable populations.

51. PROGRAM EVALUATION
Internal assessments are conducted by central teams as well as
by LQAS, periodically.
External assessments are done through large sample surveys
every 2-3 years and are conducted by NVBDCP / NIMR.

52. • The study in 10 randomly sampled high burden blocks with
API > 2 can be spread out over 80
• villages to include 1600 households / fever cases. Such
samples are adequate to detect differences of more than 10%
across two surveys. The survey data will be examined along
with other sources of information, including MIS and LQAS
and planning data.

54. THANK YOU