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Malaria control strategies in india

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

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Malaria control strategies in india

  1. 1. Dr. Priyamadhaba Behera Junior Resident MALARIA CONTROL STRATEGIES IN INDIA 12/04/2013 1
  2. 2. OUTLINE OF PRESENTATION • EPIDEMIOLOGY • EVOLVVING MALARIA CONTROL STRATEGIES IN INDIA • NVBDCP • GUIDELINE FOR DIAGNOSIS AND TREATMENT OF MALARIA IN INDIA( 2011)
  3. 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. 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. 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. 6 India’s contribution to Malaria in SEAR India contributes to 71% of total malaria cases in the SEAR
  7. 7. How bionomics of vector help to control malaria
  8. 8. Indicators for surveillance, prevalence, when ABER is low or fluctuates?
  9. 9. MILESTONES NMCP 1953 SPECTACULAR SUCCESS NMEP 1958 UMS 1971 RESURGENCE MPO 1977 MAP 1995
  10. 10. EMCP 1997 NAMP 1999 NVBDCP 2004 IMCP 2005
  11. 11. 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 ?
  12. 12. 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
  13. 13. RESURGENCE OF MALARIA 1967 TO 1976 IN 1965- SUDDEN WITHDRAWAL OF ASSISTANCE AND INSECTICIDES REGISTANCE ,STEEP RISE IN MALARIA INCIDENCE
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. DRUG DISTRIBUTION CENTRE DISPENSE ANTI MALARIAL DRUGS FEVER TREATMENT DEPOT COLLECT BLOOD SLIDES DISTRIBUTE ANTI MALARIAL DRUGS
  19. 19. RESEARCH MONITORING TEAMS TO IDENTIFY FALCIPARUM SENSITIVITY TO CHLOROQUINE TEAM TO TEST ALTERNATE DRUGS FOR CHLOROQUINE RESISTANCE HEALTH EDUCATION
  20. 20. 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
  21. 21. 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
  22. 22. 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
  23. 23. 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%
  24. 24. 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
  25. 25. 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
  26. 26. 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
  27. 27. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME
  28. 28. Launched in year 2003-04 Major vector borne diseases- • Malaria • Filaria • Kala-azar • Japanese Encephalitis • Dengue / Dengue Hemorrhagic fevers • Chikungunya
  29. 29. 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. 35
  30. 30. 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
  31. 31. Blood collected with sterile technique
  32. 32. Making the smears
  33. 33. Making of Thick smear
  34. 34. Thin and Thick smear
  35. 35. Appearance of Thick and Thin Smears
  36. 36. 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)
  37. 37. 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.
  38. 38. 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.
  39. 39. • 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.
  40. 40. THANK YOU
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EPIDEMIOLOGY EVOLVVING MALARIA CONTROL STRATEGIES IN INDIA NVBDCP GUIDELINE FOR DIAGNOSIS AND TREATMENT OF MALARIA IN INDIA( 2011)

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