GEOGRAPHY NCEA LEVEL 2: MALARIA - PHOTO CASE STUDY 2018 - INDIA, STATE OF ODISHA.

1. MALARIA
INDIA TAKES ON MALARIA
IN STATE OF ODISHA
2018 PHOTO CASE STUDY

2. REDUCING THE TOLL OF MALARIA
Since 2000, India has made major inroads in reducing the
toll of malaria. But the path towards elimination has proven
a challenge in the eastern state of Odisha, which carries
more than 40% of the country’s malaria burden.
In recent years, the state government has dramatically
scaled up efforts to prevent, diagnose and treat malaria –
with impressive results seen in a short span of time.
The work follows the recommendations of the WHO Global
Technical Strategy for Malaria which calls for early case
detection, prompt treatment and the widespread use of
mosquito-control measures.

3. An army of 900.000 trained Accredited Social
Health Activists, or ASHAs, serve on the front lines
of India’s attack on malaria. They undergo
rigorous training by the state government before
being deployed across Odisha to detect and treat
malaria, and to prevent new cases of the disease.

4. ELIMINATING MALARIA BY 2030
India’s goal of eliminating malaria by 2030 may appear at
first glance to be easily attainable.
Reported cases of the disease dropped by around half
between 2001 and 2016 and, in nearly three-quarters of
India’s more than 650 districts, the number of people falling
ill from malaria is very low.

5. Here, a community-based health activist takes
a blood sample from a villager in Odisha, which
will be used to test whether he has malaria.
ASHAs are trained to deliver life-saving
antimalarial medicines, if needed, on the spot.

6. DIFFICULTIES
But India’s path towards elimination has proven to be
particularly difficult in the remote and rugged tribal areas
of the country’s north-east region and in the state of Odisha
to the east – areas where malaria is one of the most common
health problems.
“Making advances against malaria in these areas is crucial,
considering they represent the majority of the country’s
malaria burden,” said Dr Henk Bekedam, the World Health
Organization Representative in India.

7. Villagers who test positive for malaria are
issued health cards that provide a detailed
record of their medical background and
treatment regimens. ASHAs monitor progress
of those who have been treated for malaria.

8. CHALLENGES
The challenges are many. A forest-based economy in India’s
tribal states means many people work in areas thick with
the mosquitoes that carry the malaria parasite.
Residents typically sleep outdoors, where they are easy
targets for mosquitoes. In addition, people often wear
inadequate clothing, which leaves them vulnerable to
mosquito bites, and are often reluctant to seek medical help
when they first develop symptoms of the disease.
What’s more, mosquitoes in these areas tend to transmit the
disease efficiently and have developed resistance to as many
as 3 of the 4 WHO-recommended classes of insecticides.

9. Sleeping under an
insecticide-treated net is
one of the most effective
ways to prevent malaria.
With the support of
ASHAs, the government
distributed approximately
11 million nets free of
charge in Odisha in 2017 –
enough to protect all
residents in areas at
highest risk for malaria.

10. MASSIVE SCALE UP IN NETS
Massive scale up in the use of long-lasting insecticidal nets
To overcome these challenges and following the
recommendations of WHO’s Global Technical Strategy for
Malaria, Indian health authorities are increasing efforts to
provide free access to bed nets, expand the use of rapid
diagnostic tests and provide early treatment for cases of the
disease.

11. Lowering the burden of malaria in
high-risk areas entails more than
just distributing mosquito nets.
ASHAs go door to door at night –
when the mosquitoes bite – to ensure
the nets are being used correctly.

12. WHO’S GLOBAL MALARIA STRATEGY
WHO’s global malaria strategy calls for early case detection
and treatment as well as widespread use of measures to
limit the population’s exposure to mosquitoes.
“That means a massive scale up in the use of long-lasting
insecticidal nets, indoor residual spraying and other
mosquito-control measures,” said Dr. Bekedam.

13. At a government high school in Kudutuli village, Odisha, students
participate in a malaria awareness initiative focused on personal
protection measures. The performance seen above was held just
before monsoon season, when malaria rates are highest.

14. ASHA ACTIVISTS
Much of the work is spearheaded by 900.000 trained
Accredited Social Health Activists – or ASHAs.
The ASHAs “are in each and every village” in tribal areas,
according to Dr P.L. Joshi, former director of India’s
National Vector Borne Disease Control Programme
(NVBDCP).
They serve as health activists, educators and promoters,
providing villagers with information about the disease so
that they can take steps to protect themselves.

15. Across Odisha, the government has expanded access to insecticide-treated mosquito nets in schools
with hostels. Students are taught how to set up the net and ensure it is tucked in properly.

16. 11 MILLION BEDNETS
In 2017, with financing from the Global Fund to Fight AIDS,
Tuberculosis and Malaria, the ASHAs helped distribute
approximately 11 million bednets – enough to protect all of
the residents in those areas of Odisha that are at highest
risk for malaria, including residential hostels for schools.
Across the nation, a total of 40 million bednets have been
handed out or will be shortly.

17. Indoor residual
spraying (IRS) –
which involves
spraying insecticides
on the indoor walls
and ceilings of homes
– is another powerful
way to rapidly reduce
malaria
transmission.
Here, an IRS worker
sprays a home in the
Kandhamal district
of Odisha.

18. USING BEDNETS PROPERLY
Reducing malaria in these high-risk areas entails more than
the widespread distribution of bednets.
Just as important is ensuring that people who need them are
using them.
After going door to door in the tribal and village areas at
night – when the mosquitoes bite – ASHAs and auxiliary
nurses reported that more than 80% of the residents were
using bednets properly.

19. In villages across Odisha, malaria
prevention messages are woven into
plays performed by travelling troupes.
After the performance, the actors ask
questions of their audiences to ensure the
messages were received and understood.

20. EDUCATION THROUGH FOLK
When ASHAs come across people who are not using bednets,
they educate them about the life-saving protection the nets
confer. For those who test positive for the malaria parasite,
ASHAs issue health cards that keep a detailed record of their
medication regimens and courses of treatment.
Public health officials have also enlisted the aid of folk
troupes, which travel from village to village putting on
performances that communicate the basics of malaria control.
After each performance, the actors engage their audiences
with questions to ensure that their messages were both
received and understood.
They then encourage their listeners to spread the word
among family and friends.

21. The performances
are often captured
by audience
members on mobile
phones and shared
with friends and
family on popular
chat applications,
creating an
information ripple
effect in the
community at large.

22. TAKING THE MESSAGE ACCROSS
In some high-transmission areas, health workers drive vans
equipped with loudspeakers to broadcast the messages.
They play popular native tunes, their familiar lyrics
replaced by new ones containing malaria messages that are
also printed on pamphlets and distributed to villagers.
To reach people who cannot read, the ASHAs park their vans
in the village centres, where they read aloud their health
alerts in local languages and start a dialogue, soliciting
questions and answering them.
ASHAs are not alone in carrying out such work. Numerous
other groups have contributed to India’s success in slashing
the incidence of the disease in tribal regions.
They include malaria technical supervisors, the district
vector-borne disease team, auxiliary nurse midwives and
the state programme team.

23. In some areas of Odisha, the sides of vans
are transformed into mobile message boards
focused on mosquito control. Loudspeakers
play popular native tunes that incorporate
malaria prevention guidance in the lyrics.

24. CASES DROP IN ODISHA
The numbers testify to the impact of their collective efforts.
In Odisha, the state with the greatest malaria burden in
India, there were an estimated 295 000 reported cases from
July through December 2016 – 56 of them fatal.
During the same time period in 2017, the number of cases
had fallen by nearly 50%, to approximately 156 000;
fatalities fell by more than two thirds, to 16 deaths.
Similar progress has been made in the north-eastern states,
where 7.2 million bednets were distributed in late 2015 and
in 2016.
Between 2016 and 2017, the reported number of cases of
malaria fell from about 165 000 to fewer than 37 000,
according to government figures.

25. The numbers testify to the impact of these collective efforts. According to government figures,
there were 295 000 malaria cases reported in Odisha between July and December 2016 – 56 of
them fatal. During the same time period in 2017, the number of cases had fallen by nearly 50%,
to approximately 156 000. Fatalities fell by more than two thirds, to 16 deaths.

26. KEEPING TRACK OF CASES
Obstacles remain. For example, keeping track of the malaria
burden has proven to be difficult, since private doctors do
not report their cases to the government database.
As the number of cases has dropped, so have the funds
needed to track down each case and to ensure it is properly
treated.
And more difficulties may yet appear: though resistance to
one of the primary weapons against malaria – artemisinin –
has not been identified in India, it has been found in nearby
Myanmar.
“This is a challenge,” one government official said. But, he added, none of the
challenges to eliminating malaria from India are insurmountable, even in the states
at highest risk. “We are optimistic that it can be done,” he said. “If all the
resources are there, then we can do it.”