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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  • Sporogony=8-30days,<16-18c,<7,A.gambiae which long-lived,human preference density of vector,no of bites per day per mosquito, 10 of mosquito survival
  • Sporogony time at 20 - 21ºC  P.vivax 14 - 16days (no development below 15 ºC)  P.falciparum 18 - 20days (no development below 17 ºC) Temperature over 32-34 ºC inactivates the parasite pre
  • Malaria control strategies in india

    1. 1. Dr. Priyamadhaba BeheraJunior ResidentMALARIA CONTROL STRATEGIES ININDIA 12/04/20131
    2. 2. OUTLINE OF PRESENTATION• EPIDEMIOLOGY• EVOLVVING MALARIA CONTROL STRATEGIES ININDIA• NVBDCP• GUIDELINE FOR DIAGNOSIS AND TREATMENTOF MALARIA IN INDIA( 2011)
    3. 3. The World Malaria Report 2012 :104 malaria-endemic countriesand territories for 2011. Ninety-nine of these countries had on-going malaria transmission.Extends up to 40 degree north and 40 degree south of equator219 million cases of malaria in 2010 and an estimated 660 000deaths. Africa is the most affected continent: about 90% of allmalaria deaths occur there.Between 2000 and 2010, malaria mortality rates fell by 26% aroundthe world. In the WHO African Region the decrease was 33%.what factors make Africa prone for high transmission? Howmalaria transmission of Africa differ from India
    4. 4. Malaria is a public health problem inIndia-About 95% population in the country resides in malaria endemic areas and 80% ofmalaria reported in the country is confined to areas consisting 20% of populationresiding in tribal, hilly, difficult and inaccessible areas-45-50% cases are p.falciparum casesHow falciparum differs from others and why leads to various complication?
    5. 5. Trend of Malaria Cases And Deaths 2001-2010 in Indiacases 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 anepidemic 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. 6India’s contribution to Malaria in SEARIndia contributes to 71% of total malaria cases in the SEAR
    7. 7. How bionomics of vector help to control malaria
    8. 8. Indicators forsurveillance, prevalence, when ABER is low or fluctuates?
    9. 9. MILESTONESNMCP 1953SPECTACULAR SUCCESSNMEP 1958UMS 1971RESURGENCEMPO 1977MAP 1995
    10. 10. EMCP 1997NAMP 1999NVBDCP 2004IMCP 2005
    11. 11. NATIONAL MALARIA CONTROL PROGRAMME1953OBJECTIVES• TO BRING DOWN MALARIA TRANSMISSION• TO HOLD DOWN MALARIA TRANSMISSION AT LOW LEVELSTRATEGIES•INDOOR RESIDUAL SPRAY•TREATMENT OF PATIENTS REPORTING TO HEALTHACHIEVEMENTS•DECLINE IN INCIDENCE FROM 75 MILLION TO ONLY 2 MILLION IN 1958How current treatment of malaria differs from 1953 ?
    12. 12. NATIONAL MALARIA ERADICATIONPROGRAMME1958OBJECTIVESTO ERADICATE MALARIA FROM INDIA IN 7 TO 9 YEARSACTIVITIESSPRAYING OPERATIONFORTNIGHTLY ACTIVE CASE DETECTIONRADICAL TREATMENTINVESTIGATION OF POSITIVE CASES AND REMEDIAL MEASURESACHIEVEMENTSLOWEST EVER INCIDENCE OF 0.1 MILLION IN 1965NO REPORTED DEATHS DUE TO MALARIA
    13. 13. RESURGENCE OF MALARIA 1967 TO1976IN 1965-SUDDEN WITHDRAWAL OF ASSISTANCE ANDINSECTICIDES REGISTANCE ,STEEP RISE IN MALARIA INCIDENCE
    14. 14. URBAN MALARIA SCHEME1971IN 139 TOWNS IN 19 STATES AND UNION TERRITORIESOBJECTIVESa) To prevent deaths due to malaria.b) Reduction in transmission and morbidity.NORMSThe 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/eliminatedomestic and peri-domestic breeding places
    15. 15. Control Strategies under Urban Malaria Scheme:-Parasite control-Vector controlParasite control: Treatment is done through passive agencies viz. hospitals, dispensariesboth in private & public sectors and private practitioners. In mega cities malaria clinics areestablished by each health sector/ malaria control agencies viz. Municipal Corporations,Railways, Defence servicesVector control comprises of the following componentsSource reductionUse of larvicidesUse of larvivorous fishSpace sprayMinor engineeringLegislative measureAerosol Space SpraySpace spraying of pyrethrum extract (2%) in 50 houses in and around every malaria anddengue positive cases to kill the infective mosquitoes is recommended.Town –biologistState-additional director (malaria/filaria)Central level-director NVBDCP
    16. 16. RE-CLASSIFICATION OF ENDEMIC AREASBASED ON ANNUAL PARASITE INCIDENCEAPI LESS THAN 2 API GREATER THAN 2MODIFIED PLAN OF OPERATION 1977OBJECTIVES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 FTDSAREAS WITH API < 2FOCAL SPRAYINGSURVEILLANCE AND TREATMENTFOLLOW UPEPIDEMIOLOGICAL INVESTIGATION
    18. 18. DRUG DISTRIBUTION CENTREDISPENSE ANTI MALARIAL DRUGSFEVER TREATMENT DEPOTCOLLECT BLOOD SLIDESDISTRIBUTE ANTI MALARIAL DRUGS
    19. 19. RESEARCHMONITORING TEAMS TO IDENTIFYFALCIPARUM SENSITIVITY TOCHLOROQUINETEAM TO TEST ALTERNATE DRUGS FORCHLOROQUINE RESISTANCEHEALTH EDUCATION
    20. 20. P.FALCIPARUM CONTAINMENT 1977COMPONENT OF MPOINTRODUCED WITH THE ASSISTANCE OF SWEDISHINTERNATIONAL DEVELOPMENT AGENCYTO PREVENT OR CONTROL THE SPREAD OF FALCIPARUM MALARIAAREAS
    21. 21. SURVEILLANCEAIM•CASE DETECTION THROUGH LAB SERVICES•FACILITIES FOR PROPER TREATMENTACTIVETYPESPASSIVEACTIVE SURVEILLANCE☻CARRIED OUT BY SURVEILLANCE WORKERSPASSIVE SURVEILLANCESEARCH FOR CASES BY LOCAL HEALTH AGENCIESCASES THOSE ESCAPED ACTIVE SURVEILLANCE ARE SCREENED
    22. 22. MALARIA ACTION PROGRAMME 1995RESURGENCE OF MALARIA(RAJSTAN/MANIPUR/NAGALAND/ASSAM/WB/MAHARASHTRA)EXPERT COMMITTEE 1994HIGH RISK AREAS IDENTIFIEDFTD MICROSCOPY FACILITY1000 POPULATION 30,000 POPULATION
    23. 23. ELEMENTSEARLY DIAGNOSIS AND PROMPT TREATMENTSUSTAINABLE PREVENTIVE MEASURES INCLUDING VECTOR CONTROLPREVENTION OF EPIDEMICSREGULAR ASSESSMENTHIGH 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 2005OBJECTIVESEFFECTIVE CONTROL OF MALARIABRING DOWN MALARIA MORBIDITYPREVENTION OF DEATH DUE TO MALARIACONSOLIDATION OF GAIN ACHIVED SO FARSELECTION 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 PARTICIPATIONPLAN OF ACTIONSYNTHETIC PYRETHROIDSBED NETSRAPID DIAGNOSTIC KITSARTEETHER INJECTIONSBLISTER PACKSFUNS FOR TRAINING
    26. 26. NATIONAL ANTI-MALARIA PROGRAMME 1999NATIONAL VECTOR BORNE DISEASE CONTROLPROGRAMME 2004OBJECTIVES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 BORNEDISEASE 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, Dengueand JE by half– Elimination of Kala-azar by 2010– elimination of lymphatic filariasis by year 2015.35
    30. 30. INTENSIFIED MALARIA CONTROLPROJECTLaunched in july 2005 with assistance of global fund for AIDS,TBand malaria in NE states,Odisha,jharkhand and WBOBJECTIVES:1-Increase access rapid diagnosis and treatment throughcommunity participation2-reduce transmission by used of insecticide treated bednetsand larvivorous fish3-Enhance awareness about malaria control4-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 ThinSmears
    36. 36. Specific antimalarial treatment ofsevere malariaSevere malaria is an emergency and treatment should be givenpromptly. Parenteral artemisinin derivatives or quinine shouldbe used irrespective of chloroquine sensitivity.• Artesunate: 2.4 mg/kg body weight i.v. or i.m. given onadmission (time=0), then at 12 hours and 24 hours, thenonce 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. Infirst trimester of pregnancy, parenteral quinine is the drug of choice.• Other drugs used are arteether , artemether, quinine ( along withdoxycycline/clindamycin)
    37. 37. chemoprophylaxisChemoprophylaxis is recommended travellers, migrantlabourers and military personnel exposed to malaria in highly endemicareas. Use of personal protection measures like insecticide-treatedbednets should be encouraged for pregnant women and othervulnerable populations.
    38. 38. PROGRAM EVALUATIONInternal assessments are conducted by central teams as well asby LQAS, periodically.External assessments are done through large sample surveysevery 2-3 years and are conducted by NVBDCP / NIMR.
    39. 39. • The study in 10 randomly sampled high burden blocks withAPI > 2 can be spread out over 80• villages to include 1600 households / fever cases. Suchsamples are adequate to detect differences of more than 10%across two surveys. The survey data will be examined alongwith other sources of information, including MIS and LQASand planning data.
    40. 40. THANK YOU

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