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
Dr. Priyamadhaba BeheraJunior ResidentMALARIA CONTROL STRATEGIES ININDIA 12/04/20131
OUTLINE OF PRESENTATION• EPIDEMIOLOGY• EVOLVVING MALARIA CONTROL STRATEGIES ININDIA• NVBDCP• GUIDELINE FOR DIAGNOSIS AND TREATMENTOF MALARIA IN INDIA( 2011)
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
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?
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.
6India’s contribution to Malaria in SEARIndia contributes to 71% of total malaria cases in the SEAR
How bionomics of vector help to control malaria
Indicators forsurveillance, prevalence, when ABER is low or fluctuates?
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 ?
NATIONAL MALARIA ERADICATIONPROGRAMME1958OBJECTIVESTO ERADICATE MALARIA FROM INDIA IN 7 TO 9 YEARSACTIVITIESSPRAYING OPERATIONFORTNIGHTLY ACTIVE CASE DETECTIONRADICAL TREATMENTINVESTIGATION OF POSITIVE CASES AND REMEDIAL MEASURESACHIEVEMENTSLOWEST EVER INCIDENCE OF 0.1 MILLION IN 1965NO REPORTED DEATHS DUE TO MALARIA
RESURGENCE OF MALARIA 1967 TO1976IN 1965-SUDDEN WITHDRAWAL OF ASSISTANCE ANDINSECTICIDES REGISTANCE ,STEEP RISE IN MALARIA INCIDENCE
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
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
RE-CLASSIFICATION OF ENDEMIC AREASBASED ON ANNUAL PARASITE INCIDENCEAPI LESS THAN 2 API GREATER THAN 2MODIFIED PLAN OF OPERATION 1977OBJECTIVESPREVENTION OF DEATH DUE TO MALARIAREDUCTION OF MORBIDITY DUE TO MALARIARETENTION OF ACHIEVEMENTS GAINED SO FAR
AREAS WITH API > 2SPRAYINGENTOMOLOGICAL ASSESSMENTSURVEILLANCETREATMENT OF CASESDECTRALISATION OF LABORATORY SERVICES AT-PHCESTABLISHMENT OF DDCS AND FTDSAREAS WITH API < 2FOCAL SPRAYINGSURVEILLANCE AND TREATMENTFOLLOW UPEPIDEMIOLOGICAL INVESTIGATION
DRUG DISTRIBUTION CENTREDISPENSE ANTI MALARIAL DRUGSFEVER TREATMENT DEPOTCOLLECT BLOOD SLIDESDISTRIBUTE ANTI MALARIAL DRUGS
RESEARCHMONITORING TEAMS TO IDENTIFYFALCIPARUM SENSITIVITY TOCHLOROQUINETEAM TO TEST ALTERNATE DRUGS FORCHLOROQUINE RESISTANCEHEALTH EDUCATION
P.FALCIPARUM CONTAINMENT 1977COMPONENT OF MPOINTRODUCED WITH THE ASSISTANCE OF SWEDISHINTERNATIONAL DEVELOPMENT AGENCYTO PREVENT OR CONTROL THE SPREAD OF FALCIPARUM MALARIAAREAS
SURVEILLANCEAIM•CASE DETECTION THROUGH LAB SERVICES•FACILITIES FOR PROPER TREATMENTACTIVETYPESPASSIVEACTIVE SURVEILLANCE☻CARRIED OUT BY SURVEILLANCE WORKERSPASSIVE SURVEILLANCESEARCH FOR CASES BY LOCAL HEALTH AGENCIESCASES THOSE ESCAPED ACTIVE SURVEILLANCE ARE SCREENED
MALARIA ACTION PROGRAMME 1995RESURGENCE OF MALARIA(RAJSTAN/MANIPUR/NAGALAND/ASSAM/WB/MAHARASHTRA)EXPERT COMMITTEE 1994HIGH RISK AREAS IDENTIFIEDFTD MICROSCOPY FACILITY1000 POPULATION 30,000 POPULATION
ELEMENTSEARLY DIAGNOSIS AND PROMPT TREATMENTSUSTAINABLE PREVENTIVE MEASURES INCLUDING VECTOR CONTROLPREVENTION OF EPIDEMICSREGULAR ASSESSMENTHIGH RISK AREASHIGH APIHIGH PROPORTION OF PF CASESREPORTED DEATH DUE TO MALARIASPR DOUBLEDSPR >5%
ENHANCED MALARIA CONTROL PROJECT 1997•WITH WORLD BANK ASSISTANCE•1997-2003, EXTN TO 2005OBJECTIVESEFFECTIVE CONTROL OF MALARIABRING DOWN MALARIA MORBIDITYPREVENTION OF DEATH DUE TO MALARIACONSOLIDATION OF GAIN ACHIVED SO FARSELECTION OF PHC-CRITERIAAPI>2 FOR LAST 3 YRSP.FALCIPARUM>30% OF CASES25% TRBAL POPULATONDEATH DUE TO MALARIA
MAIN COMPONENTS♣EARLY CASE DETECTION AND TREATMENT♣SELECTIVE VECTOR CONTROL AND PERSONAL PROTECTION♣HEALTH EDUCATION AND COMMUNITY PARTICIPATIONPLAN OF ACTIONSYNTHETIC PYRETHROIDSBED NETSRAPID DIAGNOSTIC KITSARTEETHER INJECTIONSBLISTER PACKSFUNS FOR TRAINING
NATIONAL ANTI-MALARIA PROGRAMME 1999NATIONAL VECTOR BORNE DISEASE CONTROLPROGRAMME 2004OBJECTIVESREDUCE MALARIA MORBIDITY AND MORTALITY BY 50%TARGETS AND INDICATORSABER>10%MBER OF 0.8%1.2 – 1.8%API 1.3 OR LESS25% REDUCTION IN MORBIDITY AND MORTALITY BY 201050% REDUCTION IN MORBIDITY AND MORTALITY BY 2012
NATIONAL VECTOR BORNEDISEASE CONTROL PROGRAMME
Launched in year 2003-04Major vector borne diseases-• Malaria• Filaria• Kala-azar• Japanese Encephalitis• Dengue / Dengue Hemorrhagic fevers• Chikungunya
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
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
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)
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.
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.
• 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.