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C07 P06 MALARIA PREVENTION and management
- 1. PREVENTION AND CONTROL PREVENTIONAND CONTROL OF MALARIA OF MALARIA
- 2. History History Military Military Medicine Medicine 1898 1898 Ross, a British Ross,a British Army doctor Army doctor established the established the parasite’s life parasite’s life cycle. Awarded cycle. Awarded Nobel prize in Nobel prize in medicine 1902. medicine 1902. Sir Ronald Ross Sir Ronald Ross
- 3. SHOULD WE FIGHTMALARIA ? SHOULD WE FIGHT MALARIA ? 1.8 billion people - 40% of world population live 1.8 billion people - 40% of world population live in malarious areas. in malarious areas. Transmission occurs in Transmission occurs in 100 countries 100 countries throughout Africa, Asia, Oceania, and Latin throughout Africa, Asia, Oceania, and Latin America, on certain Caribbean islands, and in America, on certain Caribbean islands, and in Turkey. Turkey. Malaria results in HUMAN RESOURCE WASTAGE Malaria results in HUMAN RESOURCE WASTAGE and is a SET BACK FOR ECONOMIC GROWTH. and is a SET BACK FOR ECONOMIC GROWTH.
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- 5. STRATAGIES FOR THE STRATAGIESFOR THE CONTROL AND ERADICATION CONTROL AND ERADICATION OF MALARIA OF MALARIA
- 6. MANAGEMENT OF MALARIA MANAGEMENTOF MALARIA CASES. CASES. ACTIVE INTERVENTION ACTIVE INTERVENTION MEASURES. MEASURES.
- 7. MANAGEMENT OF MALARIA MANAGEMENTOF MALARIA CASES CASES CASE DETECTION CASE DETECTION DISEASE CONTROL STRATEGIES USING DISEASE CONTROL STRATEGIES USING CHEMOTHERAPY CHEMOTHERAPY
- 8. IN HIGH RISKAREAS IN HIGH RISK AREAS Presumptive treatment of all suspected Presumptive treatment of all suspected malaria cases malaria cases Day1: Tab chloroquine - 10 mg/kg body wt Day1: Tab chloroquine - 10 mg/kg body wt Tab primaquine-0.75mg/kg body wt Tab primaquine-0.75mg/kg body wt Day2: Tab chloroquine - 10mg/kg body wt Day2: Tab chloroquine - 10mg/kg body wt Day3: Tab chloroquine - 5mg/kg body wt Day3: Tab chloroquine - 5mg/kg body wt
- 9. Radical treatment aftermicroscopic Radical treatment after microscopic confirmation of species confirmation of species P.VIVAX P.VIVAX- Tab primaquine-0.25 mg/kg body wt - Tab primaquine-0.25 mg/kg body wt P.FALCIPARUM P.FALCIPARUM-No further treatment In -No further treatment In chloroquine resistant P. falciparum cases chloroquine resistant P. falciparum cases CHLOROQUIN RESISTENT P. FALCIPARUM CASES CHLOROQUIN RESISTENT P. FALCIPARUM CASES Single dose Single dose 25 mg/kg body wt sulfalene / 25 mg/kg body wt sulfalene / sulphadoxine & 1.25mg/kg pyremethamine sulphadoxine & 1.25mg/kg pyremethamine Tab primaquine 0.75 mg/kg Tab primaquine 0.75 mg/kg
- 10. IN LOW RISKAREA IN LOW RISK AREA By chloroquine & primaquine By chloroquine & primaquine SEVERE & COMPLICATED SEVERE & COMPLICATED MALARIA MALARIA By quinine, artmesin derivatives By quinine, artmesin derivatives like artemisine, artesunate, like artemisine, artesunate, artemether, artether, mefloquine artemether, artether, mefloquine etc. etc.
- 11. MASS DRUG ADMINISTRATION MASSDRUG ADMINISTRATION In highly endemic areas (API >5/1000 In highly endemic areas (API >5/1000 population) along with anti mosquito measures. population) along with anti mosquito measures. CONTRAINDICATIONS CONTRAINDICATIONS: : In children below 5 yrs. In children below 5 yrs.
- 12. CHEMOPROPHYLAXIS CHEMOPROPHYLAXIS Drugs Drugs used are usedare Chloroquine Chloroquine Proguanil Proguanil Sulphadoxine + pyrimethamine Sulphadoxine + pyrimethamine Sulphalene + pyrimethamine Sulphalene + pyrimethamine Mefloquine Mefloquine Quinine Quinine Doxycycline Doxycycline Halofantrine Halofantrine
- 13. SPECIAL RECOMMENDATIONS SPECIAL RECOMMENDATIONS:- :- It is recommended for It is recommended for travelers travelers from non-endemic from non-endemic areas , areas , soldiers, police, labour forces soldiers, police, labour forces in highly in highly endemic areas. endemic areas. In In pregnant women pregnant women in areas where transmission in areas where transmission is very intense causing anaemia & low birth weight. is very intense causing anaemia & low birth weight. It should begin a week before arrival in the malaria's It should begin a week before arrival in the malaria's area & continued for 4 to 6 weeks after leaving the area & continued for 4 to 6 weeks after leaving the area. area.
- 14. ACTIVE INTERVENTION MEASURES ACTIVEINTERVENTION MEASURES 1.STRATIFICATION OF THE PROBLEM 1.STRATIFICATION OF THE PROBLEM 2.VECTOR CONTROL STRATEGIES 2.VECTOR CONTROL STRATEGIES STRATIFICATION OF THE PROBLEM STRATIFICATION OF THE PROBLEM: : Under modified plan of operation in Indian Under modified plan of operation in Indian endemic areas have been stratified according to endemic areas have been stratified according to API as: API as: Areas with API <2 Areas with API <2 Areas with API >2 Areas with API >2
- 15. VECTOR CONTROL MEASURES VECTORCONTROL MEASURES Anti-adult measures Anti-adult measures Anti-larval measures Anti-larval measures
- 16. ANTI-ADULT MEASURES ANTI-ADULT MEASURES Residualspraying: Residual spraying: DDT DDT Malathion Malathion Fenitrothion Fenitrothion
- 17. SPACE APPLICATION SPACE APPLICATION Pesticides in the Pesticides in the form of fog or form of fog or mist. mist. Ultra low volume Ultra low volume pesticide pesticide dispersion. dispersion. Out door space Out door space sprays. sprays.
- 18. Individual Protection Individual Protection: : A)Repellants,protective clothing A) Repellants,protective clothing B) Bed nets B) Bed nets C) Mosquito coils C) Mosquito coils D) Screening of windows D) Screening of windows
- 19. ANTI- LARVAL MEASURES ANTI-LARVAL MEASURES Larvicides: Larvicides: Oiling the standing Oiling the standing water. water. Dusting them with Dusting them with Paris green. Paris green. Temephos, modern Temephos, modern larvicide with low larvicide with low toxicity. toxicity.
- 20. Source reduction : Sourcereduction : Drainage or filling Drainage or filling Deepening or flushing Deepening or flushing Management of water level Management of water level Changing the salt content of water Changing the salt content of water Intermittent irrigation Intermittent irrigation
- 21. Integrated control: Integrated control: Bio- Bio- environmental environmental Personal Personal protection protection measures measures
- 22. MALARIA VACCINES MALARIA VACCINES ASEXUALBLOOD STAGE ASEXUAL BLOOD STAGE VACCINES VACCINES -to lower -to lower morbidity & mortality. morbidity & mortality. VACCINES VACCINES -to reduce -to reduce transmission by arresting transmission by arresting development in mosquito. development in mosquito. Ex Ex:-Pfs vac., is in clinical trials :-Pfs vac., is in clinical trials in USA & Africa. in USA & Africa.
- 23. A synthetic cocktailvac A synthetic cocktail vac for P.falciparum, SPf66 for P.falciparum, SPf66 has been tested in S.A, has been tested in S.A, Africa, SE Asia. Africa, SE Asia. SPf66,Formulated as SPf66,Formulated as peptide-alum peptide-alum combination, was selected combination, was selected on the basis of its ability on the basis of its ability to protect monkeys from to protect monkeys from infection. infection.
- 24. NATIONAL ANTI-MALARIA PROGRAMME NATIONALANTI-MALARIA PROGRAMME NMCP was launched in April 1953.Incidence declined NMCP was launched in April 1953.Incidence declined from 75 to 2 million cases from 1953 to 58. from 75 to 2 million cases from 1953 to 58. NMEP was launched in 1958.It is divided into NMEP was launched in 1958.It is divided into preparatory, attack, consolidation & maintence preparatory, attack, consolidation & maintence phases. phases. MPO, is the revised strategy was put in to operation MPO, is the revised strategy was put in to operation from April 1977 to review the situation as resurgence from April 1977 to review the situation as resurgence of malaria has grown to epidemic proportions. of malaria has grown to epidemic proportions.
- 25. History of MalariaProgramme History of Malaria Programme 1946-India started using DDT 1946-India started using DDT 1953-NMCP Started 1953-NMCP Started 1958-NMCP-NMEP 1958-NMCP-NMEP 1959-Vector Resistance detected 1959-Vector Resistance detected 1965-Re-emergence of malaria 1965-Re-emergence of malaria 1976-Peak of malaria cases 1976-Peak of malaria cases 1977-India starts MPO 1977-India starts MPO 1991-Peak of P. falciparum cases 1991-Peak of P. falciparum cases 1994-Large scale epidemics (Eastern 1994-Large scale epidemics (Eastern India/Western Rajasthan) India/Western Rajasthan) 2000-NMEP-NAMP 2000-NMEP-NAMP
- 26. MODIFIED PLAN OFOPERATION MODIFIED PLAN OF OPERATION OBJECTIVES OBJECTIVES To prevent deaths due to malaria. To prevent deaths due to malaria. To reduce malaria morbidity. To reduce malaria morbidity. To maintain agricultural & industrial To maintain agricultural & industrial production. production. To consolidate the gains so far achieved. To consolidate the gains so far achieved.
- 27. 2)RECLASSIFICATION OF AREAS 2)RECLASSIFICATIONOF AREAS Areas with Areas with API>=2 API>=2 are taken up for spray operations are taken up for spray operations 3)AREAS WITH API>2 3)AREAS WITH API>2 Spraying Spraying: - DDT, Malathion, Pyrethroids : - DDT, Malathion, Pyrethroids Entomological assessment Entomological assessment :- By susceptibility :- By susceptibility tests tests Surveillance Surveillance:- Active & passive :- Active & passive Treatment of cases Treatment of cases
- 28. 4)AREAS WITH API< 2 4)AREAS WITH API < 2 Focal spraying Focal spraying Surveillance Surveillance :- carried out every fortnight. :- carried out every fortnight. Treatment Treatment :- Detected cases should receive :- Detected cases should receive radical treatment radical treatment Follow up Follow up :- Blood Smears are followed up in :- Blood Smears are followed up in +ve cases on completion of radical treat. & +ve cases on completion of radical treat. & thereafter at monthly intervals for 12 months. thereafter at monthly intervals for 12 months. Epidemiological investigation Epidemiological investigation :-Mass surveys :-Mass surveys
- 29. 5)DRUG DISTRIBUTION CENTRES& FEVER 5)DRUG DISTRIBUTION CENTRES & FEVER TREATMENT DEPOTS TREATMENT DEPOTS Drug Policy Drug Policy for malaria treatment under national anti- for malaria treatment under national anti- malaria program is as follows : malaria program is as follows : Any fever in endemic areas during transmission season Any fever in endemic areas during transmission season without any other obvious cause may be considered as without any other obvious cause may be considered as malaria & investigated/treated accordingly. malaria & investigated/treated accordingly. Drug resistance foci are prevalent in the country but Drug resistance foci are prevalent in the country but chloroquine is still the safe, effective & cheap anti- chloroquine is still the safe, effective & cheap anti- malarial drug & is simple to be administered. malarial drug & is simple to be administered. The best approach in malaria treatment is diagnosis & The best approach in malaria treatment is diagnosis & treatment on the same day. treatment on the same day.
- 30. 6)URBAN MALARIA SCHEME 6)URBANMALARIA SCHEME Methodology is by Methodology is by Anti larval measures Anti larval measures Drug treatment Drug treatment. . It includes urban areas with > 50,000 population & It includes urban areas with > 50,000 population & slide +vity rate of 5% & above. slide +vity rate of 5% & above. 7) 7) P.FALCIPARUM CONTAINMENT P.FALCIPARUM CONTAINMENT 8) 8) RESEARCH RESEARCH 9) 9) HEALTH EDUCATION HEALTH EDUCATION
- 31. 10) 10) REORGANIZATION REORGANIZATION Administrative boundariesare set up with Administrative boundaries are set up with division of areas into zones. division of areas into zones. DMO, AMO, Lab technicians, Multi purpose DMO, AMO, Lab technicians, Multi purpose workers are posted & Lab services are workers are posted & Lab services are decentralized. decentralized.
- 32. SURVEILLANCE SURVEILLANCE :- :- Active Active Passive Passive PARAMETERS OFSURVEILLANCE PARAMETERS OF SURVEILLANCE API API ABER ABER AFI AFI SPR SPR SFR SFR
- 33. “ “I think youwill agree ... it I think you will agree ... it is easier for an officer to is easier for an officer to keep men healthy than for keep men healthy than for the Doctor to cure them.” the Doctor to cure them.” ADM Horatio Nelson - ADM Horatio Nelson - one eye, one arm, no upper teeth, one eye, one arm, no upper teeth, survivor of yellow fever survivor of yellow fever (a latecomer to Preventive Medicine) (a latecomer to Preventive Medicine)
- 34. MALARIA CONTROL THROUGHPHC MALARIA CONTROL THROUGH PHC In 1999 NMEP was renamed as National anti malaria In 1999 NMEP was renamed as National anti malaria programme. programme. ENHANCED MALARIA CONTROL ENHANCED MALARIA CONTROL PROJECT PROJECT was launched on 30th September 1997, spread over 5 was launched on 30th September 1997, spread over 5 years. years.
- 35. Components strengthened underit are :- Components strengthened under it are :- Early case detection & treatment Early case detection & treatment Selective vector control &personal protection Selective vector control &personal protection measures like insecticide treated mosquito net measures like insecticide treated mosquito net Epidemic planning & rapid response Epidemic planning & rapid response Intersectoral coordination Intersectoral coordination Institutional & management capabilities strengthened Institutional & management capabilities strengthened Use of larvivorus fish Use of larvivorus fish Govt.of India provides funds for it Govt.of India provides funds for it It received 2 years extension up to March 2005 It received 2 years extension up to March 2005
- 36. GOALS FOR 10 GOALSFOR 10TH TH FIVE YEAR PLAN FIVE YEAR PLAN ABER over 10 %. ABER over 10 %. API 1.3 or less. API 1.3 or less. 25% reduction in mortality & morbidity by 25% reduction in mortality & morbidity by 2007 & 50% by 2010. 2007 & 50% by 2010.
- 37. The Worlds Priorities?Annual The Worlds Priorities? Annual Expenditure Expenditure Global Reduction in Malaria Global Reduction in Malaria $ 1 billion $ 1 billion Basic education for all Basic education for all $ 6 billion * $ 6 billion * Cosmetics in the US Cosmetics in the US $ 8 billion $ 8 billion Safe water and sanitation Safe water and sanitation $ 9 billion * $ 9 billion * Ice cream in Europe Ice cream in Europe $ 11 billion $ 11 billion Reproductive health for all women Reproductive health for all women $ 12 billion * $ 12 billion * Perfumes in Europe and the US Perfumes in Europe and the US $ 12 billion $ 12 billion Basic health and nutrition Basic health and nutrition $ 13 billion * $ 13 billion * Pet food in Europe and the US Pet food in Europe and the US $ 17 billion $ 17 billion Business entertainment in Japan Business entertainment in Japan $ 35 billion $ 35 billion Cigarettes in Europe Cigarettes in Europe $ 50 billion $ 50 billion Alcoholic drinks in Europe Alcoholic drinks in Europe $ 105 billion $ 105 billion Narcotic drugs in the world Narcotic drugs in the world $ 400 billion $ 400 billion Military spending in the world Military spending in the world $ 780 billion $ 780 billion *Estimated additional cost required to achieve universal access in all developing countries
- 38. Malaria is adisease that is both preventable and curable, LET US PLEDGE TO ERADICATE THIS…...... MENACING MALARIA.
- 40. A PRESENTATION BY: A PRESENTATION BY : TEJASWINI RAO, TEJASWINI RAO,