NATIONAL MALARIA CONTROL PROGRAMME PRESENTED BY: BIBHUTI BHUSHAN(A07)

NAVIN KAUSHAL(A02) RAHUL KUMAR(A01) SONU DHAKAD(A05) PUNEET (A04) DR. TARUN SONI(A08)

National vector borne disease control program(NVBDCP)

National vector borne disease control program(NVBDCP)

NAMP NFCP Kala-azar control program Dengue/Dengue Hemorrhagic fever and Japanese Encephalitis(j.E.) merged as NVBDCP

MALARIA

introduction
Malaria is a potentially life threatening parasitic disease caused by parasites known as Plasmodium viviax (P.vivax), Plasmodium falciparum (P.falciparum), Plasmodium malariae (P.malariae) and Plasmodium ovale (P.ovale) It is transmitted by the infective bite of Anopheles mosquito Man develops disease after 10 to 14 days of being bitten by an infective mosquito There are two types of parasites of human malaria, Plasmodium vivax, P. falciparum, which are commonly reported from India. Inside the human host, the parasite undergoes a series of changes as part of its complex life cycle. (Plasmodium is a protozoan parasite) The parasite completes life cycle in liver cells (pre-erythrocytic schizogony) and red blood cells (erythrocytic schizogony Infection with P.falciparum is the most deadly form of malaria.

HISTORICAL PERSPECTIVE
Malaria has been a major public health problem in India. Intermittent fever, with high incidence during the rainy season, coinciding with agriculture, sowing and harvesting, was first recognized by Romans and Greeks who associated it with swampy areas. They postulated that intermittent fevers were due to the 'bad odour' coming from the marshy areas and thus gave the name 'malaria' ('mal'=bad + 'air') to intermittent fevers. In spite of the fact that today the causative organism is known, the name has stuck to this disease.

Symptoms of malaria
A history of high fever. Prostration (inability to sit), altered consciousness lethargy or coma. Breathing difficulties. Severe anaemia. Generalized convulsions/fits. Inability to drink/vomiting. Dark and/or limited production of urine.

Vectors of Malaria
There are many vectors of malaria Anopheles culicifacies is the main vector of malaria It is a small to medium sized mosquito with Culex like sitting posture

Anopheles culicifacies
Feeding habit It is a zoophilic species When high densities build up relatively large numbers feed on men Resting habits Rests during daytime in human dwellings and cattle sheds. Breeding places Breeds in rainwater pools and puddles, borrow pits, river bed pools, irrigation channels, seepages, rice fields, wells, pond margins, sluggish streams with sandy margins. Extensive breeding is generally encountered following monsoon rains.

BUCKETS

Tender coconut shells

Open Tank

Tyres

Paddles

Water logged in basement

Unused Wells

Biting time
Biting time of each vector species is determined by its generic character, but can be readily influenced by environmental conditions.

Most of the vectors, including Anopheles culicifacies, start biting soon after dusk. Therefore, biting starts much earlier in winter than in summer but the peak time varies from species to species.

Malaria control program

1953: NMCP(National Malaria control program) launched 1958: NMEP(national malaria eradication program) launched 1971: Urban Malaria Scheme(UMS) 1976: Resurgence with peak 6.47M case 1977: MPO(Modified plan of Operation) & PfCP 1979: Centrally sponsored ,50:50 basis 1985: 2 million cases 1991: Peak in Pf cases 1994: Epidemic: Eastern India & Western Raj 1995:Malaria action plan Sept. 1997: EMCP Apr. 1999: NAMP 2004:NVBDCP

Objective of National Malaria control program

To reduce morbidity due to malaria. To prevent deaths due to malaria. Industrial & Agricultural Development activities should not be affected due to malaria. The gains achieved so far should be maintained.

Strategy of National Malaria control programme Implementation Strategies: State has developed State Implementation Plan for Malaria in tune with guidelines given by Govt. Of India under Malaria Action Plan 1995.

Major components of Implementation strategies

Early detection and prompt treatment (EDPT)
Identification of High Risk Area. Strengthening of surveillance activities. Decentralization of Laboratory Services. Availability of anti malarial drugs up to the village level.

Selective Vector Control

Indoor residual spraying. Anti Larval Measures. Use of Biocides. Personal protection methods mainly Use of Impregnated Bed nets. Biological Control Measures.

Activities of National Malaria Control Program

1.Early Detection & Prompt Treatment (EDPT) Identification Of High Risk Area EDPT is the main strategy of malaria control - radical treatment is necessary for all the cases of malaria to prevent transmission of malaria. Chloroquine is the main anti-malaria drug for uncomplicated malaria. Drug Distribution Centres (DDCs) and Fever Treatment Depots (FTDs) have been established in the rural areas for providing easy access to anti-malarial drugs to the community. Alternative drugs for chloroquine resistant malaria are recommended as per the drug policy of malaria.

2.Vector Control
(i) Chemical Control Use of Indoor Residual Spray (IRS) with insecticides recommended under the programme Use of chemical larvicides like Abate in potable water Aerosol space spray during day time Malathion fogging during outbreaks (ii) Biological Control Use of larvivorous fish in ornamental tanks, fountains etc. Use of biocides. (iii) Personal Prophylactics Measures that

individuals/communities can take up Use of mosquito repellent creams, liquids, coils, mats etc. Screening of the houses with wire mesh Use of bed nets treated with insecticide Wearing clothes that cover maximum surface area of the body

 Community Participation Sensitizing and involving the community for detection of Anopheles breeding places and their elimination NGO schemes involving them in programme strategies Collaboration with CII/ASSOCHAM/FICCI Environmental Management & Source Reduction Methods Source reduction i.e. filling of the breeding places Proper covering of stored water Channelization of breeding source Monitoring and Evaluation of the programme Monthly Computerized Management Information System(CMIS) Field visits by state by State National Programme Officers Field visits by Malaria Research Centres and other ICMR Institutes Feedback to states on field observations for correction actions.

3.Capacity Building: Training to field staff &Non GovernmentalOrganisations (NGOs.) 4.World Bank Assisted Enhanced Malaria Control Project to intensify malaria control activities in tribal belt of the state. 5.Celebration of Anti Malaria Month June up to village level every year. As per guidelines given by Govt. of India Anti Malaria MonthJune is celebrated every year with various activities up to the village level. (Gram Sabha, Morning Procession, News Paper, Cable T. V., Radio, Handbills, etc.)

Activities carried out during Anti Malaria Month June

1.Organization of State level press conference on 1st June. 2.Organization of district level press conference. 3.Special edition of ArogyyaPatirika on Malaria. 4.Broadcasting of speech on Aakashwani/Doordarshan by State level officers. 5.Broadcasting of TV spots on Doordarshan. 6.Broadcasting of radio jingles. 7.Advertises in different local news papers. 8.Organization of Malariology workshops for NGOs.

6.IEC (Information, Education & Communication)

For creation of awareness among the community about signs & symptoms of malaria, treatment & management of malaria & control measures. Use of different types of media depending upon the local situation for achieving better community participation. Mass media such as TV/Radio/Cable network, Cinema slides, Pamphlets, Posters, Charts etc.

7.Urban Malaria Scheme in selected towns. 8.Implementation of Bye laws.

Urban malaria scheme

Aims:
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 promulgate and strictly implement the civic bylaws to prevent/eliminate domestic and peri-domestic breeding places

URBAN MALARIA SITUATION:

Epidemiological and disease specific background

About 10% of the total cases of malaria are reported from urban areas. Maximum numbers of malaria cases are reported from Chennai, Vishakhapatnam, Vadodara, Kolkata, New Mumbai, Vijayawada etc.

Comparative Epidemiological profile of malaria in 19 States under UMS during 2005-10

Year Population Total cases P.f P.F % SPR SFR Deaths

2005

102423064

135249

14905

11.02

2.33

0.26

96

2006

105782505

129531

17278

13.34

2.07

0.28

145

2007

112448027

102829

18038

16.82

1.92

0.32

125

2008

113334073

113810

18963

13.42

1.66

0.22

102

2009

114699850

166065

31134

18.75

2.98

0.56

213

2010*

115159555

74908

7587

18.75

2.98

0.56

31

Emerging Problem of Malaria in Urban Areas

The proportion of urban population to the total population has increased in the last few decades. This has been triggered by rural push (for earning livelihood and urban pull (for availing both Medicare/ education opportunities) phenomenon. Haphazard and unplanned growth of towns has resulted in creation of urban slum with poor housing and sanitary conditions promoting vector mosquito breeding potential for malaria, filaria and dengue fever/ Dengue haemorrhagic fever. Restricted water supply has led to water storage practices in artificial containers which have generated breeding potential of An.stephensi vectors of urban malaria and Aedes aegypti, the vector of DF/DHF. With rapid growth of population in urban towns, existing staff strength has not corresponding strengthening and is therefore inadequate for service delivery. Anti-larval activities are restricted to chemical control. The focus is not on integrated source reduction measures.

Towns not under UMS are also contributing maximum malaria cases in Mangalore. Due to population pressure all cities are expanding and parallel cities have come up and epidemic situations prevail. Gurgaon, Navi Mumbai, Noida. Old villages in expanding urban centers were kept out of overall development (sullage & sewage disposal) with unrestricted land use maintain high mosquitogenic potential. Development project activities without health impact assessment have resulted in malaria outbreaks in short terms and endemic malaria with foci of P.falciparum resistance strains in long term.

High risk towns