OUTLINE OF PRESENTATION

Evolving malaria control strategies in India. NVBDCP.

MILESTONES OF MALARIA CONTROL ACTIVITIES IN INDIA

National Malaria Control Program (NMCP) - 1953
spectacular success

National Malaria Eradication Program (NMEP) -1958

Urban Malaria Scheme (UMS) - 1971

resurgence

Modified Plan of Operations (MPO) - 1977

Enhanced Malaria Control Program (EMCP) -1997

National Anti Malaria Program (NAMP) - 1999

NVBDCP

Intensified Malaria Control Project (IMCP) -2005

New Drug Policy -2010

NATIONAL MALARIA CONTROL PROGRAMME 1953 OBJECTIVES:

To hold down malaria transmission at low level

STRATEGIES:
Indoor residual spray (IRS)

Malaria control teams to survey and monitor incidence.

ACHIEVEMENTS:
Decline in incidence from 75 million to only 2 million in 1958

NATIONAL MALARIA ERADICATION PROGRAMME1958

OBJECTIVES:
To eradicate malaria from India in 7 to 9 years

ACTIVITIES:
Spraying operation Fortnightly active case detection Radical treatment Investigation of positive cases and remedial measures

ACHIEVEMENTS :
Lowest ever incidence of 0.1 million in 1965 No reported deaths due to malaria

RESURGENCE OF MALARIA 1965

Sudden withdrawal of assistance and insecticides led to steep rise in malaria incidence.

URBAN MALARIA SCHEME 1971

Involved 139 towns in 19 states and Union Territories.

OBJECTIVES:
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.

METHODOLOGY:
It Comprises vector Control by intensive antilarval measures and drug treatment.

MODIFIED PLAN OF OPERATION 1977

OBJECTIVES:
Prevention of death due to malaria Reduction of morbidity due to malaria Retention of achievements gained so far. RE-CLASSIFICATION OF ENDEMIC AREAS It is based on annual parasite incidence (API) API less than 2 API greater than 2

Control in AREAS WITH API > 2:

Spraying insecticides Entomological assessment Surveillance Treatment of cases Decentralisation of laboratory services at- PHC Establishment of drug distribution centres (DDC) and fever treatment depots (FTDs)

Control in AREAS WITH API < 2:

Focal spraying of insecticides Surveillance and treatment Follow up Epidemiological investigation

DRUG DISTRIBUTION CENTRE

Dispense anti malarial drugs

FEVER TREATMENT DEPOT

Collect blood slides

Distribute anti malarial drugs

MALARIA CONTROL STRATEGIES under NVBDCP

1.SURVEILLANCE AND CASE MANAGEMENT:
Case detection(passive and active)

Early diagnosis and complete treatment Sentinal surveillance

2.INTEGRATED VECTOR MANAGEMENT

Indoor residual sprays(IRS) Insecticide treated bed nets(ITBN) / Long lasting insecticidal

nets(LLINs)) Anti larval measures including source reduction

3.EPIDEMIC PREPAREDNESS AND EARLY RESPONSE 4.SUPPORTIVE INTERVENTION

Capacity building Behaviour change communication(bcc) Intersectoral collaboration Monitoring and evaluation Operational research and applied field research

SURVEILLANCE
AIM:
Case detection through lab services To provide facilities for proper treatment Active Types Passive

ACTIVE SURVEILLANCE Carried out by surveillance workers

PASSIVE SURVEILLANCE Search for cases by local health agencies Cases those escaped active surveillance are screened

Parameters of Malaria Surveillance

Annual parasites incidence(API)
API=confirm cases during year/population under surveillance*1000

Annual blood examination rate(ABER)/population

Number of slides examined*100

Annual falciparum incidence(API) Slide positivity rate(SPR) Slide falciparum rate(SFR)

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INTEGRATED VECTOR MANAGEMENT

The IVM includes safe use of insecticides and monitoring of insecticide resistance. The measures of vector control and protection include:

ANTI-LARVAL MEASURES
o Source reduction o chemical control o Biological control

ANTI -ADULT MEASURES

oResidual sprays oSpace sprays

GENETIC CONTROL PROTECTION AGAINST MOSQUITO BITES

oMosquito net oScreening oRepellents

Behaviour change communication (BCC)

BCC is a systematic process that motivates

individuals, families and communities to change their inappropriate or unhealthy behaviour. BCC is directed at:
Early recognition of signs and symptoms of malaria. Early treatment seeking from appropriate provider. Adherence to treatment regimens. Ensuring protection of children and pregnant ladies. Use of insecticide treated bed nets (ITNs). Acceptance of indoor residual sprays (IRS), etc.

INTENSIFIED MALARIA CONTROL PROJECT

Launched in july 2005 with assistance of global fund for AIDS,TB and malaria in NE states,Odisha,jharkhand and WB OBJECTIVES:
1-Increase access rapid diagnosis and treatment through community participation 2-Reduce transmission by use of insecticide treated bed nets and larvivorous fishes. 3-Enhance awareness about malaria control 4-To promote community, NGO and private sector participation

Thank YoU.

Thank You

Blood collected with sterile technique

Making the smears

Making of Thick smear

Thin and Thick smear

Appearance of Thick and Thin Smears

Specific antimalarial treatment of severe malaria

Severe malaria is an emergency and treatment should be given promptly. Parenteral artemisinin derivatives or quinine should be used irrespective of chloroquine sensitivity. Artesunate: 2.4 mg/kg body weight i.v. or i.m. given on admission (time=0), then at 12 hours and 24 hours, then once a day (Care should be taken to dilute artesunate powder in 5% Sodium bicarbonate provided in the pack).
Intravenous preparations should be preferred over intramuscular

preparations. Parenteral treatment should be given for minimum of 24 hours once started. In first trimester of pregnancy, parenteral quinine is the drug of choice.
Other drugs used are arteether ,

artemether, quinine ( along with

doxycycline/clindamycin)

chemoprophylaxis
Chemoprophylaxis is recommended travellers, migrant labourers and military personnel exposed to malaria in highly endemic areas. Use of personal protection measures like insecticide-treated bednets should be encouraged for pregnant women and other vulnerable populations.

PROGRAM EVALUATION
Internal assessments are conducted by central teams as well as by LQAS, periodically. External assessments are done through large sample surveys every 2-3 years and are conducted by NVBDCP / NIMR.

 The study in 10 randomly sampled high burden blocks

with API > 2 can be spread out over 80 villages to include 1600 households / fever cases. Such samples are adequate to detect differences of more than 10% across two surveys. The survey data will be examined along with other sources of information, including MIS and LQAS and planning data.

THANK YOU