Mosquito Breeding Habitats in SSP in Gujarat

Year

1965 28.99 99,667 29,576 29.67 73,504 29.24 26,163 30.891970 50.35 694,017 199,743 28.78 593,902 26.08 100,115 44.981975 50.01 5,166,142 1,843,681 35.68 4,436,891 29.70 729,251 72.091980 49.82 2,898,140 1,055,750 36.42 2,310,129 26.47 588,011 75.511985 49.86 1,864,380 940,788 50.46 1,319,375 39.11 545,005 77.941990 50.15 2,018,783 804,148 39.83 1,266,665 27.40 752,118 60.751995 48.47 2,296,008 1,465,078 50.06 1,503,877 37.25 792,131 70.24

2000 52.59 2,019,065 1,404,737 69.57 971,149 49.28 1,047,916 88.37

% NAMP population in BPL states

at risk of malaria

Relationship of Poverty with Malaria in the Indian States Below Poverty Line in 1999-2000

Total malaria cases

in India

Total malaria cases in BPL states

% Malaria cases in BPL states

Total P. vivax cases in India

% P. vivax cases in BPL states

Total P. falci-parum cases in India

% P.falci-parumcases

in BPL states

Malaria and Poverty

• Malaria-wheels within wheels

• Malaria- a development issue

• Malaria control should rely on poverty alleviation for human development, social security & sustainable environment

MALNAD REGION, INDIA

Dense Forests were replaced by coffee plantations. An. fluviatilis transmitted malaria disappeared. Malnad is healthy.

50,000 Sq Km Area

Malnad

Malaria epidemic in Punjab in 1908 caused 300,000 deaths in 20 million populations over a period of three years.

Malaria in Punjab flares up after July-August rains. The malaria mortality figures of Punjab from 1867-1943 revealed that in 77-years majority of malaria peaks were followed by 8-year cycle.

The relationship of rainfall with malaria was investigated and epidemic forecasting methods were developed in Punjab.

Irrigation changed the malaria epidemiology and the region was converted to endemic malaria.

MALARIA IN PUNJAB

Rice Cultivation and Malaria in Punjab

0

500000

1000000

1500000

2000000

2500000

1970

1974

1978

1982

1986

1990

1994

1998

2002

Rice in HectareMalaria cases

% Share of Cropped Area1970-73 7.6%1996-98 28.4%

Bioenvironmental Malaria control at the Indian Oils Ltd. Mathura, U.P.

1388

1004

320 313163

62 28

523

62 51 54 13 3 30

200

400

600

800

1000

1200

1400

1600

1800

2000

1996 1997 1998 1999 2000 2001 2002

Malaria casesPf cases

Bioenvironmental Malaria Control in BHEL and IDPL, Hardwar, Uttranchal

0

500

1000

1500

2000

2500

3000

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Malaria cases in BHEL

Malaria cases in IDPL

Malaria Outbreak in Bargi Dam area in Narayanganj PHC, M.P.

-5000

500100015002000250030003500400045005000

Malaria casesPf cases

Dam

Dam completed

Dam impounded

Malaria Control in Karnataka in Partnership with PHC System

• Major silk producing region. Farmers unwilling to allow the use of DDT

• High malaria incidence and deaths

• Major Breeding habitats of An. culicifacies– Wells: Species A (Vector Species)– Streams: Species B (Non-Vector Species)– All wells mapped and fishes released– Malaria cases declined sharply

Impact of Fishes on Malaria

0

200

400

600

800

1000

1200

1400

1600

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Gambusia (PHC Kamasamudram)

Population 38000 in 93 villages

Malaria cases

Malaria cases

0

500

1000

1500

2000

2500

3000

Malaria cases in BHEL

Malaria cases in IDPL

Rise of malaria in DDT sprayed villages. In 1998 fishes were released in problem villages.

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

DDT (PHC Gudibanda)

Population 52554 38 problem villages

Fishes released

Malaria Cases

Impact of SP spraying (1996-98) on Malaria. In 2002 fishes were released to control mosquitoes

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Four PHCs

Population in 4 PHCs 1.3 million

SP Spraying No SprayingFishes

Malaria cases

Year DDT sprayed in mt

against 200 mt% Coverage

Chloroquine Tablets in Lakhs

Total malaria cases

P. falciparum cases

1990       496 91

1991       949 281

1992 4.00 2.0 5.00 805 1961993 1.60 0.8 5.10 626 213

1994 4.90 3.0 5.40 1503 602

1995 2.30 1.0 6.20 1820 739

1996 7.40 3.5 7.70 2290 662

1997 9.90 5.0 9.80 5279 1764

1998 14.9 7.5 9.60 8872 3340

1999 10.2 5.0 13.88 14133 3919

2000 18.0 9.0 20.30 16764 7126

SITUATION ANALYSIS OF BETUL DISTRICT, MADHYA PRADESH

Bioenvironmental Control of Malaria in Betul District, Madhya Pradesh

Results of Monitoring Malaria Incidence in Betul District

02000400060008000

100001200014000160001800020000

Malaria cases

Pf cases

0

100

200

300

400

500

600

Malaria cases

Pf cases

Impact of Fishes on Malaria(Rise in 2000 was due to epidemic in adjacent villages)

Population 85672 in 160 villages

0

2000

4000

6000

8000

10000

12000

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

PHCs Banavara and Kanakatte

Malaria cases

Impact of Bioenvironmental Interventions in 100 million population in Maharashtra

204969

165985

137712

8140656043

3556819897

0

50000

100000

150000

200000

250000

1997 1998 1999 2000 2001 2002 2003

Interventions Started in 1997

Total Malaria Cases

P. falciparum Cases

Impact of Fishes on Malaria

0

200

400

600

800

1000

1200

1400

1600

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Gambusia (PHC Kamasamudram)

Population 38000 in 93 villages

Malaria cases

Malaria cases

Impact of Bioenvironmental Interventions in 100 million population in Maharashtra

204969

165985

137712

8140656043

3556819897

0

50000

100000

150000

200000

250000

1997 1998 1999 2000 2001 2002 2003

Interventions Started in 1997

Total Malaria Cases

P. falciparum Cases

Editorial  United against malaria  “WHO’s Global Malaria Eradication

Campaign achieved some notable successes but it also proved that, without a much more flexible and variable strategy combined with poverty reduction, self reliance and sound environmental management, the war against this disease could not be won.”

 Dr. Hiroshima Nakajima

Director General of WHO

World Health. 51st Year, No.3, May-June 1998

Dr. Halfdan Mahler, Former Director-General, World Health Organization who initiated the

imaginative Small Pox Eradication Programme said

“All countries benefit from the fruits of India’s TB research-all countries except India”

Health Catastrophe of 21stCentury- Future Impact of Malaria

Malaria problem will prove a great hindrance to socio-economic

development in the fields of health, education, land exploitation, mining, road

construction, agriculture, tourism et al. leading to greater poverty and under-

development

SHARPENED OLD TOOLS AND UTILIZATION OF NEW TOOLS AND STRATEGIES

WILL PRODUCE MORE FOCUSED AND SUSTAINABLE

MALARIA CONTROL

New Tools in Malaria Control• MALARIA DIAGNOSIS

• Dipstick/pLDH tests• TREATMENT

• Artemisinin & Drug Combination• ENVIRONMENT

• Health Impact Assessment• VECTOR CONTROL

• Situation specific based on stratification, An. Sibling species, Bioenvironmental Methods, Treated Bed Nets, Bacillus thuringiensis, Neem Based Repellents, Selective Spraying

POVERTY ALLEVIATION STRATEGIES WILL

REDUCE POPULATION AT THE RISK OF MALARIA

BETTER QUALITY AND COVERAGE OF HEALTH

SERVICES WILL ACHIEVE EFFECTIVE MANAGEMENT

OF MALARIA

DEFORESTATION WILL DISLODGE HIGHLY EFFICIENT

VECTORS OF MALARIA Example: Anopheles dirus

HEALTH IMPACT ASSESSMENT WILL BECOME MANDATORY

AND THIS WILL REDUCE RECEPTIVITY TO MALARIA

ENHANCED COMMUNITY AWARENESS WILL HELP IN MALARIA PREVENTION

AND EARLY CASE DETECTION AND PROMPT

TREATMENT

NEW DIAGNOSTICS, DRUGS, DRUG

COMBINATIONS WILL REDUCE MALARIA FROM

EVEN THE MOST DIFFICULT TERRAINS

ACKNOWLEDGEMENTS

Late Professor V.Ramalingaswami, FRSProfessor M.G.K. Menon, FRS

THE INDIAN COUNCIL OF MEDICAL RESEARCHTHE NATIONAL ANTI MALARIA PROGRAMME

HEALTH DEPARTMENTS OF THE STATE GOVERNMENTS

SCIENTISTS AND TECHNICAL STAFF OF THE MALARIA RESEARCH CENTRE

AND ITS FIELD STATIONS

NATIONAL AND INTERNATIONAL COLLABORATING INSTITUTIONS