GUIDELINES SUGGESTED FOR THE DEVELOPMENT OF INSTRUMENTS FOR USE IN ROLL BACK MALARIA FOR ADAPTATION AT COUNTRY LEVEL
Item
- Title
-
GUIDELINES SUGGESTED
FOR THE DEVELOPMENT OF
INSTRUMENTS FOR USE
IN
ROLL BACK MALARIA FOR ADAPTATION AT COUNTRY LEVEL - extracted text
-
a
(
(
f
(
t
GUIDELINES SUGGESTED
(
(
4
FOR THE DEVELOPMENT OF
INSTRUMENTS FOR USE
IN
ROLL BACK MALARIA
FOR ADAPTA TION A T COUNTR Y LE VEL
Postgraduate Institute of Medical Education and Research,
___________________ Chandigarh
______________
JAN 3-5,2000
A meeting to discuss the draft guidelines for the development of instruments for
use in Roll Back Malaria was held at Postgraduate Institute of Medical Education &
Research, Chandigarh from Jan 3-5, 2000. Experts working in the field were invited to
discuss the formulation of guidelines for Diagnosis, Treatment, Transmission and Control
of malaria.
Accordingly, members were requested to formulate groups for discussion on the
following topics
I.
Guidelines for simple ways to diagnose and treat malaria
2.
Inter programme linkage with safe motherhood and other programmes
3.
Home care through empowerment of women
4.
Personal protection against mosquito bites.
5.
Elimination of breeding places in and around houses.
6.
Roll back malaria: a component of healthy city/town/village
The guidelines suggested are submitted herewith for further consideration
(NANCY MAU.A)
Professor I lead
Dept of Parasitology,
PGIMl’R, Chandigarh
GUIDELINES FOR SIMPLE WAYS TO DIAGNOSE AND TREAT MALARIA
Convenor:
Prof. S.C. Varma
Cb-convenor:
Prof N. Mai la
Members:
Dr. V.P. Sharma
Dr. R.C. Mahajan
Mr. V.K Monga
Dr G.C Bansal
Dr. T. Adak
Prof. KM. Joshi
Dr M L. Dubey
Dr R Sehgal
Dr. Sunil Kaul
Dr. Archana Sud
What is malaria
Malaria is an illness with fever which if untreated can result in serious
complications & death It is caused by Plasmodium species. These parasites exist as four
species
P. vivax
P. falciparum
P. ovale
P. malariae
(Jf these first two species are the cause of malaria in the Indian subcontinent
3
P. falciparum infection can lead to serious illness with potentially fatal
complications. The other three usually result in uncomplicated febrile illness. The
parasite is transmitted by mosquito bite
There are approximately 300-500 million clinical cases of malaria per year in the
world. Transmission usually does not occur in areas 6000 feet above sea level In India
Pfalciparum infection is more common in northeastern states, Orissa and forested areas
P.vivax is more prevalent in peninsular India. The infection may occur more commonly
during or after the rainy season in the tropics. Pattern of drug sensitivity to chloroquine
varies in different regions. In India the highest levels of resistance to chloroquine are seen
in northeastern states, Orissa, Gujarat and some parts of Rajasthan. Resistance to
sulphadoxine-pyrimethamine combination has surfaced in the northeastern states. (Map
of India indicating resistance in SE Asia- enclosed Annexure I)).
How to recognise malaria
Every case of fever in endemic areas or in people with history of travel to high
endemicity area in the past four weeks should be considered to be due to malaria
unless proved otherwise.
Other prevalent infections that may cause fever in an area must also be known and
kept in mind
Classically a prodrome consisting of headache, myalgias, malaise and nausea
occur before the first episode of fever.
Typical fever of malaria occurs in cycles occurring on alternate days (every 48
hours). The fever occurs with chills, rigors and ends with profuse sweating.
4
P.malariae fever recurs every fourth day (every 72 hours). However, this classical
pattern is not seen in all cases, particularly so in P.falciparum malaria.
Atypical symptoms like abdominal pain, vomiting & dry cough may be present in
some patients. Particularly in children there is no classical pattern of fever
regardless of the infecting species
Low blood sugar is an important problem in children and pregnant women with
malaria particularly when being treated with quinine Patients may develop
profuse sweating or change in consciousness due to low blood sugars alone
When to seek medical attention
Certain situations indicate possibility of severe disease Patient should be referred
to a health care centre in the following situations
Pregnant women and children
Persistent and/or very high fever
Restlessness
Refusal to feed in children
Pallor
Jaundice
Change in level of consciousness (cerebral malaria, hypoglycemia)
Convulsions
Increase in respiratory rate
Cold & clammy skin
Bleeding from any site.
Black or brown discolouration of urine (cola coloured urine)
5
Fall in quantity of urine
Failure to respond to available anti malarial treatment
Laboratory Diagnosis
Whenever possible, a blood smear should be collected for identification of
malarial parasite before starting treatment. Species identification should be done
as far as possible. Report should be available in 24 hours. Where available,
dipstick test for identification of Pfalciparum antigen must be carried out in case
a patient is becoming serious and blood smear is negative or is not available.
In high risk areas, facility for dipstick test for P.falciparum should be provided at
the fever treatment depots (FTD) for early diagnosis. In case of limited
availability of these kits, priority should be given to children and pregnant
women.
Effort should be made to train some responsible community members to diagnose
P.falciparum by the dipstick method
Where facilities are available patient or a blood sample should be taken to a
primary health centre for laboratory confirmation of diagnosis In other cases
presumptive diagnosis should be made and treatment be given
In case typical attacks of fever are seen, the diagnosis should be taken as malaria
and complete treatment given
6
How to manage malaria
Home care
Fever should be brought down as quickly as possible with tepid water sponging
Paracetamol 500mg to Igm for adults and lOmg/kg per dose for children may be
used in patients with very high fever and failure of physical means.
Patient should be given plenty of fluids.
Glucose or sugar solutions must be given, particularly to children and pregnant
women.
Community level
If a presumptive diagnosis of malaria is made then the local fever treatment depot
should be contacted and patient treated with chloroquine.
Treatment policies will largely depend on the local endemicity of parasite and
sensitivity pattern. Drug policies already laid out by the malaria control guidelines
of individual countries should be followed.
There is no benefit of giving Primaquine to all patients in hyper-endemic areas
given the risk of haemolysis in G6PD deficient individuals.
It is to be noted that chloroquine and quinine can safely be given during
pregnancy including the first trimester. However, quinine infusion should be in
dextrose solution to avoid hypoglycemia.
Primaquine should not be given during pregnancy and in infants.
Sulpha-pyrimethamine combination can be given after the first trimester up to one
month prior to delivery
7
Sign of serious illness should be actively looked for and the patient referred to a
primary health centre as per indications mentioned above
Administrative level
There should be a functional drug distribution centre (DDC) or fever treatment
depot (FTD) in each village and urban slum
Timely replenishment of antimalarials should be made to DDC/FTD
Paediatric chloroquine formulations should be available
Local patterns of daig resistance should be known.
Chemoprophylaxis
Should be offered as per national guidelines to:
All travelers from non-endemic to endemic areas.
Pregnant women in endemic areas.
8
INTER PROGRAMME LINKAGES WITH SAFE MOTHERHOOD
AND OTHER PROGRAMMES
Convener:
Prof. Rajesh Kumar
Members:
Dr. S.K. Ghosh
Dr. Ashwani Kumar
Dr. R. Abel
Malaria is one of the diseases that affect motherhood both directly and indirectly
Malaria by itself can produce anemia and sometime maternal mortality. Besides, deaths
due to malaria among children cause insecurity in the family, thereby denying family
planning. Integrating both programmes would increase programme effectiveness and
efficiency.
Malaria in pregnancy as part of Reproductive and Child Health (RCH)
Malaria in pregnancy should be included as part of the RCH. This should be
incorporated into the syllabus with specific emphasis on the treatment schedule and
prophylaxis. RCH programme should also invest in malaria control through purchase of
antimalarial drugs in emergency situations. Treatment of pregnant women and children
should follow the national drug policy on malaria. No other drugs or systems should be
used when malaria has been diagnosed
Malaria as a part of Integrated Management of Childhood Illness (IMCI)
As is done in African countries malaria among children should be incorporated as
one of the diseases under the IMCI programme This will ensure that medical
practitioners develop the skills for diagnosing and treating children with malaria and in
managing complications
9
Link up with Integrated Child Development Services (ICDS) project
Since ICDS is a nationwide project malaria control especially among pregnant
women and children can be brought under the ICDS programe Anganwadi workers may
be trained to identify and refer pregnant women and children presenting with signs and
symptoms suggestive of malaria to facilitate early diagnosis & treatment They may also
be trained to provide presumptive and complete treatment, prevention of man- mosquito
contact through bed nets, elimination of breeding site etc A periodic review & ret-raining
should be undertaken.
Health Workers involved in Malaria
Since Female Health Workers (FMPHW) and ANMs are directly responsible for
pregnancy care and childhood illnesses, they should be trained fully on the management
of malaria. Since this is a centrally funded programme all posts are likely to be filled up
which would ensure complete coverage.
Training of local care givers
There are a variety of categories of personnel in the community who could be
trained for malaria treatment. These could include:
Teachers
Pharmacists
Forest guards
Post masters
PDS-shop keepers
Religious leaders
Traditional/Local practitioners
10
Panchayat leaders
Malaria link volunteers
Fever Treatment Depots (FTD)/ Drug Distribution Centre (DDC) personnel
They should be trained to suspect malaria early among those with fever. If presumptive
treatment is started then they should ensure complete course of treatment One full course
of drugs may be provided in one strip. In case of severe illness with loss of sensorium and
or loss of consciousness they should refer them to pre determined referral centres If Dais
are trained they should be taught to suspect malaria and refer They should remove
misconceptions surrounding malaria
Project/Construction related malaria
Major projects and construction works are providing migrant labour with gainful
employment. In addition, seasonal agriculture work also supports migrant labour. These
categories of persons should be identified as high risk groups for malaria.
If such a group (including their family members) is more than 3000 strong, the
health department should post one ANM or Female Health workei exclusively foi this
population. Alternatively the project management itself can employ an ANM or FMPHW
to handle both reproductive health needs as well as needs of malaria. If the population is
smaller and scattered over a larger area then the individual health worker should give
priority to migrant labour as high risk groups.
The managers and supervisors of these projects should be educated about the
problem of malaria, how it can be handled and the available resources from the
government. In this way the management may be encouraged to take interest in the
11
welfare of the migrant labour and provide support for safe motherhood and malaria
control among the labour
Other special situations that need support are
A
border malaria
interstate
state-international
B
infrastructure for urban slums
C
stone quarries
D
brick kilns
E
road constructions
F
building constructions
G
dams
H
industrial constructions
Special efforts must be made to plan locally for each of these situations for malaria
control.
Personal Protection
When personal protection measures such as nets are promoted in the community
then the community should be encouraged to give priority to pregnant and lactating
women first, followed by children in ascending order of age and linally other adult and
male members.
Dais and health workers could promote the social marketing of nets and other
preventive measures. All individuals may be encouraged to pay some money to give
value to the net. Malaria control should be a part of the work of all health workers
12
especially because of problems associated with pregnancy and childhood Dais and
MPHWs can provide IEC on personal protection. In general the people have a desire for
protection from mosquito bite.
Malnutrition and Malaria
Anemia is the most common malnutrition problem associated with malaria. The
anemia may be present prior to malaria, or this may be exacerbated by malaria or malaria
itself can cause anemia. In all such situations emphasis should be on simultaneous
treatment of malaria and anemia.
Guidelines on Integration by District Leadership
Since malaria control requires integration of different sectors within and outside
health, for effectiveness at the District level only the Collector, Magistrate or
Commissioner can bring about this integration. The following are some suggested
guidelines which may help the leadership.
The malaria situation should be reviewed periodically as part of the overall review
of the district activities. Emphasis could be made prior to, during and after the
transmission season.
Review the situation of malaria at the district level with focus on pregnant
women, children, complicated cases, deaths, types of malaria, pattern of utilization of
drugs etc. Information should be obtained from Govt, hospitals/dispensaries, private
practitioners and medical institutions. This should be a two way process. The malaria
staff may proactively involve individuals in providing the information. Instead of
passively waiting for information, different approaches may be used to obtain the
information. Feed back should be provided by malaria staff on action taken
Different
13
individuals involved with sources of malaria information may be invited for the review
meeting.
Identify available resources within various sectors at the district level which can
contribute to malaria control as necessary.
■ In one of the Districts of Himachal Pradesh, two departmental heads were blaming
each other for acute diarrhoea and deaths. A new collector made both parties sit
together, identified the needs of both The collector was able to identify resources in
another department for needed repairs & maintenance as well as resources for I EC in
the education department. By pooling the available resources the problem was
The collector should insist upon the Assessment of impact on Environment of all
major projects undertaken in the district and ensure necessary modification in design
Integrate malaria control with other ongoing programmes like Pulse Polio
Immunization, RCH, ICDS etc.
Review staffing positions, filling up essential vacant positions or make alternate
arrangements
Review training programmes conducted for malaria control
Malaria epidemics could be cyclical and can occur even in non tribal areas.
Epidemic warning signs and preparedness for epidemic should be reviewed especially
prior to the transmission season
Promote better inter departmental coordination
The following programes/institutions may be also involved
DWCRA/Sclf Help Group
Labour Welfare Board
14
Tribal Welfare
Island authorities
Women welfare
Swastha Karimi scheme
PM’RY - to include folk artists as an economic activity
Social Forestry
Mahila Samaj/Mandals in rural areas and Women clubs/Kitty’s in urban areas
Integration of malaria with safe motherhood would go a long way to help the poor
and the marginalised. Insurance schemes may be considered for malaria especially for
poorer sections. This should include malaria referrals, including transportation and
deaths. While malaria is predominantly a problem of the poor, failure to make early
diagnosis and start early treatment could seriously affect any section as witnessed with
the death of an IAS officer, whose wife was a doctor but still he died due to delay in
suspecting malaria
At the state level the Chief Secretary may coordinate the interdepartmental
activities.
The Health Secretary will coordinate all programes within the health department
Wherever the Zilla Parishad system operates effectively, the Zilla Parishad /
Panchayat President/Chairman may review, monitor, and coordinate various sectors for
effective operation
15
HOME CARE THROUGH EMPOWERMENT OF WOMEN
Convenor:
Prof. Indu Gupta
Members
Mr. V.K. Khosla
Mr. H.C. Gera
Dr. Neeru Singh
Dr Neena Valecha
Dr B.N. Nagpal
Prof. Lata Kumar
Dr. N.L. Kalra
HOME CARE THROUGH EMPOWERMENT OF WOMEN
Empowerment of women in countries where status of women is still low (lack of
literacy, lack of authority etc.) goes a long way in giving them stature and confidence in
dealing with various aspects of life
It is in this context that we consider empowerment of women is important in
being a partner in management of health care at home and making decisions in health
matters, because she is pivot of caring for all the members of the family Home care
through empowerment of women precisely means providing wider knowledge to women
on matters of health and disease including ability to make decisions which are respected
and accepted by the family and the community. This impacts directly on early diagnosis
and prompt treatment. Basically empowerment of women means
(i)
Creating awareness among women through basic knowledge for prevention of
Malaria and other common diseases.
16
(ii)
Providing adequate information for identifying the seriousness of the problem and
adopting simple methods to undertake Home Care within the family.
Before the women are empowered it is quite necessary to identify the different
ways through which the concept of home care can be introduced Depending upon
the physio-demographic area, the women groups can be divided into different
settings.
1.
Rural
2.
Urban slums
3.
Labour colonies
4.
Urban areas
Rural
In the rural areas the women can be empowered through women members of the
Panchayats or local bodies. The other spheres which hold significance in empowering
women are as under:
Women organisation
Mahila Mandals
Anganwadi
Religion places/social gathering
Weakly markets
Street plays/puppet shows/other source of entertainment
Besides this, a special health concious group can be identified This group will
include female members from Teachers, Panchayat member. Bank employees and
women working in Post offices.
17
The women in the urban slums can be imparted knowledge through
NGO/voluntary organisations and cooperative societies
The women in the urban areas can be empowered through
Welfare Associations
Women development Council
Women Clubs/Kitty
Voluntary Organisations involving women
Red Cross, Lions club
Army Wives Welfare Association
Police Wives Welfare Association
The members of these organisations are to be trained by imparting knowledge regarding
Home care of Malaria who in-tum will train women at home. Their training shall include
the following thrust areas
1.
Health education and awareness about malarial disease.
2.
Cleanliness in and around the house including water management and disposal.
3.
Other preventive measures eg. use of bed-nets, mosquito proofing etc.
4
Knowledge and awareness about existing local health infrastructure.
HOME CARE PACKAGE
1.
Fever as a symptom to be taken seriously and presumptive treatment for malaria
to be giver} preferably after taking smear for malarial parasite
2.
Symptomatic treatment like sponging, plenty of fluids, antipyretics
Identification of problem/complication e g drowsiness, vomiting, low urine out
put, convulsions which need immediate referral
is
4.
Pregnant women/infants & children with fever to be dealt with as emergency and
full treatment to be given depending on diagnosis
5.
Chemo-prophylaxis for pregnant women especially in high endemic areas
6.
Village level volunteer women health worker. (To be trained as per UNICEF
module)
Recognition of women in the society
After women receive the training, the N G O s/ voluntary organisations/ Local
bodies/ Panchayat should in some way honour these women so that their services are
recognised which ultimately becomes an incentive for involvement of more women
19
PERSONAL PROTECTION AGAINST MOSQUITO BITES
Convenor:
Dr. T. Adak
Members:
Dr. Neeru Singh
Dr. B.N. Nagpal
Dr. Sunil Kaul
Dr. R. Sehgal
Dr. Ashwani Kumar
Mr. V K Monga
Dr N L Kalra
PREAMBLE
Prevention of malaria and other mosquito-borne diseases by reducing man
mosquito contact by rendering residential premises mosquito proof and through personal
protection measures is a time tested community based approach
However with the advent of DDT in the Public Health Programme, the use of erstwhile
technologies/ knowledge including personal protection measures lost its significance
In the pre DDT era, various methods utilized for personal protection were as follows
1
Use of smoke
2.
Mosquito Net
3.
Mosquito Proofing of the houses
4.
Use of various types of oils
5.
Use of protective clothing etc.
20
Currently a few more options have become available such as
1.
Allethrin based mats
2.
Mosquito coils
3.
Mosquito repellent creams/lotions
4.
Vaporisers for mosquito repellency
5.
Electrical Gadgets
6
Light traps
7.
Ultra sonic devices
8.
Insecticide treated bed nets/curtains
From a review of the currently available methods of personal protection, it has
been observed that mode of action of the most of the available repellents are chemical
based which in spite of safety limits, due to their prolonged use affect the community in
more than one ways. Repellents used for external usage result in development of rash and
other manifestations, those inducing inhalation promote acute respiratory problems
Therefore herbal based compounds viz Neem based products like lotions, cream, mats
agarbattis (Joss sticks) are considered safe
Similarly, mosquito proofing of houses is more cost effective and sustainable
However, where this is not feasible or practical, use of insecticides treated nets (I fN)
have definite advantage because treated nets not only protect the users but also offer
some degree of protection to non-users
On the basis of experience so far gained, the above mentioned measures have
been found suitable for rural, urban and semi urban areas and forest areas
21
)
k
DO'
1
Insecticide Treated Nets/curtains
From the experience gained in the usage of ITN it has been observed that to
optimize the use of net the following basic information is essential
1.
Mosquito biting time and site of contact.
2.
Sleeping habits/socio-behavioural practices of the communities to be protected.
It may be mentioned that none of these measures can provide absolute protection
against mosquito bites and the diseases transmitted by them.
Operational aspects including delivery and cost sharing and social marketing of
these measures for different ecological settings are shown in the table (Table 1).
Operationalization of use of repellents/ITN programme in different settings
The strategy for the sustainability of these methods at the community level is as
follows:
1.
The Programme Manager at the District Level will be overall incharge working
under the preview and guidelines of District Malaria Society.
2.
His/her responsibility will include the procurement, distribution, providing back
up support and coordination of the IEC and other promotional activities through
Media, Education, local self Govt. Institutions, NGOs, etc.
3.
It is recommended that the money received from the sale of the subsidized items
such as nets will be handled by the Malaria Society
4.
The monitoring mechanism should be developed according to local situation for
which a committee could be set up taking representatives from the community
and Malaria Society
22
5.
It is recommended that an annua] evaluation of the programme may be conducted
by a small committee with representatives of Malaria Control programme.
community, NGOs, local self Govt and experts wit h social science background
6.
It is recommended that during distribution and use of mosquito nets the priority
should be given to the pregnant women, infants and children The significance of
protecting this vulnerable group should be highlighted through mass media and
TEC activities.
7.
Natural herbal repellents like Neem oil, Citronella oil, Eucalyptus oil, etc could
be encouraged in the programme These products are under free sale in the
market. Availability of these products should be ensured at all times.
Precautions in promotion and use
1.
While providing and promoting products using synthetic pyrethroides the
community should be made aware of their possible side effects to the users.
2.
Some electrical gadgets and acaustic devices presently being marketed as
mosquito repellents have been found to be of doubtful efficacy and hazardous
community should be made aware about them through mass media. They may be
encouraged to take up the matter with Consumer Redressal Forum. The false
claim of the companies could be brought to the notice of Registering or other
appropriate authority.
R & D ISSUES
1.
The socio-economic and socio-cultural factors affecting the use and acceptability
of various personal protection measures need to be studied by social scientists
with the help of vector control specialists.
23
2.'
To evaluate the efficacy and safety for long term use of mosquito repellent
devices, scientific studies need to be conducted and the results of these should be
made available to the users.
3.
Operational research should be the necessary component of the personal
protection activities of the RBM
A list of various options available for personal protection and their safety is given in table
2.
24
ELIMINATION OF BREEDING PLACES IN AND AROUND HOUSES
Convenor:
Dr S.K. Ghosh
Co-convenor: Mr. V.K. Khosla
Members:
Dr. R. Abel
Dr. N. Valecha
Dr. M L. Dubey
Dr. H.S. Bhatti
Prof. R.M. Joshi
Preamble:
Mosquito can be effectively controlled by eliminating breeding habitats as much
as possible There is a great role for the people residing in and outside the houses For
this, active participation of community is necessary
The possible breeding grounds (indoor and outdoor) and actions required to
eliminate mosquito breeding are shown in table 3
25
ROLL BACK MALARIA : A COMPONENT OF
HEALTHY CITY / TOWN / VILLAGE
Chairperson: Prof. Lata Kumar
Convener:
Prof Rajesh Kumar
Members:
Prof. Indu Gupta
Prof. Subash Verma
Dr. G.C. Bansal
Dr. Vikas Bhatia
Dr. Archana Sood
Mr H.C Gera
A large number of malaria cases are being reported from urban and rural parts of
the affected countries. Though a malaria control organisation has been established in
towns and cities having population of more than 40,000 in India,the infrastructure has not
kept pace with the urban growth particularly in the urban slums. Therefore, control of
malaria should be included as an important component of “Healthy city/town and village”
project of WHO.
The concept of “Healthy city/town/village” includes provision of basic amenities.
adequate supply of water, proper disposal of solid wastes and excreta In addition, system
to collect information on all communicable diseases including malaria, establishment of
disease prevention units, rehabilitation of slum-dwellers into resettlement colonies also
contribute significantly to the development of healthy cities, towns and villages
Though a large number of mosquitogenic conditions exist in cities, towns and
villages, the following conditions should be taken care on priority in developing “healthy
26
cities/towns/villages ” project. (Refer to table for action needed and agencies to be
involved)
1,
Improper open drainage system.
2..
Indiscriminate throwing and collection of solid waste at dumping sites
3.
Water collection around water supply system due to missing laps and leaking and
broken pipes
4.
Choked nullah/storm drains.
5.
Water storage for construction purpose.
6.
Ponds, tanks and wells.
7.
Inadequate sewerage disposal and treatment.
8.
Water collection in containers, plastic items, tyres, coconut shells, discarded
materials etc.
9.
Storage of water for animals.
10.
Ditches on both sides of roads and rail tracks.
II.
Ornamental water collection in gardens.
12.
Tree cavities and grooves.
13.
Man-holes and vent pipes.
14.
Lack of community awareness of above factors and conditions.
Agencies and Partners
In order to tackle these problems, there is need to build up partnership with
private agencies, industries (CII), non-government organisations and community self
help groups and community based organisations under the leadership of local body, e g
panchayats, municipal committees etc
27
Malaria control organisation should have active liasion with local authorities eg
Municipal Corporations, public health engineering deptt., PWD, Irrigation etc
Strengthening of Inter-sectoral coordination is utmost important to combat mosquitogenic
conditions in urban and rural areas.
Legislative measures
Building bye-laws should be implemented. Some simple technologies like using
scrubber for vent pipes, locking of manhole covers and overhead tanks etc are to be
identified and implemented.
MONITORING OF HEALTHY CITY/V1LLAGE
Competition between mohalla & lanes of villages & towns and cities having most
sanitary and healthy conditions could be a good method to improve malaria control
Organisations maintaining and involved in the sanitary and environmental upgradation programme should be rewarded and recognised
The healthy citytown/village should achieve decline in malaria cases as one of the
parameters of success. Cities/villages should be given incentives for achieving malaria
control. More stress should be given on environmental management rather than on use of
synthetic insecticides. Activities of NGO’s, social groups should also be monitored and
their credibility assessed It must be ensured that 2-3% of the budget on construction
should be spent on preventive anti-malaria activities and while choosing site for house
construction, areas with less mosquitogenic potential should be selected.
India has more than 3000 towns having population of more than 5000, but no
anti-malaria programme has been developed for these areas In absence of proper
planning of a national programme, the gains in malaria control will not be possible.
28
The concept of “biovillages” being promoted will not be a viable without
including a health component particularly for prevention of malaria
Malaria control through environmental & engineering methods should be an
important part of Engineering and architect courses so that the design of buildings, roads
etc. does not lead to malariogenic conditions. (Table 4)
29
A
>
( JAMMU 8 KASHMIR
n
INDIA
)
STATUS OF P. FALCIPARUM RESISTANCE TC
CHLOROQUINE (1978-1992) DISTRICT WISE
I
1984
HIMACHAL
PRADESH
< 1984
PUNjAa
•>
Chandigarh
ARUNACHAL
PRADESH
HARYANA
1980-1935 /----
-ch
SIKKIM
NEPAL
1973-1932
I / Bhuja**
Rajasthan
1 979-1 930
NAGALAND
0
y
BURMA
MEGHALAYA
MANIPUR
GUJ
MiZORAM
0
/ HBr
i
7 J 1979
piu
AMAN
O
MAHARASHTRA
o
o
BANGLADESH
1978
OF
1979
0
BENGAL
ANTDHRA^
PRADESH
o
yaaian
GOA
karnatakaVt
Lo°
'kerala
O
1931
TA^IL
NADU'
o
O
ANDAMAZJ & NICOBAR '<?
/ PONDICHERRY
KARA1KAL
Q
O RJ & RJ| LEVEL RESISTANCE
RIH LEVEL RESISTANCE
V LIQUIDATED Rill LEVEL
Resistance
30
Table 1
Operational Areas
Cost sharing/social marketing
Promotional strategy
Delivery
outlets/
system
Ethnic Tribes
Differential subsidy to promote
equity
I EC (Tribal welfare/
Develop Authority)
Tribal Councils
Panchayat, Dept
of Forest,NGOs
Non-Tnbal Rural
Areas
-do-
I EC, Health Camps, Exhibi
tions, Media (Indoor and OutDoor Programme) School
Health Education, Religious
gatherings, NGOs
Panchayat (Loca
self Govt. )/FTD
DDC, PDS,
Sanitary Mart/
Unit, PHC,
Anganwadi,
NGOs
Urban population
Social Marketing
TEC, Media, Interpersonal
Contacts, School Education,
Exhibitions, Cable TV Spots,
Cinema slides, NGOs
Semi-urban areas and
Labour Hutments/
Slums
Social Marketing/Differential
Subsidy to promote equity
-do-
Social Marketing
Govt, should
exempt sales tax
on the sale of ne
as incentive for
Promotion of its
Use
Slum developMent Authority,
PDS, Welfare
Organisations,
NGOs
Development
Projects
Mandatory provision of supply of
curtains/nets to migrant labour
State legislation through
Ministry of Labour/Health
Employers
Social/Religious
Gathering/Fares
Cream, Lotions, Nets
Religious preaching,
condition for permission to
hold such gatherings by
local self Govt when
applicable
Local Self
Govt./
Organisers
■ 3^
31
0608S
-----
■ A 00OCC1
.
Table 2: Various options for personal protection and their likely side-effects.
Personal Protection
Options
Active Ingradient/
Principal
Likely side effects
Allethrin Based Mats
Synthetic pyrethroids
Respiratory / eye problem
including astlima, itching.
Headache, Rashes,etc
Mosquito coils
Herbal/Synthetic
Pyrethroids
-do-
Mosquito repellent
creams
Herbal/chemical
Skin irritation or rashes
Vaporisers
Synthetic Pyrethroids
Respiratory disorder,
escalation of eyes, itching
headache, rashes
Electrical Gadgets
(Electrocuters)
Electrocution
Nil
Ultrasonic devices
Sound waves
Headache and hearing
impairment
Light Traps
Light attraction
Nil
Insecticide Treated
Nets
Synthetic pyrethroides
Insecticide Treated
Curtains
-do-
-do
Mechanical Barrier/
Nil
Mosquito proofing/
Window screening
EFFC
Neem oil
Natural compounds
Lotions (DEET, DMP) Chemical
Skin irritation
Nil
Skin irritation
Euclyptus oil
Natural oils
Nil
Citronella oil
-do-(saturated oil)
Nil
Protective clothing
Mechanical Barrier
Nil
Note:Effective protection by these repellent except treated mosquito net/curtain and house
proofing varies from 1-4 hours in the field in different seasons. The effectiveness also varies
against different mosquito species. All the repellents are more effective against Anopheles
(Malaria vectors) than culex (filaria and J.E. Mosquitoes) and Aedes (Dengue vector).
32
Table 3
Type of Breeding
Habitat
Action required
Type of mosquitoes breed
Cemented/Earthen pots/
Cistern
-Empty out the water once
in 7 days
-Cover with wire mesh/
cloth when not in use
- Use tight fitting lids
Mainly Anophles, Culex
and Aedes
Flower vases/excess water
collection on flower pots
-Change/empty out the
water once in 7 days
Aedes
Cooler/Air conditioners
-Change the water once in
7 days
-Observe a dry day in
a week (scrub dry)
Aedes, Culex and Anopheles
Water meter chamber
-Proper sealing
-Leak proofing
-do-
In-use wells
-use larvivorous fishes
-Cover when not in use or
screen with net
Anopheles and Culex
-Unused wells
-Hermetical sealing
-Use EPS beads
-Use crude oil
-Use Larvivorous fish
Mainly Culex
Wells
Overhead Tanks (OUT)
-Use mosquito proof tanks Mainly Anopheles
-Hermetical sealing/tight lids
-Make OHT accessible
for inspection
-Demolish the discarded one
completely
Underground Tanks/Sumps
-Cover the lid tightly
-Use larvivorous fish
Anopheles and Culex
33
Tap pits
-Should be discouraged as
-dofar as possible
-Make a small hole at bottom
to drain out
-Avoid leaking taps
-Use biolarvicides
Cess pits/pools
-make soakage pits
mainly Culex
-periodical draining/channelize
them to one major pool for
better management
-Use larvicides like Fenthion
-Recycle the water for kitchen
garden
-Cleaning of edges
House Drain
-Regular cleaning
-Making soakage pits
-do-
Unused tyres/discarded
tins/bottles/solid wastes
-Store the tyre under a
shade
-Destroy all discarded
bottles/tins etc.
Mainiy Aedes
Coconut shells
-All the coconut shells
should cut into four
quarters
-do-
Septic tanks
-Cover vent pipes with
mosquito nets or put
plastic scrubber to cap
-Cement sealing/plastering
the cracks and crevices
Mainly in Annigeres
Water collection on
Sun shades/window shades
-Drain out the water mainly Mainly Anopheles
in rainy season
It is important to have effective IEC programmes to motivate/mobilize the
community to be aware and take part in controlling the mosquito breeding.
34
TABLE 4
Healthy cities/towns-villages : Mosquitogenic conditions. Actions needed and
Agencies Involved
Action required
*Drainage system
Municipal corporation
- covered drainage
system with gradient
Local bodies
-Soakage pits, in villages &
slums
*Solid waste dumping
Partners
Responsible agency
Mosquitogenic conditions
Community
participation
for soakage
pits
Big cities:conversion of
1Municipal Corp
garbage to manure &
garbage to power
Small cities/towns: cover
by thick layer of earth
Industrial wastes management
Cll/Industries
cc
* Water leakage/collection
from supply system
Maintenance of supply
system
. Taps in place
*Choked nullah/storm
drains with stagnant water
.deweeding, de-silting
to make them operational
Public works
Department (PWD)
* Wat er storage and
collection at construction
sites
Treatment of water with
Larvicides
.Filling up of ditches
after completion of
construction
Effective application and
implementation of building
bye-laws/mosquito control
bye-laws
Municipal Corporation
Larvicides provision
by Malaria deptt.
*Ponds,tanks and
wells
In the ponds use bio-larvicide
and on wells, use mosquito
proofing by wire-gauze
*Sewerage disposal and
treatment
System should be
operational and functional
Facility expansion vis-avis population growth
.Monitoring by
local persons/
Organisations
Contractors/
Builders/
owners of
sites
PWD
Community
volunteers
Public health
engineering
35
*Discarded materials
including tyres
Facilities for adequate
disposal of discarded
and waste materials
Individual
responsibility
*Storage of water for
animals
cleaned regularly
-dovillage
panchayat,
NGOs
*Ditches on both sides
of roads and rail tracks
Earth-levelling/
connecting with natural
drainage system or use
larvicide
*Ornamental water
collection/Flower pots
Biological control
(eg. Fish release)
*Tree cavities/grooves
Treated during rainy
and post-rainy season
Making holes at the base
of tree cavity/Filling with
sand
Public health
Engineering
Institutional
and Individual
responsibility
Malaria deptt
Horticulture
deptt.
*Man-holes and
vent-pipes
Man hole-covers in
place preferably cementmade (no monetary gain
for theft)
wire-meshing (mosquito
proofing) with size of
hole less than 1.5 mm
Municipal Corp
* Awareness of
community
Strengthening of IEC
activities using
audio-visual Aids
IEC cell of health
deptt.
NGO’ local
agencies
Social groups
Mass media
School
teachers and
students
36
LIST OF PARTICIPANTS
1. Dr. V.P. Shanna
D-l/55 Satyamarg
Chanakyapuri,
New Delhi-21
2. Dr. R.C. Mahajan
Emeritus Medical Scientist
Adviser 1CMR,
Secretary INSA, New Delhi
Dept, of Parasitology
PGIMER, Chandigarh
3. Dr. N.L. Kalra
Consultant
Malaria Research Centre, New Delhi
A-38, Swasthya Vihar,
Delhi - I 10092
4. Dr. Neeru Singh
Deputy Director
Malaria Research Centre (Field
Station) Medical College Building
Jabalpur - 482003
5. Dr. T. Adak
Assistant Director
Malaria Research Centre
22, Sham Nath Marg,
New Delhi - 110005
6. Dr. Neena Valecha
Assistant Director,
Malaria Research Centre
22, Sham Nath Marg,
New Delhi - I 10005
7. Dr. S.K. Ghosh
Officer Incharge Malaria Research
Centre
Epidemic Diseases Hospital Complex
Old Madras Road
Bangalore - 560038
8. Dr. Ashwani Kumar
Officer Incharge
Malaria Research Centre, Field Station
Directorate of Health Services
Building
Campal, Panaji, Goa 403001
9. Dr. B.N. Nagpal
Senior Research Officer,
Malaria Research Centre,
22, Madhuban Vikas Marg,
Delhi 110092
10.Dr. Sunil Kaul
Iv ,
ML
Uy
( kflvA/"
II (r-o'j (
11 .Dr. R. Abel
Physician C^S>t'-Gy'
RUMSA(^UjM
12.Mr. V.K. Khosla
Deputy Director, Malaria, Haryana,
SCO 51-52, Sector 17A
Near Jagat theatre, Chandigarh
13.Dr. G.C. Bansal
Asstt. Director
Add Delux Building, IV Floor,
Sector 9, Chandigarh
14.Dr V.K. Monga
State Entomologist Punjab,
Parivar Kalyan Bhawan,
Room No. 502,Sector 34A,
Chandigarh
15.Shn H.C. Gera
Anti Malaria Officer,
Add Delux Building, IV Floor,
Sector 9, Chandigarh
37
16.Dr. Indu Gupta
Prof. Dept, of Obst. & Gynae.
PGIMER,
Chandigarh
21 Dr. Vikas Bhatia
Reader,
Dept, of Community Medicine
Govt. Medical College,
Sector 32, Chandigarh
17.Dr. Lata Kumar
Prof. & Head
Dept, of Paediatrics
PGIMER, Chandigarh
22.Dr. Nancy Malla
Prof. & Head
Dept, of Parasitology
PGIMER, Chandigarh
18. Dr. R.M Joshi,
Prof. & Head
Dept, of Microbiology,
Govt. Medical College,
Sector 32,
Chandigarh
23.Dr. M.L. Dubey
Addl. Prof.
Dept, of Parasitology
PGIMER, Chandigarh
19.Dr. Subash Verma,
Prof. & Head
Dept, of Internal Medicine
PGIMER, Chandigarh
20.Dr. Rajesh Kumar
Prof. & Head
Dept, of Community Medicine
PGIMER, Chandigarh
24.Dr. R Sehgal
Addl. Prof.
Dept, of Parasitology
PGIMER, Chandigarh
25.Dr. Archna Sud
Assistant Professor
Dept, of Internal Medicine
PGIMER, Chandigarh
26.Dr. H.S. Bhatti
Lecturer
Dept, of Parasitology
PGIMER, Chandigarh
38
- Media
6089.pdf
Position: 2824 (3 views)