7191.pdf
Media
- extracted text
-
Situational Analysis ofMalaria j
in
District Tumkur, Karnataka,
under
Roll Back Malaria Initiative
I
■
Malaria Research Centre
(Indian Council of Medical Research)
22, Sham Nath Marg, Delhi-11005
\
r/
-
r \■
\ '
*^wrr' \ i
'■
/
wM
7^1 Ik
( •
i II? a
< _. \l
\2
^3
I
MPi1
«■
1
1,
kffi
■■''
\
it
5
u 2t3
5
h—
y
71-'-“
al
"VF-’o
cn
o 2~
or
□
?!
o-
21 Hi
/tz
V-/ '.
|k A-- -’
I
H
/*K<
'■:
il
^A- . ’ __<
<
■
H H
atili>!»
Miik'
*"•„ ' . J ***»a4u -"2^* ! 4 2
I
-
F71P'
’ll V
h
z
ii
f-mM
h
H if
\’ vi -
\
i i 1®
MP
<TsL4i
2
. il
k .
2J
aW
Be
k
Team Members
Field Survey
1. November 5-17. 2000
(i)
Dr. T.Adak. Deputy Director, Malaria Research Centre, 22,
Sham Nath Marg, Delhi-110054
(ii)
Dr. G.P. Singh. Joint Director, National Anti Malaria
Programme. 22, Sham Nath Marg, Delhi-110054
(iii)
Dr. Ravi Kumar. Chief Medical Officer, Regional Office, H &
Fw, Bangalore, Karnataka
(iv)
Dr. S.K. Ghosh, Asstt. Director, Malaria Research Centre, (Field
Unit) Bangalore. Karnataka
2. August 26 to September 16, 2001
(i)
Dr. T. Adak. Deputy Director. Malaria Research Centre, 22,
Sham Nath Marg. Dehi-110054
(ii)
Mr. O. P. Singh. Senior Research Officer. Malaria Research
Centre. 22. Sham Nath Marg, Dehi-110054
(iii)
Dr. G. S. Sonal. Joint Director, National Anti-Malaria
Programme. 22. Sham Nath Marg, Dehi-110054
(iv)
Dr. Ravi Kumar. Chief Medical Officer, Regional Health &
Family Welfare Bangalore, Karnataka
1
Executive Summary
Tumkur is one of the highly malarious district of Karnataka state reporting over 15,000
cases annually. Latest epidemiological data (2000-2001) shows that this district
contributes over 15% of malaria cases of the state. Anopheles culicifacies and An.
fluviatilis are two mosquito vectors responsible for malaria transmission in this area.
The state health officials at different levels were contacted for analysis of situation in
the district and generation of data during November 2000 and August-September 2001,
which will be helpful in the preparation of the action plan and implementation of Roll
Back Malaria strategy.
The conclusions are as follows:
1. The laboratory set up, case detection and treatment: The quality of
blood smear in general is very poor, resulting in poor staining and incorrect
identification of malaria parasite species. Discrepancy was found while cross
checking the slide especially the diagnosis of ring stage of P. falciparum. It is
recommended to provide training in malaria microscopy and refresher course at
yearly interval. Monitoring and cross-checking system is inadequate, which
needs urgent attention. The technicians are inadequately deployed in PHCs
with high malaria incidence. The number of staff posted at any PHC has no
relation with malaria incidence. In high incidence reporting PHCs neither
microscope nor technicians are posted. Therefore staff may be transferred from
low incidence PHC to high incidence PHCs.
2.
Vector Control: Currently three insecticides, DDT, malathion and
deltamethrin are being used for indoor residual spraying for control of vector
population. The data on insecticide resistance in malaria vector species is not
available. There is no scientific rationale behind selection of villages to be
sprayed and type of the insecticide to be used for indoor residual spraying.
Synthetic pyrethroids are being indiscriminately used which may lead to
development of resistance.
3. Drug resistance: Data on drug resistance could not be available from Pf
Monotoring Team. 7-Day in-vivo drug susceptibility study carried out by the
team revealed that the P. falciparum is susceptible to chloroquine. However,
there are evidence of indiscriminate use of alternative drugs such as
pyrimethamine-sulphalene combination, E-mal and bulaquine by private
medical practitioners, shop-keepers and community. Majority of these groups
are not aware of National Drug Policy. Efforts should be made to update their
knowledge on present malaria drug policy.
4. Treatment: Although all the patients attending govt, health establishments are
covered under Fever Radical Treatment, the parasitological results show large
numbers of P. falciparum cases both with ring and ring with gametocytes
2
probably due to poor surveillance and non-compliance of drug consumption.
This is primarily due to large numbers of tablets to be taken at a time. For
example an adult patient has to consume at least 18 tablets of primaquine (2.5
mg) beside 4 tablets of chloroquine on day-1. This problem may be overcome
by introducing blister pack (2 tabs) of chloroquine (600 mg) and primaquine
(45 mg).
5. Research input: There is urgent need of research input to resolve some of the
basic problem required for effective planning of malaria control strategy.
i. Stratification of vector species distribution especially sibling species of
An. culicifacies and An. fluviatilis, which differs in distribution pattern
and relative vectorial efficiency
ii. Vector incrimination studies to identify the vector species and
transmission period for planning proper intervention strategies.
iii. Monitoring of insecticide resistance in two malaria vectors An.
culicifacies and An. fluviatilis for the selection of proper insecticide.
iv. G.R. of breeding places for planning the release of larvivorous fishes
for control of larval breeding.
v.
Drug sensitivity of P. falciparum and P. vivax against commonly used
antimalarials.
vi. Efficacy of 5-days radical treatment of primaquine in P. vivax should be
studied
6. Logistic: Allocation of adequate fund should be made available against
TA/DA and POL to implement proper monitoring and supervision, filling up of
vacancies, training etc. Quality control of insecticides, insecticide spray,
spraying equipments and drugs should be ensured.
7. IEC: Emphasis should be given to strengthen IEC activities for effective
involvement of community.
Two workshops were organized, one at district headquarter, Tumkur, another at
PHC C.N. Hally with representatives from government health officials, other
government departments, NGOs, school teachers, representatives of community
and panchayat, private health care providers etc, who are prospective potential
partners. Different working groups came forward with specific recommendations
for formulating malaria action plan.
While analyzing the malaria epidemiological data (1999-2000) in Karnataka state it
was evident that beside few problematic talukas of Tumkur district adjoining few
talukas of three other districts, namely Chitradurga, Chikmaguluru and Hussan are
contributing more than 25% of total malaria cases and approximately 80% of the
total P. falciparum cases (Table -, Fig - 3) in the Karnataka state.
For the preparation of malaria action plan these aspects may need utmost attention.
3
Introduction
JVIalaria is a major public health problem, endemic in over 100 countries in
the world. The World Health Organization (WHO) estimates there are over 300
million clinical cases every year, with over a million deaths. The DirectorGeneral of WHO initiated a new global partnership, Roll Back Malaria (RBM),
to tackle malaria as a priority health disease. The RBM was initiated for the
first time in Africa as over 90% of the disease burden occurs in Africa.
Subsequently, RBM initiative was extended to India and other South-East
Asian countries.
India has experienced resurgence of malaria in 1976s due to several logistic
and technical reasons and 6.4 million cases were reported in 1976. As a result
Modified Plan of Operation (MPO) was launched in 1977 to tackle the situation
and malaria cases came down to 2.5 to 3 million cases annually by 1985. Since
then the incidence of malaria has been contained to around 2-3 million cases
annually. However, the proponion of P.falcipanim cases and sharp increase in
death due to malaria has been recorded mainly due to frequent outbreak
The aim of the Roll Back Malaria initiative is to reduce the malaria morbidity
and mortality by utilizing the existing infrastructure and resources available
according to the local need. RBM aims at health sector reform, community
empowerment and human development to achieve sustainable reduction of
malaria involving bilateral agencies, the research community, the private sector
and NGOs. A strategic action plan for Roll Back Malaria was recommended
during an inter country meeting of South East Asian countries held at WHOSEARO, New Delhi in year 1999, which endorsed situational analysis of the
district and identification of problem at the local level.
In this context five districts i.e.» Tumkur (Karnataka), Aizwal (Mizoram).
Jodhpur (Rajasthan), Goa and Keonjhar (Orissa) have been selected
representing five different epidemiological zones of the country for malaria
situational analysis by National Anti-Malaria Programme based on high
malaria incidence. The aim of the present study was to analyze the situation of
malaria, available infrastructure and health delivery system, their strength and
weakness and resources (both government and non-govemment) that can be
exploited for effective malaria control involving community. The present report
is outcome of the two visits made during November 5-17, 2000 and August 26
to September 16, 2001.
It is envisaged that this report will be helpful in formulating RBM action plan
for district level implementation by National Anti-Malaria Programme aiming
to reduce the malaria burden in general.
4
Objectives
The general objective of the situation analysis is to facilitate the development
of action plan for malaria control in the pilot districts under Roll Back Malaria
Initiative.
Specific objectives:
i.
To assess the strengths and weaknesses of the health infrastructure for
supporting disease control activities at the state, district and at other
administrative levels within the district.
<2.
To assess treatment and prevention practices at household and
community level, and to identify community priority needs for health
care delivery with reference to malaria.
3,
To assess the strengths and weaknesses of the formal, informal, private
and public health care delivery systems for malaria control.
4.
To collect evidenced based, data of malaria with special reference to
case detection and treatment, disease prevalence, drug sensitivity of
Plasmodium falciparum, prevalence of vector species and their
abundance, host preferences, breeding habitats and insecticides
resistance status in vector species.
5.
To identify potential partners and opportunities for more effective
intervention, prevention and treatment of malaria especially at the
community level.
6.
To identify ways to strengthen the health sector to deliver disease
control interventions more effectively.
5
Methodology
1. The study was initiated after preliminary discussions with officials of National Anti
Malaria Programme, Delhi, Regional Office of Health & Family Welfare,
Bangalore and Directorate of Health & Family Welfare, Govt of Karnataka,
Bangalore.
2. The district level officers of various Government departments and Volunteer
Organizations based at Bangalore and Tumkur, private health practitioners,
teachers, elected members of Panchayat etc., who can be associated for malaria
control activities in the district as potential partners, were contacted.
3. For collection of entomological, parasitological and other relevant data of Tumkur,
concerning state health officials were approached.
4. The study villages were selected on the basis of last two years (1999-2000)
epidemiological data. Following evidenced based data were generated from study
villages.
Entomological:
a. Estimate of relative densities of malaria vector species, sibling species
composition and mosquito fauna.
b. Breeding habitats of anophelines
c. Susceptibility status of vector species against commonly used
insecticides
Parasitological:
a.
Fever survey in villages of 2 PHCs (covering about 1000 population
each PHC), one with high malaria and other with low malaria incidence.
b.
Susceptibility of P. falciparum against chloroquine.
c. Collection of epidemiological data from two selected villages.
5. Two workshops were organized, one at district headquarter. Tumkur, another at C.
N. Hally PHC of district Tumkur. The representatives of various govt, departments,
NGOs, health care providers and community representatives, who can be potential
partners in implementing Roll Back Malaria by participating directly or indirectly,
were invited to attend the workshop.
6
District Profile
Salient features of district profile of the district Tumkur, one of the malaria endemic
districts of Karnataka state are given in table-1. Map showing the location of district
Tumkur, Karnataka, India is given in figure-1.
1. Geographical: Tumkur is situated in the south- western part of the country
at latitude 13.2° N and longitude of 77.08’ E. The district is spread into 10596
km2 and comprises of 10 talukas, 12 towns and 4054 villages. The ratio of area
under urban/rural is 1:5.
2. Climate: The temperature in this area ranges between 14.2 to 33.1°C and
the relative humidity (RH) ranges between 27 to 90%. The average annual
rainfall is 587 mm.
3. Demographic features: The population of district is 2305819 with
population density of 218 per km2, mainly residing in rural areas and
agriculture is their main occupation. The average per capita income is Rs 4427.
Major crops in this area are Ragi, paddy, jowar and coconut. The literacy rate
in males and females are 66 and 42 respectively.
4. Health indicators: The birth rate and infant mortality rate and death rates
are 22, 54 and 7.8 (per thousand) respectively.
Health Infrastructure
The details of health infrastructure present in district Tumkur are given in table-2.
There are 2 general hospitals, 38 Health units, 93 Primary Health Centres (PHC) and
376 sub-centres in the districts besides 646 Drug Distribution Centres (DDC) and 4
Fever Treatment Depots (FTD). Out of 93 PHCs, only 81 are reporting malaria in the
district, the organizational and structural functions of health system are shown in
table-3. Malaria is one of the major diseases that prevail in the district Organizational
structure of different government health agencies responsible for malaria control in the
state and district are shown in table 4-9.
Malaria Profile
Malaria is the main health problem in Karnataka state. Tumkur is one highly
malarious district of Karnataka and contributes over 15% of malaria cases of the state
during year 2000-2001. The data on malaria cases reported Karnataka state and in
district Tumkur since 1990 are shown in table-10 & 11. On an average over 15,000
malaria positive cases are reported annually in Tumkur district, of which >25% are P.
falciparum. Malaria incidence (API) in ±e district during last 10 years ranged between
7
1.6 & 17.2. Malaria is mainly a rural problem in Tumkur district, however, Tumkur
town also reports malaria incidence and is covered under Urban Malaria Scheme.
Malaria incidence reported from Tumkur town since 1997 is given in table-12. In
Tumkur town temephos and fenthion are being used as larvicide beside pyrethrum
space spray as additional measures in and around the houses where malaria cases are
detected.
An. culicifacies and An. fluviatilis are the two major vectors responsible for the
transmission of malaria in this area. The vector control strategy relies mainly on
residual insecticides spraying of DDT, Malathion and synthetic pyrethroids. The
major vector An. culicifacies has developed resistance to DDT and partially to
malathion. Among other vector borne diseases, Japanese Encephalitis and Dengue are
prevalent in some districts of Karnataka, but there is no confirmed deaths reported
from this district. Mosquito nets are used occasionally only by individuals.
Based on the malaria incidence of last few years Tumkur district authorities have
identified following talukas namely C.N. Halli, Sira, Gubbi, Thuruvekere, Thiptur and
part of Tumkur as high risk problematic areas of the district, which is shown in figure
2.
8
Table-1 .Tumkur District Profile
(Karnataka)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
11
12
13
14
15
16
17
18
19
20
21
23
24
25
26
27
28
Geographical area
Latitude and Longitude
Terrain
Population (1991 census)
Urban (area)
Rural (area)
Percapita income
No. of Town with municipal
No. of Talukas
No. of villages
Density/ sq.km
Village Panchayats
Male - Female ratio
Literacy rate (%)
IMR/ birth rate/ Death rate
Rainfall range
Temperature range
Relative humidity (RH)
Area under cultivation
Important crop
Live stock
Channels
Dam
Tank
Wells
Mainwater bodies
Bore wells
Lift irrigation
Others
10596 km2
13.2° N and 77.08’ E
Undulating >95%
2305819
382163 km2
1923656 km2
Rs. 7427
12
10
4054
218
321
1 : 0.95
Male: 66.49; Female: 41.93
54 / 22 / 7.8
688-861 mm
14.2-33.1°C
27 - 90%
543653 (Hectare)
Ragi, Paddy, Jowar, Coconut
1416532
270
4
26712
16943
55852
151
34
9
Table-2. Health Infrastructure in District
Tunikur
1.
General hospital (Tumkur)
1 (400 bed)
2.
General hospital (Tiptur)
1 (100 bed)
3.
Taluk hospital (KSHDP)
7 (50 bed)
4.
Ayurvedic hospital
28
5.
Urban malaria scheme (Tumkur)
1
6.
Primary Health Unit
38
7.
PHC
8.
Sub-centres
376
9.
DDC (Drug distribution center)
646
93 (Malaria reporting 81)
10. FTD (Fever treatment depot)
4
11. MPW (Multi purpose worker)
376
12. ANM (Auxiliary Nurse and Midwife)
555
10
»
I
Table-3. Public Health System: Organizational and Structural Functions
Level of
Public
Health
System
Central
(Delhi)
List of organizations .
General function
Directorate of health
services (Ministry of
Health and Family
Welfare) Government of
India.________________
Directorate of National
Anti-Malaria Programme
(Ministry of Health and
Family Welfare)
Government of India
Highest planning and policy making
body for the control of different
communicable and noncommunicable diseases in the
country._______________________
Directorate of National Anti-Malaria
Programme (NAMP) Delhi (under
DHS) for planning, policy making
and procurement body in respect of
malaria, J.E, kala-azar and filariasis
control.________________________
Malaria Research Centre (ICMR)
Delhi undertakes basic, applied and
field research in the field of malaria
and other vector borne diseases.
Functions specific to MCP
■
/9W
Malaria Research Centre
(Indian Council of
Medical Research).
7
1
Highest planning and policy making body and
responsible for all budgetary allocation for
malaria.
NAMP Directorate is responsible for advisory,
planning, policy making, procurement of
insecticides, mosquito nets, drugs, spray
equipments, microscopes, diagnostic and other
supplies.
Malaria Research Centre provides research
support to NAMP on various aspects of
epidemiology and control of malaria. It has a
network of 12 field stations located in different
eco-epidemiological zones of the country.
Provides the testing ground for new technologies
and innovative approach, and helps in the transfer
of
technology
through
training,
field
demonstration and mass awareness programmes
involving various media. The center also provides
opportunity to the young scientists & paramedical
staff to undertake advanced research and training
for capacity building._________________
11
State
(Karnataka)
District
(Tumkur)
National Institute of
Communicable Diseases
(Ministry of Health and
Family Welfare)
Government of India.
Directorate of Health
services located at
Bangalore.
National Institute of Communicable
Diseases (NICD) is responsible for
basic and applied field research in
the field of different communicable
diseases including malaria.________
Director, Health Services, is overall
incharge of the health system
including all communicable and noncommunicable diseases in the state
for
planning,
policy
making
supervision, guidance and providing
budget.______________________ __
Regional
office
for Co-ordinates between the state and
Health & Family Welfare center on all health matters.
Government of India,
Bangalore.____________
Pf Monitoring unit
To monitor resistance status in
malaria parasite to chloroquine.
Malaria Research Centre
field station (1CMR)
Bangalore.
National
Institute
Communicable Disease
Bangalore.
District Health Officer
(Under Zila Parishad).
To help the state govt, in transfer of
technology in bio-environmental
control of malaria.
Surveillance and research specific to
plague.
District health officer is the chief and
responsible
for
all
health
programmes in the state under Zila
Parishad of the Panchayat Raj
System.
Supports the National Anti-Malaria Programme in
providing research and manpower development.
Exclusively meant for supervising, planning and
implementing malaria control operations in the
state.
There is a separate cell for overall co-ordination
of malaria control between state and central
directorates.
Monitoring resistance status in malaria parasite
against anti-malarials and provides research input
to the state malaria control programme._________
To conduct research as per the needs of state govt,
and to investigate any outbreak of malaria in the
state.
Provide supports to state health authorities to
investigate malaria out break and helps in
monitoring as and when requested.____________
DHO supervises malaria control programme and
provides budget for the same.
12
District malaria officer.
Sub Divisions
(Taluk)
Taluk Health Officer
Primary
1 Icalth Centre
(PHC)
The Medical Officer
inchargc is responsible
for all health care system
of PHC.
Overall incharge of malaria control operations in
the district without administrative and financial
control, which is control by District Health
Officer.___________________________________
Responsible for all health problems Also responsible for supervision of malaria
control.
of the taluka.
Overall inchargc of malaria control
operations in the district.
Malaria inspector and Health Health supervisors are multipurpose workers
supervisor (male & female) arc responsible for supervision over health workers of
responsible for supervision of sub-centres.
malaria surveillance in the PHC.
13
*
Table-4-ORGANOGRAM OF HEALTH SERVICES
STATE KARNATAKA
I
Sr. REGIONAL DIRECTOR
(Dr. P.K. Shome)
I
ZILLA PARISHAD
PRESIDENT
DIRECTOR
(Dr. G V. Nagaraj)
DISTRICT SURGEON
(UNDER PANCUAYAT RAJ)
Regional Office for Health & Family Welfare
(Govt, of India)
ADDITIONAL DIRECTOR
(Communicable Diseases)
(Dr. M V. Murgendrappa)
DEPUTY
COMMISSIONER
CHIF EXECUTIVE
OFFICER
(CEO)
(Mr JAYARAMARAJ URS)
IAS
IAS
OBTHCfT FAMI Y PAI NNWG Of FICLH
___I_______
■ STRICT MMUNSAT1ON OFFICER
DISTRICT NURSING OFFICER |
S*-2 .V“ - 1
I
I
“I
8 • 0, V O
INSECT^ COLLECTORS'
|S*-2. V-1
STATE ENTOMOLOGIST
(Mr. A. PRAKASH)
SCIENTIFIC OFFICER
(Mr. K. S. SUDHARSHAN)
TECHNICIAN
S - 20, V - 12
1
I.
DIVISIONAL JOINT DIRECTOR
(4 Divisions)
(Dr. GANGADHAR NAIK)
(Bangalore, Mysore, Gulbarga & Belgaum)
I
BANGALORE DIVISION
DEPUTY DIRECTOR
(Dr. T. SHANKAR)
| DISTRICT HEALTH EDUCATION OFFICER I
lOtStRICT SURVI 11 ANCL OfTCER
_ ]|
Mr. S K KARADI
(KHSDP)
I
■
5
I ASSISTANT ENTOMOLOGISTl
WOMEN AND CHILED
WELFARE DEPARTMENT
J _ __ Dr
| DISTRICT HEALTH SUPERVISOR
j
DISTRICT MALARIA OFFICER
Dr SIDDAGANGAIAH
□I
LAB'TECHNicfANS”
( N.S.K. BHAGAWAT)
f
_____
[ DEPUTY DISTRICT HEALTH EDUCATION OFFICER |
DISTRICT T B OFFICER
|
|
RESEARCH ASSISTANT
32^2, V“-0_______
__________ I
I
DISTRICT I LPROSY Of f ICLR
•y
.!< )IN I DIRI CIOH
(Mdldiia & Filaria)
(Dr. R.K. Kumara Swamy)
___________ I___________
___ I__ I
DISTRICT HEALTH OFFICER
(Dr. CHIKKA BASAVA1AH)
I
| ‘ CHIEF MEDICAL OFFICER
i
Dr. K. RAVI KUMAR
Mr R K KOLLI
BLOCK HEALTH EDUCATOR
S - 17. V-3
||
LAB TECHNICIAN
|
j
ip'iNSEct c6llect6rs"||
!|S-2. V-2
|
S • - SANCTION! D
V-VACANT
14
Table-5. ORGANOGRAM OF DMO OFFICE
(DISTRICT TUMKUR)
DISTRICT MALARIA OFFICER
(DMO)
(Dr. SIDDAGANGAIAH)
ASSISTANT MALARIA OFFICER
OFFICE SUPERINTENDENT
ZTTTZ7-L______
FIRST DIVIS ON ASSISTANT
J
(S -1, v - O)
I
(S * - 1 . V
- O)
(S • - 1 . v
I
health supeivisor
I
I
(S - 1, V - O)
________
I
„
SENIOR HEALTH INSPECTOR
TYPIST
(S - 1, v - O)
- D
(S - 7, V - O)
i
L
______
I
JUNIOR HEALTH INSPECTOR
(Trained as microscopists)
(S - 7, V - 1)
LAB TECHNICIAN
(S - 1 , v - 1)
' ’''
"
DR IV E R
(S - 4. V - 1 )
(1 VEHICLE ON ROAD. 2 VEHICL.SS
‘
(2 VEHICLE TRANSFERRED TO 3ho AND 2 TO ZP)
15
*
TABLE- 6. CITIES UNDER URBAN MALARIA SCHEME
I
1
BANGALORE
CHICKMAGLUR
RAICHUR
I
I
BELLARY
I
TUMKUR
I
HASSAN
I
BELGAUM
I
HOSPEF
TOWN MUNICIPAL COUNCIL
35 WARDS
MEDICAL OFFICER
S* - 1.V-1
zzzz
•, ti
JUNIOR HEALTH INSPECTOR
S-8.V-0
. • •• -V-< V-r/
DRIVER WITH A JEEP
S* - SANCTIONED
V**-VACANT
■I
16
TABLE-7. ORGANAOGRAM OF A TALUK HOSPITAL
TALUK - CHIKKANAYAKAMA HALLI
(District tumkurI
TALUK HEALTH OFFICER
(THO)
Dr P R. CHIDANANDAPPA
ADMINISTRATIVE MEDICAL OFFICER
Dr. C. MAHA DEVAPPA
T
LAB TECHINICIANS
SENIOR HEALTH ASSISTANT
S*-2, V“-1
S*-1.V-0
X-RAY TECHNICIANS
JUNIOR HEALTH ASSISTANT
S-1.V-0
S-1.V-0
PHARMACIST
SENIOR LADY HEALTH VISITOR
ME DICALL OFFICERS
(S--7.V-2)
(Woridng - physc*n . surgeon gya>«colog6t.paed*trcim< t dentist VACANT - OPTHALAMOLOGIST & ANAESTHES6T
BLOCK HEALTH OFFICER
S’-I.V -0
I
i
S -2, V -1
i
S - 3. V - 0
I
AUXILLARY NURSE & MIDWIFE
S - 2. V - 0
I
I
FIRST DIVISION ASSISTANT
S-3. V-1
!
I
SECOND DIVISION ASSISTANT
S-1.V-0
ATTENDANT
S - 6. V - 6
17
TABLE-8. ORGANOGRAM OF PRIMARY HEALTH CENTRE
PHC - CHIKKANAYAKANA HALLI
MEDICAL OFFICER
-1
ONE /TWO
I
T
T
PRIMARY HEALTH UNIT
MEDICAL OFFICER
(27 PHUs IN DISTRICT TUMKUR)
SENIOR HEALTH ASSISTANT
LAB TECHNICIANS
r
JUNIOR HEALTH ASSISTANT
I
S-1.V-1
I
T
T
1
FIRST DIVISION ASSISTANT
S-1.V-0
DRIVER
ATTENDANTS
S-1.V-0
S-2.V-0
i
AUXILIARY NURSE MIDWIFE
FEMALE
!•
18
TABLE-9. ORGANOGRAM OF Plasmodium falciparum MONITORING UNIT,
BANGALORE, KARNATAKA
SENIOR RESEARCH OFFICER
DELHI
I
RESEARCH OFFICER
HEAD
I
'I
LAB ASSISTANT
S * - 7, V ** - 0
■ TRAINED AS MICROSCOPISTS
I’
I
DRIVEER
S - 1, V-0
PEON
S - 1, V - 0
i
S*
- SANCTIONED
v ** - VACANT
19
Malaria Profile of Karnataka
sfea
(1991-2001)
350000 p-
300000 -
(/)
LU
35
■
Deaths
i—---------------- 1
Malaria cases |
250000 -
s
I
MJ
n
■
50000
n
H
■
I ■ ’
.i
'
■
■
?
. v
'
%
(/)
.
F
;■20'
§
//
ffl-15 r
' l/fl - IB ?l
H
-
■ a
J ’
0
'
| A _ ■- 10
w-_
I I
y‘ -
p’ci>«“
<
100000
30
I.
25
H
*
Sd
< 200000
o
<
or 150000
_
-- 5
I■4 o
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 20^1*
YEAR
Malaria Cases
Pf Cases
Sept
Deaths
API
<
u
Table-10. Incidence of Malaria
(KARNATAKA STATE)
x
Year
y.
1991
Malaria Pf
• Radical
No. of
ABER API SPR SIR
Cases Cases treatment confirmed
deaths
6845523 44565 10135
43430
1.2 0.7 0.2
0
17.2
1992
6918592
81057
16826
63200
3
17.1
2.1
1.2
0.2
1993
7098510
196466
49246
190644
4
17.3
4.8
2.8
0.7
1994
7110997
266679
37789
257338
7
17.9
6.8
3.8
0.5
1995
7111888
285830
39601
279535
32
17.4
7.0
4.9
0.6
1996
7681802
219198
32606
216127
13
18.5
5.4
2.9
0.4
1997
7613013
181450
46326
180976
7
17.8
4.2
2.4
0.6
1998
7568155
118753 | 26776
115695
3
17.3
2.7
1.6
0.4
1999
8185995
97274 I 21416
94578
11
18.6
2.2
1.2
0.3
2000
8004765
95387
22220
16.7
2.0
1.2
0.3
16.7
2.0
2001* 6818646
112907
36356
14.3
2.4
1.7
0.5 I 14.3
2.4
BSE
* up to August.
20
MALARIA CASES
cn
o
o
o
o
K)
o
o
o
o
o
o
o
o
o
o
o
o
o
>
i-
>
X
>
< J
CD
■u
I—•
X
I
!
=r
I
2. I
_*
.
'
-
<
CD
TJ
1
GO
1
4-
o
o
o
o
>▻>
cn O cn
o o o
o o o
o o o
s
CD
cn
DO
Z5.
m
>
X
>
X
X
£
2
m
CD
CD
G1
C£>
10
C?
■
i
, /
C
*
C
X
CD
CD
O
C£>
CO
co
CD
CD
CD
o
j_
r
MALARIA CASES
re
o
o
o
s
I
GO
>
I"
o
i
>
5
>
ho
o
+?
(/)
'
2
2
7)
CD
CD
GJ
o
o
o
o
o
o
o
—
CD
CD
bO
(A
■
1
hJ
{^>
fi)
Rife
1
c
o
o
\
‘
K>
.
N>
o
z
cn
o
o
o
X
i 2
/
-. I
o
o
o
o
<D
cp
O
z
g
c
rn
z
o
m
z
(/)
cn
o
o
o o
CD =
rt> "3
»
ho
o
o
Table-11. Incidence of Malaria
(TUMKUR DISTRICT)
Year
Population
BSE
Pv
Pf
Total
ABER
API
API
SPR
SfR
Pf%
1990
2323921
454268
9393
3290
12683
19.5
5.4
1.4
2.7
0.72
25.9
1991
2323921
478035
5159
1895
7054
20.57
3.03
0.8
1.47
0.39
26.88
1992
2323921
451419
5731
2293
8024
19.4
3.45
0.09
1.77
0.05
28.57
1993
2347610
506058
23013
17605
40618
21.46
17.22
7.4
8.02
3.47
43.34
1994
2369576
456863
26788
8010
34798
19.8
14.68
3.3
7.6
1.75
23.01
1995
2369576
448059
19362
2091
21453
18.9
9.05
0.8
4.78
0.46
9.74
1996
2369576
465672
8234
516
8750
18.8
3.6
0.02
1.86
0.11
5.8
1997
2369576
421561
3563
460
4023
17.7
1.6
0.19
0.9
0.1
11 4
1998
2440059
459273
2334
476
2910
18.8
1.19
0.19
0.6
0.1
16.35
1999
2440059
442897
3348
819
4167
18.15
1.7
0.33
0.9
0.18
19.65
2000
2440059
646654
10550
3746
14296
26.50
5.86
1.54
2.21
0.58
26.20
2001*
2440059
492020
14982
5218
20200
20.16
4.11
1.06
25.83
* Up to August
21
Table-12. Urban Malaria Scheme in Karnataka vs
Tumkur
KARNATAKA
Year
1997
1998
1999
2000 (Aug)
BSE
150267
141008
114237
76367
Malaria Cases
14450
8739
4991
1647
Pf
937
750
244
240
Radical Treatment
_______ 14213
_______ 8355_______
_______ 4991_______
1572
TUMKUR
S.No.
Year
Pop.
BSE
+VE
Pf
RT
1.
1997
200000
6685
157
28
155
2.
1998
239000
9552
142
16
142
3.
1999
239000
8299
96
22
96
22
S’
. .
.
,
V
PROBLEMATIC TALUKAS IN TUMKUR DISTRICT
ANDHRA PRADESH
PAVAGADA
CHITRA DURGA
DISTRICT
ANDHRA PRADESH
ANDHRA
PRADESH
J-
CHIKKA MANGALORE
DISTRICT
MANDUGIRI
j—
JKORATAGERE
KOLAR DISTRICT
thipatur/^^^B1S
Mfcxx #'W
Kfi dr
BANGALORE DISTRICT
’t'■ ■ '
MANDAYA DISTRICT
PROBLEMATIC TALUKAS
KUNIGAL
FIG. 2
Malaria prevalence
To collect evidence based data field visit were made in three PHCs, Huliyar, Mathigatta
and Dasudi of Taluk C. N. Hally. Team also visited adjoining Taluk Hospital at Sira and
had detail discussion on malaria situation of Taluk. Before undertaking field survey,
several discussions were made with state health officials and data generated on malaria
epidemiology were analyzed. The data on malaria prevalence in Tumkur district were
obtained from the office of the District Malaria Officer, Tumkur.
The month wise malaria cases in district Tumkur during year 2000-2001 are shown in
table-13 and fig-4. Though the malaria cases appear throughout the year, there are two
peaks of malaria, a spurt of large peak around April-August and a very small peak around
December. The compilation of malaria cases revealed that malaria cases have increased
substantially in year 2001 as compared to preceding year. In year 2001 till August 20200
malaria cases have been detected as against 14296 cases in whole year of 2000. There is
78% increase in total malaria cases and 86% increase in P. falciparum cases in 2001 as
compared to preceding year (Jan-Aug data).
The taluka-wise malaria cases during year 2000-2001 are shown in table-14. The two
taluka, C. N. Hally and Sira had maximum number of malaria cases especially P.
falciparum cases. The two talukas together contributed 65% of total malaria cases and
68% of P. falciparum cases appeared during year 2000 in the district. In Taluk C. N.
Hally, about l/3rd of malaria cases are reported from two PHC, C. N. Hally and
Mathigatta. The month wise data on malaria incidence of PHC C.N. Hally are shown in
table-15. The incidence of total malaria cases and P falciparum cases have increased in
2001 from preceding year in PHC Mathigatta, whereas decreased in PHC C. N. Hally
table-16. Further the subcentre-wise malaria incidence of PHC C.N. Hally and Mathigatta
are given in table 17 & 18.
1. Fever Survey
Few villages from these two PHC were visited by the team for point prevalence study. In
order to find out the malaria prevalence the fever survey was carried out in 6 villages of
Mathigatta PHC alongwith passive slide collection carried out at Mathigatta PHC
Hospital. The results of slide examination are shown in table 19.
Examination of blood smear revealed overall SPR to be 24.44, ranging between 8.62 and
60.00. It may be pointed out that majority of malaria cases were P. falciparum (Pf%
=92.31). Most of these cases were found to have ring stage indicating very poor
surveillance, although the annual blood examination rate (ABER) is as high as 25%.
It was observed that the active surveillance in term of slide collection is poor by existing
NAMP norm. This is evidenced by comparison of single day’s point prevalence
23
surveillance data generated during the field visit vs. 7 months data (Jan-Aug 2001) by
state health agency.
It may be pointed out that during our point prevalence study carried out in a primary
school revealed large number of student are infected with Plasmodium falciparum
showing lack of typical clinical symptom of malaria. Hence existence of asymptomatic of
malaria cases cannot be ruled out in this area. In view of this suggested that detailed
investigation should be carried out to find out the presence of asymptomatic of malaria
cases.
2. Malaria Microscopy
The study team visited 2 PHCs of Taluk CN Hally i.e., CN Hally and Mathigatta, and
PHC Sira (Taluk Sira). Blood smears collected from patients who reported to PHC
hospital in the month of August and September 2001 were crosschecked for malaria
parasites. It was observed that quality of blood smear and staining is very poor in general.
Examination of blood smears revealed discrepancy in result particularly false negativity of
P. falciparum cases by PHC technicians (Table-20). It was observed that technicians are
capable of identifying P. falciparum gametocytes only. Ring stage of P. falciparum
parasite invariably missed by the technicians. Out of 300 confirmed negative slides, 12
were found positive for P. falciparum rings only. All together P. falciparum rings were
found to be missed in 23 slides.
It may be mentioned here that our vector control strategy in a given area is mainly relies
on incidence of malaria; hence proper reporting of cases is essential. Underreporting of
malaria cases resulting from poor quality of blood smear, staining and technical
inefficiency is a great concern not only for policy decision but also reducing morbidity
and mortality as well as transmission risk.
3. Treatment
Tumkur district have been identified as high risk area due to occurrence of few malaria out
break in the year 1999-2000. As per the guidelines of NAMP, all fever cases are given
Fever Radical Treatment (FRT)'with 1500 mg of chloroquine (adult dose, 600 mg each on
Do and Di and 300 mg on D2) and 45 mg of primaquine on day 0. Subsequently on
examination of the blood smear, if found positive for P. vivax, three days of primaquine
treatment (30 + 30 + 15 mg) are given for radical cure subsequently within 3 weeks.
Data analysis revealed that the FRT is not very, effective in containment of falciparum
malaria. Analysis of parasitological data generated by team and PHC laboratory revealed
that majority of P. falciparum cases detected were found to have ring and gametocyte.
This strongly indicates poor compliance with reference to drug consumption. In such
circumstances the efficacy of FRT should be investigated to reduce the drug pressure.
At present under FRT large numbers of anti-malarial tablets are given for treatment. The
number of "tablets given for adult is: 1500 mg of chloroquine consisting of 10 tablets
(10+10+2) and single dose of 45 mg of primaquine consisting of 18 tablets (2.5 mg).
Therefore the patient is supposed to take total of 22 tablets on first day in presence of
health worker which probably never happened. Due to such large number of tablets to be
24
consumed by the patients the compliance of taking the drug is probably very poor. Hence
it is recommended that the NAMP should made available chloroquine and primaquine
tablets of higher strength to reduce the no. of tablets in blister pack as per Maharashtra
model. It is envisaged that such action will improve the patients’ compliance to drug
consumption.
4. Chloroquine resistance
In order to find out the drug susceptibility status of P. falciparum against chloroquine, we
conducted 7-day in-vivo drug sensitivity tests, following WHO test protocol, against 19 P.
falciparum cases. The results of in-vivo test suggest that chloroquine is very effective and
should be used as first line of treatment (table 21).
It may be pointed out that there is Pf monitoring team at RHO office at Bangalore, which
is adequately staffed. The status of chloroquine resistance, as monitored by monitoring
team, could not be obtained inspite of our best effort.
It may be mentioned that majority of patients are invariably treated either with
sulphadoxine-pyrimethamine combination or E-mal (a and p artether) as a first line of
treatment, as evidenced by discussion with private medical practitioners, community and
chemists. Various medical stores were visited to know the common anti-malarial drugs
available, which reflects common drugs being used by patients either by prescription of
General Practitioners or self-medication. The E-mal and bulaquine is the most commonly
used drugs found available with medical stores. In view of efficacy of chloroquine it is
suggested that community and private health care agencies should be sensitized about
NAMP drug policy and should be advised to use chloroquine as first line of treatment to
reduce the drug pressure and delaying the development of resistance to front line drugs.
5. FTD/DDC:
Currently only few Fever Tratment Depot (FTD) and Drug Distribution Centre (DDC) are
working in Tumkur district. Only Anganwari workers are helping out in FTD and DDC.
No other community leader is engaged in this service. It was obsen ed that there is poor
liaison between MPW and FTD/DDC. The functioning of FTD/DDC should be improved
by improving liaison with MPWs and involvement of community.
25
Malaria Entomology
1. Vector prevalence:
Indoor resting mosquitoes were collected from some of the villages of PHC Mathagatta,
CN Hally and Desudi. The anopheline fauna and their relative density in study villages are
given in table-22. Two vector species Anopheles culicifacies and An. fluviatilis were
found in very small number in this area. The low density of vector species is probably due
to prevailing drought condition during our visit. The examination of abdominal conditions
of indoor resting An. culicifacies revealed high proportion of gravid mosquitoes.
2. Sibling species composition:
Under RBM initiative necessary technical assistance and strategic investment for the
development of better tools and intervention strategies should be provided through
focused research. In this context, it may be pointed out that in Karnataka state vis-a-vis
Tumkur district, An. culicifacies and An. fluviatilis have been recognized as vector. It is
well known that both these vector species are complexes of sibling species, which greatly
differ in distribution pattern and transmission potential. Hence it is desirable that the
whole state should be stratified based on the distribution of different sibling species of An.
culicifacies and An. fluviatilis and their relative transmission potential. Vector
incrimination should be carried out to identify the vector responsible for malaria
transmission and transmission period for planning effective vector control strategies.
Limited studies have been done on sibling species composition of An. culicifacies. MRC
data suggest that the An. culicifacies population in this area comprises of about 72%
species A (vector) and 28% species B (non-vector). However no data is available on
sibling species composition of An. fluviatilis.
3. Breeding sites:
Study carried out in some villages show that there are limited mosquito breeding sites in
rural area such as Tanks, Ponds. Wells etc which can be managed by introduction of
larvivorous fishes, Gambusia and Guppy. These breeding sites remain generally perennial
and therefore fishes can sustain in these sites. Such demonstration has already been carried
out by MRC team in three districts of states. These fishes are available in millions in
different parts of the state. In all water bodies these fishes should be introduced and
subsequently schedule monitoring should be carried out to find out the propagation and
effectiveness of fishes. There is no information of village wise breeding habitates,
therefore GR should be carried out for successful use of larvivorous fishes. Some
perennial Tanks/Ponds should be identified as hatcheries for regular replenishment of
larvivorous fishes in mosquito breeding habitates. Other state department such as fisheries
department should be involved for technical help and transportation of fishes. Technical
expertise of MRC, Bangalore may also be exploited.
26
4. Insecticide spray history:
The history of insecticides spray in Tumkur district during year 2000 and 2001 are given
in Table-23. During year 2000 two insecticides, DDT and deltamethrin and in the year
2001 three insecticides i.e. DDT, deltamethrin and malathion were used. First round of
spray was carried out during 15th February to 15th April, second round during 15th July to
15th September and special round in August each year. During year 2000, deltamethrin has
been sprayed in 10 PHC in regular spray schedule and in 6 PHCs as special spray round,
while in 2001 deltamethrin was used only during special round.
5. Insecticide resistance:
The present status of insecticide resistance could not be monitored during study tour due
to very poor vector density in the study area. The data on insecticide resistance is
inadequate with state health agency. For effective planning of vector control, insecticide
resistance data should be generated at sub-centre level. In absence of such data indoor
residual spraying strategy may not be cost-effective. There is no supply of insecticide
impregnated paper to monitor the insecticide resistance against different malaria vectors
hence data on insecticide resistance is not available. It may also be mentioned that their is
inadequate allocation of financial grant to meet the TA/DA of the staff and POL for the
transport vehicle which are absolutely essential to undertake the studies on insecticide
resistance.
As there was no sufficient data on insecticide resistance against different malaria vectors
rationale for the selection of insecticide to be used in a given area for residual spray found
to be questionable. Even synthetic pyrethroids are being used frequently, which involve
high cost, without evidence of resistance against cheaper insecticides. It appears that the
choice and schedule of insecticide spray is decided on the basis of availability of
insecticide. It is strongly recommended that insecticide resistance in vector must be
monitored at sub-centre level for judicious use of insecticides.
Infrastructure:
It was observed that in Mathigatta PHC, which is one of the high incidence reporting
PHCs. In this PHC neither microscope was available nor any laboratory technician was
posted for blood slide examination.
In spite of 15 day’s training given to all the technician during the initial appointment it
was surprising that the quality of blood smear preparation and identification of parasite
species was found to be very poor. Therefore, it is suggested that refresher training course
should be organized immediately to improve the quality of blood smear preparation,
staining and identification. Cross-checking system existed at district and state
headquarters as per NAMP norm however the functioning of this cross checking
mechanism is inadequate. Hence it is suggested that the urgent attention should be given
to improve the cross checking mechanism.
27
The staffing pattern, numbers of sanctioned and vacant posts of health workers used in
malaria control are shown in table-24. Substantial numbers of staff position are vacant.
The number of staff posted at each taluka has no relation with number of malaria cases in
the Taluka. The staff therefore may be transferred to problematic areas particularly C. N.
Hally and Sira, which contribute 65% of the total malaria cases in the district.
It was observed there is a great burden of record keeping and reporting to the peripheral
staff at district and PHCs. These data are rarely analyzed for decision-making particularly
deciding about the intervention strategies. The delivery of intervention strategies requires
urgent strengthening of staff, and thus monitoring of the relevant components of the health
sector ranging from health policies, health system management, service delivery and
involvement of other important sectors needs immediate attention.
There is urgent need of providing training to health officials involve in malaria control.
The training needs of health personals are summarized in table-25. Besides training there
is need of effective cross-checking mechanism and supervision of staff. It was observed
that proper cross checking mechanism and supervision as mentioned in NAMP’s
guidelines are not being effectively followed.
The poor supervision and monitoring is also due to inadequate fund allocation against
TA/DA. Bills pertaining to TA/DA are generally pending for years.
28
Table-13. Incidence of Malaria
District-Tumkur
YEAR 2000
MONTH
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
TOTAL
BSE
37257
'39620
40024
35661
53854
91918
69595
71688
67517
45718
48379
43285
646654
Pv
267
293
237
518
1828
2561
1910
902
422
475
477
637
10526
Pf
80
74
55
136
419
799
860
380
228
184
266
205
3770
Total +ve
347
367
292
654
2247
3360
2770
1282
650
659
743
932
14296
YEAR 2001 (UP TO AUGUST)
MONTH
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
TOTAL
BSE
43534
45207
48688
54243
91952
78991
72136
57267
492018
Pv
576
793
1213
2614
3507
3211
1918
1079
14911
Pf
208
187
467
639
1096
1067
990
564
5218
Total +ve
784
980
1680
3253
4603
4278
2908
1643
20129
29
Figure-4. Month-wise malaria cases in
Tumkur district
Year 2000
5000<1—
I
■ Y
Si. •••
4000
P. vivax
1
3000-
A
l:r
sis
□ Pv
0Pf
P. falciparum
2000
1000
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year 2001
5000
4000 •
P. vivax
3000
□ Pv
SPf
2000•wst'
■
P. falciparum
s • ..
1000
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
30
Table-14. Taluk wise Incidence of Malaria
DISTRICT-TUMKUR
YEAR 2000
Taluk
1
2
3
4
5
6
7
8
9
10
11
Tumkur
Kunigal
Gubbi
Thuruvekere
Tiptur_____
ON Hally
Sira_______
Madhugiri
Pavagada
Koratagere
TumkurTown______
Total
No of
PHCs
10
8
10
5
8
8
8
12
8
6
1
Population
BSE
Pv
Pf
284478
240833
253177
171441
179500
214072
282586
245073
243032
151879
71602
46961
72967
52032
64937
113392
94050
48114
31008
36709
804
90
771
645
893
2557
4128
66
22
170
202
83
146
89
281
1617
947
61
6
61
total
+ve
1006
173
917
734
1274
4174
5075
127
28
231
200000
2440059
14887
646654
371
10550
180
3746
551
14296
YEAR 2001 (UP TO AUGUST)
1
2
3
4
5
6
7
8
9
10
11
Taluk
Tumkur
Kunigal
Gubbi
Thuruvekere
Tiptur_____
CN Hally
Sira_______
Madhugiri
Pavagada
Koratagere
TumkurTown______
Total
No of
PHC
s
10
8
10
5
8
8
8
12
8
6
1
Population
BSE
Pv
Pf
284478
240833
253177
171441
179500
214072
282586
245073
243032
151879
52493
34799
52425
79724
57245
91446
67842
43495
24712
25655
855
192
535
1222
2089
5302
3239
960
11
705
321
74
161
158
948
2106
628
572
4
285
total
+ve
1176
266
696
1380
3037
7408
3867
1532
15
990
200000
2440059
8929
492020
397
14982
257
5218
654
20200
31
J’lS < I
Ooi
97191
■
t,.
/
Table-15. Incidence of Malaria
PHC CN HALLY
YEAR 2000
MONTH
BSE
Pv
Pf
Total +ve ■
Jan
Feb
Mar
Apr
May
Jun
Jul___
Aug
Sep
Oct
Nov
Dec
TOTAL
358
380
338
338
1031
3401
1619
1180
992
619
435
329
11020
5
4
1
14
104
224
28
20
4
10
6
5
425
1
0
4
7
23
116
121
68
21
14
7
2
383
6
4
5
21
127
340
149
88
25
24
13
7
808
YEAR 2001 (UP TO AUGUST)
MONTH
BSE
Pv
Pf
Total +ve
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
TOTAL
405
507
608
724
1672
1695
1133
882
7626
17
8
5
5
28
57
27
16
163
13
1
1
3
2
5
4
3
32
30
9
6
8
30
62
31
19
195
32
Table-16. Incidence of Malaria
PHC MATHIGATTA
YEAR 2000
BSE
480
530
612
1084
2739
3201
2310
1247
1268
766
826
627
15690
MONTHJan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec .
TOTAL
, Pv
3
0
4
28
159
100
22
0
12
18
11
47
433
Pf
3
0
4
~36~
67
46
4
10
7
13
25
314
Total +ve
6
0
8
50
245
167
68
4
22
25
24
82
747
YEAR 2001 (UP TO AUGUST)
MONTH
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Total
B
BSE
1031
914
1121
1551
2477
2388
1888
1489
12859
Pv
63
48
97 260
481
324
156
29
1458
Pf
15
13
9
47
153
175
131
39
582
Total +ve
78
61
106
307
634
499
287
68
2040
33
I
3
i
250000
200000
i
□ TOTAL
■ PF
•. Si -
150000
i
_________________ :-----------
. .
100000
'•
50000-1
Al
•
:1
0
KARNATAKA
TUMKUR
C.N.H.+SIRA
C.N.H.+M.GHATTA
-
,
Table-17. Incidence of Malaria
PHC- CN Hally
YEAR 2000
Subcentre
No of
villages
Population
BSE
Pv
Pf
total
+ve
1
C.N. Hally
Town/
21840
5119
23
20
43
2
Jogihally
10
6136
497
30
8
38
3
Navile
9
3822
915
16
4
20
Total
19
31798
6531
69
32
101
YEAR 2001 (UP TO AUGUST)
Subcentre
•No of
villages
Population
BSE
Pv
Pf
total
+ve
1
CN Hally
Urban/Rural
17960
8231
366
309
675
2
Jogi Hally
10
7612
632
15
9
24
3
Navile
9
6643
2571
46
198
244
Total
19
32215
11434
427
516
943
Population: 4080 (urban), 17760 (C.N. Hally)
34
Table-18. Incidence of Malaria
PHC- Mathigatta (Taluk- CN Hally)
YEAR 2000
Subcentre
No of villages
Population
BSE
Pv
Pf total +ve
1
Mathigatta
Kamalapura
2560
4369
7161
5097
1614
4093
3359
28253
1482
637
1054
1273
17
2
3
4
5
6
7
9
9
10
10
5
7
4
54
13
7
35
30
Soralamavu
Harernahally
Hosahally
Gubehally
Belaguli
Total
20
39
31
479 52 34
2478 5
19
807 33 13
8210 197 151
30
27
74
61
86
24
46
348
YEAR 2001 (UP TO AUGUST)
Subcentre
No of
villages
Population
BSE
Pv
Pf
total
+ve
1
Mathigatta
9
3230
802
244
108
352
2
Kamalapura
9
4271
321
Soralamava
10
4237
100
169
61
490
3
4
Harernahally
10
285
107
392
5
Hosahally
687
56
27
6
Gubehally
5
7
5000
4440
3728
1362
1592
1877
334
104
7
Belagully
4
1924
1003
97
8
1
83
483
9
Total
54
26830
7420
1348
577
1970
161
35
Table-19.Malaria prevalence in study villages of PHC Mathigatta
(Taluk CN Hally, district Tumkur), January-August 2001.
Villages
Popul
ation
PJ Total SPR
Surveillance
agency
BSE Pv
31.X.01
MRC*
10
5
6
60.00
50.00
Jan-Aug’Ol
NAMP
443
106 62
168
37.92
13.99
31.8.01
MRC*
84
2
29
31
36.91
34.52
Jan-Aug’Ol
NAMP
160
42
21
63
39.37
13.12
31.8.01
MRC*
35
1
10
11
31.43
28.57
Jan-Aug’Ol
NAMP
119
34
32
66
55.46
26.89
31.8.01
MRC*
75
2
14
16
21.33
18.67
31.8.01
MRC*
24
0
8
8
33.33
33.33
31.8.01
MRC*
58
1
4
5
8.62
6.90
Period
■
SJR
(%)
Passive surveillance
Mathigatta PHC
ho sp i tai_________
Active surveillance
95‘^
Kamakipura
164
Kamalapura Gotahatti
692
Ilosure
Surgan hally
Vaddarhatti
Bagur 1
School
• point prevalence study
36
1
Table-20. Result of cross examination of
blood smear
Source of
blood smear
No. of Examined Cross-examination result
slides by
PfR PfrG
Pfg
Pv Total
PHC C.N. Hally
100
50
PHC Mathigatta
200
100
PHC
MRC
PHC
MRC
PHC
MRC
PHC
MRC
0
7
0
0
0
5
0
0
0
4
0
7
0
0
0
0
0
0
24
17
0
0
49
49
0
2
26
26
0
0
51
51
0
13
50
50
0
5
100
100
•GT
. 37
Table-21. Drug sensitivity test in P falciparum against
Chloroquine
(Mathigatta PHC, Taluk CN Hally)
Code
KG1_________
KG3_________
KG15________
KG18________
KG21________
KG24________
KG27________
KG28________
KG35________
Mathigatta 1664
SV1__________
SV2__________
SV3__________
SV4__________
SV6__________
SV8__________
SV13
Date offirst dose of '
CQ administration
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31 .08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
31.08.01
Blood examination result
Day 0
Day 1
Day 2
Day 3
Day 7
PfRG
PfR
PfR
PfR
PfR
PfR
PfRG
PfR
PfRG
PfR
PfRG
PfR
PfR
PfRG
PfRG
PfRG
PfR
PfG
Neg
Neg
Neg
Neg
Neg
PfG
Neg
PfG
Absent
PfG
Neg
Neg
PfG
PfG
PfG
PfG
PfG
Neg
Neg
Neg
Neg
Neg
PfG
Neg
PfG
PfG
PfG
Neg
Neg
PfG
PfG
PfG
PfG
PfG
Neg
Neg
Neg
Neg
Neg
PfG
Neg
PfG
PfG
PfG
Neg
Neg
PfG
PfG
PfG
PfG
PfG
Neg
Neg
Neg
Absent
Neg
PfG
Neg
Absent
Absent
PfG
neg
neg
PfG
Absent
PfG
PfG
KG= Kamalapur Gallarahatti
SV= Suregehally Vaddarhatti
38
Table-22: Anopheline density in study villages
Village
Subcentre
PHC HUUYAR
Ballekatte
Thanda______ Maruth Nagara
Maruth Nagara
Ballekatte
Kankere______ Kankere_____
Kankere_____
Kurehatty
Kankere
Gowdagere
Total_______
PHC MATHIGATTA
Hosahally
Segabage
Kamalapura
Kamalapura
Hornahally
Laxmipura
Hornahally
Gopalpura
Bergur______ Belaguli
Otikere______ Belaguli
Mathigatta
Mathigatta
Total______
PHC DAS UDI
Ballapanahatty Dasudi
Bullenhatty
Dasudi
Total
Total
An culicifacies
An.fluviatilis An. subpictus An. annularis An pallidus An vagus
UF FF SG G Total MHD Total MHD Total MHD
Total MHD
Total MHD Total MHD Total MHD
6 2
0 £ 0 1
£ £ 1 0
£ £ 0 0
2 2 17 10
20
9
1
1
0
31
13.30
3.00
1.00
1.00
0.00
4.13
£
£
0 £ 0 6 6 88
7 £ 0 6 6 12
12
0 0 0 2 2 88
10
0 1133
1 0 0 2 2 00
1 0 0 2 2 00
3 4 4 13
13 11
11
13
4 32 42
14
25
10
5
3
3
31
91
14.00
25.00
10.00
5.00
3.00
3.00
15.50
11.25
£
£ £ £ £ £
£ £ £ £ £
0.00
0.00
0.00
£
£
2
1 10 7
£
0
0
0
0
0
_0
£
£
0
£
£
£
£
£
1
0
0^
0.00 78
0.00 140
0.00 _56_
0.00 88
0.00 154
0.00 516
52.00
46.67
56.00
88.00
154.00
68.80
0.00
1.00
0.00
0.00
0.00
0.00
0.00
0.13
7
10
75
166
18
26
48
350
7.00
10.00
75.00
166.00
18.00
26.00
24.00
43.75
£
£
£
£
£
£
£
0.00
0.00
0.00
47
23
70
47.00
23.00
35.00
£
£
2
£
£
£
2
1
0
0.00
0.67
0.00
0.00
0.00
0.27
£
1.00
0.00
0.00
0.00
0.00
0.00
0.00
0.13
£
£
£
£
£
£
£
0.00
0.00
0.00
£
£
£
£
£
1
0
0
0.00
0.33
0.00
0.00
0.00
0.13
£
£
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
£
£
£
£
£
£
£
0.00
0.00
0.00
£
£
0
0
1
0
0
0.00 98 65.33
0.00 152 50.67
0.00 57 57.00
0.00 89 89.00
1.00 155 155.00
0.13 551 73.47
0.00 22 22.00
0.00 36 36.00
0.00 85 85.00
0.00 171 171.00
0.00 21 21.00
0.00 29 29.00
0.00 79 39.50
0.00 443 55.38
0.00
0.00
0.00
47
23
70
47.00
23.00
35.00
*
39
Table-23: Insecticide spray history in Tumkur district (2000-2001)
Taluk ‘
PHC
Insecticides used (rounds) ,
Gubbi
Kunigal
Turuvekere
Sira
Hosakere_____
Doddachangavi
Kadaba______
Nithur_______
Chelur_______
Yedavani_____
Mayasandra
Turuvekere
Banasandra
Dandinashivara
Mavinakere
Sira
Bukkapatna
Thavarekere
Koratagere
C N Hally
Pattanayakanhalli
Thovinakere
Handankere
CN Hally
Huliyar
Mathigatta
Kandikere
Dasudi
Tumkur
Tiptur
Madhugiri
Sattikere_____
Thimmanahally
Kyathsandra
Ramagondanhally
Bellavi_________
Honnavalli
Badavanahally
Midigeshi______
I D Hally
2000
’
DDT (2)
DDT (2)
DDT(l)
Deltamethrin (2)
Deltamethrin (2)
DDT(l)
DDT (2)
Deltamethrin (2)
Deltamethrin (2) OR
DDT (2)
DDT (2)
DDT (2)
DDT (2)
Deltamethrin (S)
DDT (2)
Deltamethrin (S)
DDT (2)
Deltamethrin (S)
DDT(l)
DDT (2)
Deltamethrin (S)
Deltamethrin (2)
Deltamethrin (2)
Deltamethrin (2+S)
Deltamethrin (2+S)
Deltamethrin (2)
Deltamethrin (S)
DDT (2)
DDT (2)
Deltamethrin (S)
Deltamethrin (2)
2001
DDT (2)
DDT(l)
DDT (2)
DDT (2)
DDT (2)
DDT (2)
Malathion (2)
Malathion (2)
Malathion (2)
DDT(l)
DDT (2)
DDT (2)
Malathion (S)
Deltamethrin (S)
Deltamethrin (S)
Deltamethrin (S)
Deltamethrin (S)
Deltamethrin (S)
Malathion (I)
DDT(l)
DDT (2)
DDT (2)
Deltamethrin (S)
DDT(l)
Malathion (S)
Malathion (S)
S= Special round
40
Table-24. Staff Position and Vacancy
(District Tumkur, Karnataka)
Name of the
Taluka
(No. of PHC)*
Tumkur (9)
Senior Health
Assistant
Sanctioned Vacant
6
0
Junior Health
Assistant
Sanctioned Vacant
38
10
Lab. Technician
Sanctioned Vacant
9
3
Kunigal (8)
5
2
43
23
8
2
Gubbi (10)
4
0
38
22
10
1
Turuvekera (5)
4
1
26
8
5
2
Tiptur (8)
3
0
32
10
8
3
C.N. Haiti (8)
4
2
29
14
8
6
Sira (8)
6
3
48
28
8
6
Madhugiri (12)
4
1
49
35
12
5
Pavagada(7)
4
4
35
23
7
2
Koratagere (6)
3
0
26
15
5
2
Total 10(81)
43
13
364
188
80
32
♦ Malaria Reporting PHCs - 81 (Total PHC - 93)
41
Table-25. Training Required For Health
Functionaries
(TUMKUR DISTRICT, KARNATAKA)
TRAINING
STATUS
S.NO POSITION
SANCTIONED
IN
POSITION
1
DMO
1
1
Trained
2
Medical Officers
93
79
To be Trained
3
Malaria Inspectors
7
7
To be Trained
4
Senior Health Inspectors
43
31
Trained
5
Junior Health Inspectors
360
177
To be Trained
6
Lab Technicians
81
49
40 To be Trained
7
Auxiliary Nurse and
Midwife
555
555
To be Trained
8
Mahila Swathiya Sangha
(MSS) .
345
345
To be Trained
42
Partnership and Linkages
Two workshops were organized to identify partners to be involved under Roll Back
Malaria initiative. One workshop was held at district headquarters Tumkur on 3rd
September 2001, another at Taluk C. N. Hally of^ district Tumkur on 7th September
2001. Representatives of various non-govemment organizations, government sectors,
private sectors and community attended the workshops. The target sectors were:
•
•
•
•
•
•
Health Department
Non-Govemment Volunteer Organizations (NGOs)
Private Health Care Providers
/
Non-Health Government Sector
'
Education Departments
Community Representatives- MPMLA/Village President
The objectives of these workshops were to interact with different groups and get their
opinion for their active partnership in formulating malaria action plan.
A. Workshop at Tumkur
The workshops was organized by MRC and NAMP with the help of District Health
Office, Tumkur on 3rd September 20001 at IMA Hall, Tumkur. A total of 90 participants
from various sectors attended the workshop. Among important person following were
present
1. Shri T. B. Jayachandra. Honourable Minister. Agriculture, Karnataka
Government and District Minister. Tumkur
2. Shri S. Shivanna, MLA. Tumkur
3. Dr. M. V. Murungendrappa. Additional Director (Health Services),
Government of Karnataka
4. Dr. Chikka Basavaiah, District Health and Family Welfare Officer (DHO),
Tumkur
5. Dr. S. Siddagangaiah, District Malaria Officer, Tumkur
6. Dr. Ravi Narayan, President. Community Health Cell, Bangalore
7. Dr. T. Adak, Dy Director, MRC, Delhi.
Shri S. Shivanna inaugurated the workshop. Later Honourable minister Shri T. B.
Jayachandra joined the workshop.
To work out the strategies for building partnership with various sector under Roll Back
Malaria initiative under local need and situations, the participants were divided into three
44
groups, each group came out with recommendations after group discussion. Group leaders
of each groups presented the outcome of discussion and their recommendation.
Recommendations o f Working Groups:
Group 1. Govt, health officials, NGOs and Education
Group Leader:
Sliri N. K. Yetiraj, President, Tunkur Science Forum,
Tumkur
Rapporteur:
Dr. Rajan Patil, Community Health Cell, Bangalore
A total of 25 representatives from volunteer organizations and education department
participated group discussion. The outcome recommendations of the group are as follows:
A. Involvement of volunteer organizations
Partners in Programme:
1. Broader and separate meetings of NGOs should be organized for effective
planning and implementation.
2. Various voluntary organization such as Stri Shakti/Yuva Sanghas/Self Help
groups / Mahila Sanghas groups may be involved in the programme
implementation.
Strategies for IEC:
Through Gram Sabha, Kalajathas. slide/video/film shows, popular science lectures,
wall writing, poster and charts etc
Development of Infrastructure
1. Shop keepers / disabled people from community may be identified for
establishment of
□
Fever Treatment Depot (FTD)
□
Drug Distribution Centre (DDC)
2. Village level Health Committee may be established, activated if already
present.
B. Involvement of education svstem
1. Cluster level training meeting
Tumkur District Education structure is divided into clusters. Each cluster covering
schools (both govt and private) in two panchayat area. There are about 28 panchayats
in CN Halli, hence 14 clusters. Each cluster covers bout 50 teachers who meet bi
monthly. The malaria could be introduced in these meetings.
Samudaya Shale :
This programme is initiated by the Deputy director, Public Instruction Department.
Under this scheme the school is supposed to organize community meetings in the
45
school campus. The basic objective of this scheme is to keep the community informed
about the progress of the children studying in the school and developments in the
school. This scheme has been a failure, since the turnout in these meetings was very
meager. The department changed the frequency from monthly to once in three months.
In the group discussion it was felt that this scheme could be made more interesting if
the issues concerning community are taken up in the meeting rather than just
restricting these meeting to progress of students and schools. Malaria could be starting
point in these meetings.
2. School and community meetings must be used to create awareness.
3. Resource persons to be identified motivated and trained to conduct awareness
programme. Forced, circular work will not work.
4. Inter-linkage with various departments and forums such as Revenue, Gram
Panchayat, Health, Agriculture, Horticulture, Women and Child Welfare, Nehru
Yuvaka Kendra, Mahila Sangha, Yuvaka Shangha etc. should be established.
5. Peoples’ representative should also be involved for sustained movement.
Group 2. Government Health/Non-Health Officials
Group Leader:
Dr. P. R. Chidananda, Taluk Health Officer, CN Hally
Rapporteur :
Mr. T. R. Raghunatha Rao, Ex-Dy Director-General, ICMR
The group consisted of government medical officers and paramedical staff and officials
from other government department. A total of 21 participants attended the workshop. The
group discussed the reasons of malaria endemicity in Tumkur. The reasons identified and
their recommendations were as follows:
A. Technical
1. Many cases are migratory and no mechanism exists to monitor, treatment and
follow up them. More often the patients give incomplete address and it is difficult
to follow them up for RT.
2. Very "often patients by-pass the physicians and approach Chemists directly for
medicines, this has often lead to incomplete treatment of malaria and thereby drug
resistance. This type of OTC dispensing of drugs should be prevented by enacting
laws.
3. Some of the private practitioner of traditional medicine and quacks give wrong
treatment. They must be educated about national drug policy of malaria treatment.
4. Even in government hospitals, supply of antimalarials is irregular, insufficient and
erratic which are to be urgently addressed.
5. Laboratory facilities are inadequate. Technicians are newly appointed and need
training. Microscopes need periodic servicing and 5X eyepieces to be replaced
with 10X. Quality of blood smear and staining is to be improved.
6. Incentive is to be given to efficient technicians.
7. Active surveillance should be strengthened by appointing existing vacancies.
46
8. Adequate transport and provision for POL should be made available for carrying
out effective active surveillance
9. Malaria programme should be treated at par with other programme for the purpose
ofTA/DA.
10. There is not enough administrative power to DHO/THOs for effective
management of malaria activity, this need to be addressed.
11. A uniform national drug policy should be enforced on the GPs and nursing homes.
B. Community Participation and Intersectoral Coordination
1. Elected members of district should meet periodically to assess the situation. Under
their guidance government departments should come together to do their part of
duty towards malaria control
2. GPs and private nursing home people should also be involved in such meetings.
Group 3. Private health care providers
A total of 35 participants from health care providers such as private health practitioners,
dispensaries, diagnostic laboratories attended the meeting. Some government health
officials were also present in the group. The group’s recommendations are as follows
1. The group strongly recommended the partnership of general health practitioners,
dispensaries, diagnostic laboratories, and shopkeepers.
2. The group realized need of stronger interaction between government health agency
and prix ate health care provider for effective malaria control.
a. The health implementing agencies should provide information about latest
national drug policy to the private practitioner.
b. The government should make educational materials available to local
practitioners for rational and scientific treatment.
3. The private practitioner may contribute to solve the malaria problem by educating
their patients about.
a. The necessity of complete treatment for malaria treatment to avoid
recrudescence and drug resistance.
b. Educating the patients about how to prevent themselves from malaria.
c. Suggest to patient for report to hospital in case of any fever.
4. The private practitioner should report of their finding to local health agency about
a. Malaria cases detected in their clinic
b. Drug resistance
c. Occurrence of epidemic noticed
5. The private practitioners should recommend the patients for blood smear
examination for rational treatment
47
6. In case GPs does not have diagnostic facilities with them, government diagnostic
facilities available at periphery may be utilized for blood smear examination of
their patients
7. It was observed by private diagnostic laboratories that some patients get their
blood examined without consulting physicians, in such cases patients should be
advised to consult physicians for correct treatment and should educate about
consequences of wrong treatment.
8. Treatment of malaria on the basis of merely clinical feature should be discouraged.
Proper radical treatment should be ensured following blood smear examination.
B. Workshop at CN Hally
Another workshop was organized in C. N. Hally of district Tumkur by MRC and NAMP
with the help of Taluk Health Office, C. N. Hally on 7th September 20001 at Ambedakar
Bhawan. A total of 92 participants from various sectors attended the workshop. Among
important person following were present
1. Shri Suershbabu, MLA, Karnataka
2. Mrs. Draksayini, President, Zila Panchayat, Tumkur
3. Dr. Ravi Kumar, Chief Health Officer, Regional Directorate of Health &
Family Welfare, Bangalore
4. Dr. S. Siddagangaiah, District Malaria Officer, Tumkur
5. Dr. C. Mahadev, Taluk Health Officer, C. N. Hally
6. Dr. T. Adak, Dy Director, MRC
Shri Suershbabu, MLA Karnataka, inaugurated the workshop. Mrs. Draksayini, President.
Zila Panchayat, Tumkur, was the Chief Guest.
To work out the strategies for building partnership with various sector under Roll Back
Malaria initiative under local need and situations, the participants divided into three
groups and discussed. Group leaders of each groups then presented the outcome of
discussion and their recommendation.
Recommendations of Working Groups:
Following recommendations were come out from various groups. The recommendations
originally were in local language, which was transcript by Shri T. R. Rghunatha Rao.
Group I NGOs
Facilitator; Shri A. Prahlad, CHC, Bangalore
A. Community understanding on Malaria:
The group felt that community need health education about the malaria particularly
about their cause, measure of prevention and role of community in malaria control.
48
There exists lack of community cooperation in contiol of malaria and knowledge
about malaria that is to be motivated.
B. Participation as partners in Malaria control
1. Getting organized
2. Awareness camps
3. Cooperating with village panchayats
4. Formation of informal health committees
5. Involving other likeminded association
6. Cooperating with local Midwives/Nurses etc.
7. Cooperating with local health workers
8. Cooperating with Anganwadi workers
9. Involving School Teachers
10. Utilising available media
11. Establishing malaria screeing center
12. Appointing village health workers
13. Undertaking appropriate malaria control programme at right time
C. Establishing link with community vs. Govt and vice - versa
Establishing Links with NGOs Vs Govt
1. Efforts to get Govt policy changed to control malaria through intersectoral
cooperation
2. Establish healthy relation with village panchayat
3. Strive for effective style of malaria control work by Govt agencies
4. Strive for village level malaria control programme policy
5. Have village health committee
6. Through School committees
7. Conducting PRA activities
8. Through Anganwaadi workers
9. Utilize health workers
10. Through Self Help groups
11. Village
12. Publicity through Information Centres
13. Training elected Taluk & Village officers
14. Establishing pressure groups in the community.
Group II School Teachers /Science Forum/Clubs/Chemists
1. The students are most potential target group for health education. For effective
health education there is need of training of school teachers.
2. For proper health education school teachers should be trained on malaria
through Zonal Resource Centre.
3. The Physical Culture Teachers, which are 88 in numbers in C.N. Hally taluk,
should be trained in their monthly meetings.
49
4. The high-school teachers, specially science teachers, should be trained through
Taluk Science Forum.
5. The school teachers and students should collectively undertake village sanitary
work.
6. Continuous malaria information centre may be established in community.
7. The services of ‘Kalajatha’, a successful mode of street plays, can be taken for
imparting health messages in community.
8. The clubs such as Rotary Clubs may encourage the community, group or
organization for such work by awarding prize.
9. It was advised that Chikkanayaka Youth Club should conduct seminar on
malaria under the leadership of Dr. H. Sudashan, Chairman, Karnataka Health
Task Force.
Group- III: Govt. Health Workers
Number of participants: 13
1. Staff pattern - Earlier one male and one female worker used to take care of 3 to 5
thousand population, but now they have to cater 8 to 10,000 persons, In addition
Junior and Senior workers have pressure work of other responsibilities. All these
has resulted in improper work. The REASON is posts that are vacant for over 10
years remain unfilled. These posts should be filled immediately for effective
malaria control.
2. In malaria control Sr. health workers responsibility is great, but in the newly
created PHCs Sr. Health workers Post has not been sanctioned. This should be
done soon and posts filled u p.
3. Quick case finding and PT - To fulfill this each and every Health Centre should
ha\ e a Malaria Laboratory suitable staffed.
4. Immediate Treatment of fever cases - Although Sr. Health Worker is supposed
to take care of this activity, it is Jr. H.W. who has been asked to do this at the cost
of surveillance work. When he does this along with other National Programme
entrusted to him, naturally certain technical deficiencies crop-in. Like Leprosy
treatment, giving antimalarjals in Capsule form of increased strength (bringing
down quantity of tablets) may be tried.
5. Health workers in Malaria has been denied regular TA & DA from 1996, where as
other programme workers get it This has caused heartbums and demoralized
staff;. Therefore this may be restored and transport facility given.
6. Insecticides - There is public apathy & non-cooperation to insecticide spraying.
The reason is insecticides like DDT, BHC & Malathion odour and colour is
50
disliked by the community. They demand and insist either ICON Or Solfac
insecticide be sprayed. This has resulted in no spray in households, but they insists
spraying in cattleshed also.
7. In addition there must be unform insecticide (same insecticide) spraying in the
whole taluk. For this purpose, firstly this activity should be done simultaneously in
whole taluk, secondly the daily wages given by the Govt is far less than outside
resulting in no workers for the activity. Therefore daily wages should be increased.
8. Village Sanitation/ Cleanliness - In this regard Health workers need the whole
hearted cooperation of Village Panchayat and the Community.
9. Due to the very special style of malaria treatment in Private Nursing Homes many
cases are not recorded (more than half). But since the treatment is more often non
malaria specific malaria problem is getting complicated.
10. There is an immediate need for truthful health education about malaria in the
community. This should be given top priority.
ll. Printed registers for records maintenance are not available. .As a result valuable
data is scanty/ unavailable.
12. Human and effective supervision will increase efficiency at lower levels.
13. To enable Health workers to do their work more efficiently interest free loans may
be given to buy Two-wheelers.
14. Health workers daily handle blood contaminated needles and syringes, therefore
these workers may be immunized against Hepatitis B and other diseases freely.
15. Community feels Govt, given antimalarials are of low quality and efficiency,
therefore quality of antimalarials may please be improved.
Group IV Govt. PHC Doctors
Number of participants: 20
Facilitator; T.R. Raghunatha Rao.
Group Leader; Dr. B.V. Channabasavaiah, Medical Officer, Tiptur.
1. Improve
- Infrastructure
- Staff Vacancies (Man-power development)
- Active surveillance (Early diagnosis & Treatment)
2. Good transport facilities
51
-ti
3. Give - Continuing Medical Education particularly on Malaria in this sector so also
appropriate courses to Sr. Health Workers (M&F).
4. Provide Good Health Education (Print & Electronic media)
5. Bring G. Ps, Private practitioners under control particularly for national
programmes. Prevent misuse of drugs.
6. Do Timely insecticide spray at a TIME especially in border districts also and
introduce biological control methods.
7. Change in Hospital working hours-bring it 9 a.m. to 4 p.m. this enables more
patient care including lab service.
8. Give uninterrupted supply of medicines. Slides, Lancet and Stains.
9.
Appoint good well trained Lab Technicians.
10. Provide good Supervisory staff.
We do well implementation of programme.
Comments:1. Among 20 doctors of the group 6 were from the neighbouring districts. They as
well as Tumkur district (CN Hally) doctors were of the opinion that it is a great
problem to locate patients. Reason is often they belong to other district although
they come to nearby PHCs. This has resulted in statistics of a district distorted.
Therefore they suggest that for atleast for malaria control PHCs coming under the
boundary areas be formed under one umbrella of administrative control. This will
yield more positive result in the control of malaria.
2. When PHC doctors are posted from no-problem area to problem area like CN
Hally, doctors should be given orientation as to the nature and depth of problems
therein. In fact one of the doctors did confess that when he was transferred to CN
Hally recently, his knowledge of malaria was insufficient.
3. Therefore all the doctors felt that they should get Continuing Medical Education
from competent persons preferably MRC/NAMP at least once in 3 years.
4. Similarly Laboratory Technicians too should get refresher courses to keep their
skills sharp.
5. When their attention was brought to the malaria teaching programme produced by
MRC, they had no information about it. They said, it should be loaned these tapes
by the Jt. Director for viewing and educating themselves and other workers.
52
___ _ eA
Oo,
07191
y /'
si v
s*
■-V
-
...-zzM
.
6. In one voice they said 'How a medical officer is responsible for a case of death if
the patient did not come to them’? Unfortunately elected representatives of all
levels hold them responsible and victimize them. This should stop.
7. Regarding Antimalarials supply, all of them said, always it is short supplied. When
it is needed it is not there. For eg. if 2000 primaquine is indented they get 500
only. How they can do RT?
8. Continuing on antimalarials, patients feel bad at the large number of tablets
(Chloroquine & Primaquine) they have to swallow. Can it not be reduced by
capsuling them? Similarly adult and pediatric tablets should be supplied to make
dispensing easy.
9. They ask, when GPs and Nursing Home prescribe and administer latest
antimalarials like emok why Govt, still persists in Chloroquine? Although it is
very well known that drug resistance is of the order of 40%. Why not Govt, also
does the same and control malaria.
10. If the above is not possible, let there be a National antimalarial drug policy. Every
one Govt. & non-Govt. Private, GPs enforced to follow it.
11. Let malaria control be responsibility of all concerned departments of the Govt.
Like PWD, Fisheries. Forestry, House building etc. Enforce intersectoral
coordination and cooperation.
12. For insecticidal spraying actually there is no money to lift these and do spraying.
Also it has to be done when needed not when the Govt, gets the stock. There is no
planning in advance.
13. Existing timings of PHCs hamper patient care. In villages people come between 9
am to 3 pm. at that time Lab is not working. Therefore for maximizing patient care
in one visit Change it to 9 am to 4 pm.
14. Slides supplied are of r.Jt good quality, this results in improper smear taking and
diagnosis. Do supply gcod quality slide and on time. Also there is need to increase
technicians strength at ’.east during these epidemic times. This will enable early
diagnosis and proper treatment.
15. Genuine problems of Health Workers like filling up of vacant posts, posts due to
retirement, posts in newly created PHCs should be attended to. From 1996 TA &
DA of these staff are withdrawn. Therefore put malaria workers on par with other
National Programmes for TA & DA.
16. There is no Health Education worth its name. To bring about effective community
participation, introduce health education extensively and intensively.
53
17. Even PHC doctors does not have transport how can he treat positive cases
scattered in over 8 to villages, even Pf cases get ignored. There is no transport to
bring slide smears from over 100 Kms.
18. Stop political and other interference in transfers, reporting to duty even on
deputation etc.
19. Finally doctors were of the view if many of their problems are solved they will be
too happy to implement and control malaria. The problem persists because it is not
addressed to and solved.
Model of Action Plan:
During workshop a voluntary organization (NGO) group, Community Health Cell based at
Bangalore, came out with a working model for mobilization of community by involving
various government and non-govemment organizations. An outline of their perceived
concept and action plan is given in fig-5.
54
Plan of action for List - Tumkur
Zilla Panchayat
▼
Chief Executive Officer (zp)
Jpty. Commissioner
F
DHO
1
Taluk Executive Officer
Dy. Director
DMO
(Fisheries)
DSO
(District Surveillance Officer)
Taluk Health Officer
PHC MO
l
ANM
MPWs
I"
Collaborate work for
[|i
(
Releasing of Fish along with
Gram panchayats
To provide
Gram
panchayats
with
materials like
ringnet,
dragnets
(mosquito
net cloth),
straners, etc
—
■
I
Taluk Asst. Dir (Fisneries)
To produce larvivorus fishes i.e..
Guppies for use in wells (& Gambusias
in tanks (never mix the two fishes
together)
I
Grass Carp fish eliminates aquatic weeds
in irrigation town where malaria vector
breeds exclusively. Hence these fishes
are suggested to be released @ 20% of
the total edible carps
=
Village Community
FIG. 5.1
55
Opportunities for
Community
mobilization through
education system
>
CHAITANYA SCHEME
(activity based learning)
SAKSHAR MITRA
(Community contact programme)
>
P.T. TEACHER
(Sports + Health Education)
CONTINUING EDUCATION
CENTRES
(Preraks and up Preraks)
<
>
MINI PROJECTS
(by teachers in twos)
SAMUDAYATTA SHALE
>
TEACHER TROUPE
(perform Kala-jarhs)
FIG. 5.2
56
COMMUNITY MOBILIZATION IN CN HALLI
CHC
MRC
ROHE
PHA
POTENTIAL PARTNERS
CEO
(ZP)
TSF
(Tumkur
Science Forum)
Teacher
Training
PRIs
Gram
Panchayats
STL
(a module to teach
malaria control for
children)
NGOs
Medical
College
CN Hally/
Sira/Gubbi/
Tiptur
IMA
(Local Practitioner)
PHA
(People’s
Health
Assembly)
Capacity
Building BS prepm
Samudayatta
Shale/Sakshara
Mitra schmes
GPs
PHC/
DMO/
DHO
SHGs
(Self Help
Groups)
VILAGE COMMUNITY
FIG. 5.3
57
»
TARGET GROUPS FOR IEC
TO MOBILIZE COMMUNITY IN
CNHALLI
4
1. STUDENTS
2. WOMEN GROUP
3. GEN. PUBLIC
4. PANCHAYAT
MEMBERS
E
FIG. 5.4
58
STARTE6IES TO INVOLVE SCHOOL CHILDREN
Middle
Schools
{n=105}
(in CN Halli Taluk)
Avg. 100 students/ school
Total coverage> 1,00,000
High Schools (n=45)
Jr. Colleges (n=9)
Degree Colleges (n=3)
A
MIDDLE SCHOOLS (n^=105 teachers)
35 teachers - in each batch,
Total = 3 Batch,
HIGH CHOOLS AND
JR. COLLEGES
(n=50-60 teachers)
50-60 teachers
(combined)
=2
Tools- STL module on malaria. Videos, Posters
Training Centres: 1. CN Halli Town
2. Huliyar
3. Hannadekere
FIG. 5.5
I
One batch
59
STARTE6ES TO IWOLVE liOMEA IN
CH HALLI TALUK
'? ■■
SELF HELP GROUPS (SHGs)
Total SHGs in CN Halli Taluk:
700
1 SHG = 10-15 women
(700 SHGs x 15 women)
Coverage - 7000 - 10,500 women
FIG. 5.6
60
CONTINUING EDUCATION CENTRES
Resource available :
1 Prearak & 1 up-prerak / 2000 population
I-
CN HALLI TALUK POPULATION -
3 LA
J
Hence total preraks available
C
100 Preraks
100 Up Preraks
1.
2.
3.
4.
Training SHGs (4 groups at a time)
Smear collection
FTDsandDDCs
Facilitating conduct of Kala Jathas
FIG. 5.7
61
KALA-JATHA TEAMS
Composition:
Each KJ team - 10 members
(5 teacher + 5 poor artists (tailor, plumber, coolies etc))
KJ Team = 10 artists/1 team
Total 4 KJ teams
Total villages in CN Halli = 300
Each KJ team covers 75 VILLAGES @ 2 VILLAGES/DA
@ 2 HOURS IN EACH VILLAGE
4 KJ TEAMS REQUIRE 40 DAYS TO COVER ALL
VILLAGES (300) IN CN HALLI
FIG. 5.8
62
POTENTIAL PARTNERS FOR CONTROL
PROGRAMME
L Government Departments:
1. Leprosy, Tuberculosis, Women and Child Welfare dept.
2. Engineering Department
3. Fisheries Department
4. Irrigation Department
5. Agricultural Department
6. Department of Mines and Geology
7. Education Department
IL Other Non Government Agencies:
C H
1. Indian Medical Association (IMA) (Two branches at Tumkur and Tiptur)
2. Federation of Retd. Engineers Association located state HQ looking after sanitation /
drainage problem
3. Voluntary Organisations - Rotary and Lions Club
4. Banks- Rural Development Cell (Canara Bank)
5. Private Medical Practitioners
(a) Allopathy
(b) Indian System of Medicine
(c) Quacks! RMPS
6. Community leaders
7. Panchayat leaders
8. School teachers
9. Post Master
III National Research Institutes (Bangalore)
1. National Institute of Communicable Diseases (NICD)
(Plague Surveillance Unit)
2. Malaria Research Centre (MRC)
(ICMR)
3. Regional Occupational Health Centre
(ICMR)
4. National Institute of Virology (NIV)
(ICMR)
Conclusions
Followings are the important conclusions of the situational analysis of the district, which
need specific attention.
CASE DETECTION AND TREATMENT:
A. Surveillance, and Microscopy
1. The surveillance system is generally inadequate. Many MPW posts are vacant
specially that of male MPWs.
2. The quality of blood smear is generally poor, leading to poor staining and
wrong identification of malaria parasites.
3. The quality of staining of blood smear is generally poor
4. It was observed that technicians are not familiar with ring stage of P.
falciparum, and only thick smear is examined. This leads to false negativity of
P. falciparum cases, which are with ring stages only.
5. Lack of sufficient technician: 50% of lab technician’s posts are vacant. In some
of the most problematic areas the laboratories are not functioning (e.g.
Mathighatta PHC). This is causing undue delay in examination of the blood
smears and delay in communication of result and radical treatment. It was
observed that the range of delay in examination of blood smears is 7 days to 20
days and the range of KT delay following blood examination is 5 days to 15
days, in case of Mathighatta PHC.
6. The condition of microscope is generally very poor.
7. Th'ere is need of training on slide preparation and malaria microscopy. One
week training on malaria microscopy and refresher course at yearly interval
may be urgently organized.
B. Treatment
1. Currently in Tumkur, which has been identified as high risk areas, all fever
cases are subjected to Fever Radical Treatment (FRT). The MPW give 600 mg
Chloroquine and 45 mg primaquine (adult dose) on first day at the time of
taking the blood smear and supposed to give 600 and 300 mg chloroquine on
2nd and 3rd respectively in his presence. But he can not do this because of work
pressure. Therefore he gives the tablets to the person and asks him to take them
on next two days. Our experience has shown that the patient compliance is
poor in this regard. Not even body takes the full course of tablets.
63
POTENTIAL PARTNERS FOR CONTROL
PROGRAMME
I. Government Departments:
1. Leprosy, Tuberculosis, Women and Child Welfare dept.
2. Engineering Department
3. Fisheries Department
4. Irrigation Department
5. Agricultural Department
6. Department of Mines and Geology
7. Education Department
IL Other Non Government Agencies:
C H
1. Indian Medical Association (IMA) (Two branches at Tumkur and Tiptur)
2. Federation of Retd. Engineers Association located state HQ looking after sanitation /
drainage problem
3. Voluntary Organisations - Rotary and Lions Club
4. Banks- Rural Development Cell (Canara Bank)
5. Private Medical Practitioners
(a) Allopathy
(b) Indian System of Medicine
(c) Quacks / RMPS
6. Community leaders
7. Panchayat leaders
8. School teachers
9. Post Master
III National Research Institutes (Bangalore)
1. National Institute of Communicable Diseases (NICD)
(Plague Surveillance Unit)
2. Malaria Research Centre (MRC)
(ICMR)
3. Regional Occupational Health Centre
(ICMR)
4. National Institute of Virology (NIV)
(ICMR)
Conclusions
Followings are the important conclusions of the situational analysis of the district, which
need specific attention.
CASE DETECTION AND TREA TMENT:
A. Surveillance, and Microscopy
1. The surveillance system is generally inadequate. Many MPW posts are vacant
specially that of male MPWs.
2. The quality of blood smear is generally poor, leading to poor staining and
wrong identification of malaria parasites.
3. The quality of staining of blood smear is generally poor
4. It was observed that technicians are not familiar with ring stage of P.
falciparum, and only thick smear is examined. This leads to false negativity of
P. falciparum cases, which are with ring stages only.
5. Lack of sufficient technician: 50% of lab technician’s posts are vacant. In some
of the most problematic areas the laboratories are not functioning (e.g.
Mathighatta PHC). This is causing undue delay in examination of the blood
smears and delay in communication of result and radical treatment. It was
observed that the range of de.ay in examination of blood smears is 7 days to 20
days and the range of RT de’ay following blood examination is 5 days to 15
days, in case of Mathighatta PHC.
6. The condition of microscope is generally very poor.
7. There is need of training on slide preparation and malaria microscopy. One
week training on malaria microscopy and refresher course at yearly interval
may be urgently organized.
B. Treatment
1. Currently in Tumkur. which has been identified as high risk areas, all fever
cases are subjected to Fever Radical Treatment (FRT). The MPW give 600 mg
Chloroquine and 45 mg primaquine (adult dose) on first day at the time of
taking the blood smear and supposed to give 600 and 300 mg chloroquine on
2nd and 3rd respectively in his presence. But he can not do this because of work
pressure. Therefore he gives the tablets to the person and asks him to take them
on next two days. Our expenence has shown that the patient compliance is
poor in this regard. Not even body takes the full course of tablets.
63
2. The poor compliance of drug consumption is primarily due to large numbers of
tablets being given on the first day FRT. At a time an adult patient is supposed
to take 18 tablets of primaquine (2.5 mg) and 4 tablets of chloroquine (150
mg). It is recommended to introduce the blister pack of chloroquine (600 mg)
and primaquine (45 mg) for better compliance of drug.
3. The radical treatment is supposed to be taken for five days in case of P. vivax.
This does not happen always. In most areas with high malaria incidence, this
has been reduced to three days. The total quantum of primaquine however
remains same but it is distributed over three days instead of five days(
30+30+15 mg for adult cases)
C. FTD/DDC
1. Currently only few FTD and DDC are working in Tumkur distict. Only the
Anganwadi workers are helping out in FTD and DDC. No other community
leader is helping in this regard.
2. Poor liaison is observed between MPW and FTD/DDC.
DRUG RESISTANCE
There is no data available on drug resistance in P. falciparum. Though the study
team has generated some data on therapeutic efficacy of chloroquine against P.
falciparum, which indicate that the parasite is susceptible to chloroquine,
monitoring of drug resistance in different area is urgently required
INSECTICIDE RESISTANCE
Mechanism for periodic monitoring of insecticide resistance at subcentre levels is
urgently required. There is no any record of insecticide resistance in vector, which
is an essential component for policy decision on insecticides to be used in an area.
RESEARCH INPUT:
There is urgent need of research input in collaboration with research organizations
to resolve some of the basic problem required for effective planning of malaria
control strategy.
i. Stratification of vector species distribution especially sibling species of An.
culicifacies and An. fluviatilis, which differs in distribution pattern and
relative vectorial efficiency
ii. Vector incrimination studies to identify the vector species and transmission
period for planning proper intervention strategies.
iii. Monitoring of insecticide resistance in two malaria vectors An. culicifacies
and An. fluviatilis for the selection of proper insecticide.
iv. G.R. of breeding places for planning the release of larvivorous fishes for
control of larval breeding.
v. Drug sensitivity of P. falciparum and P. vivax against commonly used
antimalarials.
64
vi. Efficacy of 5-days radical treatment of primaquine in P. vivax should be
studied
LOGISTIC
1. Allocation of adequate fund should be made available against TA/DA and POL
to implement proper monitoring and supervision, filling up of vacancies,
training etc.
2. Quality control of insecticides, insecticide spray, spraying equipments and
drugs should be ensured.
3. District Malaria Officer, who is responsible for all activities related to malaria
control should be empowered by providing adequate administrative and
financial power.
INTERSECTORAL COORDINA TION/COMMUNITY PARTICIPA TION
1. The help of other government or non-govemment sector for malaria control is
negligible. Malaria is still being perceived as a responsibility of health department.
Other department does not see them role in causation of malariogenic condition or
in control of such situation.
2. The fisheries department has identified existing hatcheries in Tumkur district for
larvivorous fishes. But there are no mechanisms for transportations of fishes to the
field.
3. The community is not aware of their responsibility. They think that malaria control
is sole responsibility of government. They even don’t know how they can help in
malaria control. Therefore, the IEC activities should be strengthened.
While analyzing the malaria epidemiological data (1999-2000) in Karnataka state it
was evident that beside few problematic talukas of Tumkur district adjoining tew
talukas of three other districts, namely Chitradurga, Chikmaguluru and Hussan are
contributing more than 25% of total malaria cases and approximately 80% oi the total
P. falciparum cases (table-26 and fig-3) in the Karnataka state.
65
Weaknajisas of the Programme
■
■
■
■
■
■
■
■
■
a
a
■
■
■
■
Poor surveillance- MPW post vacant.
Inadequate staff in high incidence PHCs
Quality of blood smear & staining poor,
thin smear is not stained.
Pf ring generally not detected.
Inadequate laboratory infrastructure
Cross checking mechanism poor.
National drug policy not followed.
FRT ineffective- poor drug compliance, 22
tablets (Ch'quine 4 + Primaquine 18) on
dayl
Indiscriminate use of E-Mal/ Metakalfin/
Ablaquine
RT of P. vivax cases is delayed.
Malaria information system inadequate
Lack of supervision, monitoring and
analysis of data
Insecticide/Drug resistance status not
known
Choice of insecticides and area to be
covered irrational
Inadequate TA/DA allocation
Strengthening required in;
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
Supervision and monitoring
Cross checking
Introduction of blister pack of drugs
Monitoring of insecticide/drug resistance
Malaria Information System
Computerization of data, analysis and
interpretation
Training and redeployment
Proper functioning of DDC and FTD
GR of breeding places
Promotion of inter-sectoral coordination
Introduction of larvivorous fishes
De-centraiization of administrative/
financial power
IEC involving NGOs/ Community
Quality control of drugs/ insecticides/
spraying
Higher budgetary allocation on TA/DA
RESEARCH INPUT
Vector incrimination studies
Stratification of vector/si bling species
Monitoring of insecticide resistance
GR of breeding places for introduction of
larvivorous fishes
3
Drug sensitivity test
Efficacy of 5-days RT for P. vivax
NAMP
MRC - RHO - NICD
rd o / \ r ri
f 1J U /J
Ur .r v
; ... >
j
(TUMKUR, HASSAN, CHITRADURGA, CHIKMAGALUR,)
,vrvrTl-,xv-?^ iciya
'iHXGimn v
x*—
\v"
i
__ 7
n
liRlYllR
Ramagin
VanivilosG;
/
-J
ra
.r~-~
I ?•
/'•Hoidur
,
-F
Vi
Road
'E
...... -
/
/
;r
_________
HOSDURGA
z ■.< ■
f I 6
Jcvana ondanah
I
! X
'
y
nrnfn'ADnRaA'..
X
A
A
f■
ipur
/. 1
\
Elladakere^
'
’’
Yk
St
I\
^aa9urti^r,ramaf^u|i^
^Yagati
KADUR
I
Shinggtagere^
Mit/ino
?V
*
231
k?'- ll K0^*
ikkaf
rankanav*
ItstTvcir
ere /
Jlxz
Z
Wm CUR
• Hagai
/ fI
L\AJ !
\
dyachamaraiapuro
\
i
x
iAJayac
f < J
K / ^Banavar
3 HIKNAYAKANHALLI
' Kibbai
ARSIKEREy
^dddagurij
X«
Ha
\
Koradi
Bage^ham
*-—bamp
teondra (
)
RUVEKER
i.:w
ona
►
SalaqacneidT
, l.... ....
Duddo
>
al
PHC”S : CHIKNAYAKANHALLI, ARSIKERE, HOSDURGA, KADUR
J
Distno-Aise epidemiologies e
Jan-Sep 2001
of Karnataka-
1
SING
*
1
Bangalore(U)
152003
149646
306
123
2
Bangalore(R)
221479
3
Chitradurga
408854
221479
408854
523
48750
112
13586
1
4
Tumkur
559225
552790
22371
6053
1
5
Hassan
427251
6
7
8
Chickmagalore
Kolar________
Davangere
Shimoga
203686
7366
18998
3195
553
838
2506
5589
902
162
9
319437
308368
232271
206258
427251
315149
303373
228385
10
11
12
Belgaum_____
Bijapur
Bagalkote
443277
228192
239118
443277
228192
239118
859
2857
2501
184
234
558
13
14
Dharwad
Gadag
191385
143153
191385
143153
235
339
38
22
15
Haveri
246540
246540
168
10
16
17
18
U. Kannada
Gulburga
Bidar
19
Bellary
Raichur
Koppal
164378
252337
165322
171939
252595
141054
164378
252337
165322
168307
246594
139054
141
6238
800
4159
6495
3313
9
753
67
773
1054
394
427S55
106938
844386
2073C4
230349
724C0
24633
427855
106938
835089
207304
230349
72400
24633
19713
22697
7047
7392295
3786
114
10255
3120
2372
80
1441
1219
17
387
257
478
9
675
521
961
80
153735
32
302
6
36685
20
21
22
23
24
25
District
, Mysore_____
Chamrajnagar
I Mandya______
; D.Kannada
26
27
28
I Udupi
29
UKP Kembavi
UKP Almatti~
30
31
Kodagu_____
UKP N.Pura
UKP B.R.Gudi
Total
?
BSC
19713
23338
7047
7438399
/
174
5
1
4
12
MALARIA INCIDENCE IN 4 DISTRICTS
(CHICKMANGALORE, HASSAN, TUMKUR & CHITRDURGA
-isoooon
140000
120000
100000
Pf- 76%
30000
60000
Total- 63°/(
4000020000
0
.z
Ell
KARNATAKA
4 Districts
OTHERS
4 DISTRCTS
16%
28%
%
I
□ Pv
InPv
BPf
72%
84%
Acknowledgements
We express our gratefulness to Dr. G. V. Nagraj, Director, Dr. M. V.
Murungendrappa, Additional Director, Dr. R. K. Kumara Swamy, the then Jt.
Director (Malaria & Filaria), Dr. H. M. Basavana Gowda, Joint Director (Malaria
& Filaria), Directorate of Health and Family Welfare, Government of Karnataka,
for providing necessary information and permission for carrying out evidenced
based situational analysis of malaria in Tumkur district of Karnataka state. We are
also thankful to, Mr. A. Prakash, state entomologist, Mr. K.S. Sudarshan, State
Scientific Officer, and Mr. N.S.K. Bhagwat, Zonal Entomologist (Bangalore zone)
for day to day help in collecting valuable data. Thanks are also due to Dr. P.K.
Shome, Sr. Regional Director. Ministry of health and family welfare, Govt, of
India, Bangalore for his valuable guidance.
Our special thanks to Dr. Chikka Basavaiah, District Health Officer, Tumkur; Dr.
S. Siddagangaiah, District Malaria Officer, Tumkur and Dr. C. Mahadev, Taluk
Health Officer, C.N. Hally Mr. B.R. Jayaramaraj Urs, Deputy Commissioner,
district Tumkur for providing necessary information and facilities, and extending
cooperation for organization of workshops and field work. Thanks are due to Dr
Ravi Narayan and Mr Rajan Patil of ‘Community Heath Cell’, Bamgalore, and
Shri N. K. Yetiraj, President, Tunkur Science Forum, Tumkur for extending help
in organizing workshop.
We express our sincere gratitude to Dr. V.P. Sharma, Consultant WHO, Dr P. R.
Arbani, Sr Malaria Advisor, WHO-SEARO, New Delhi and Dr. S. Pattanayak, ex
Director. NAMP for valuable advice and suggestion through out the period of
study.
Thanks are due to Dr. S.K. Subbarao, Director, MRC and Dr. Ashok Kumar,
Director, NAMP for providing necessary directions, guidance and facilities
We also like to thank World Health Organization, South-East Asia Region, New
Delhi for providing financial assistance allocated to MRC under country budget.
67
List of Key Health Officials of Karnataka State and
Tumkur district
1. Director Health Services - Dr. G.V. Nagaraj
2. Additional Director - Dr. M.V. Murugendrappa
3. Joint Director (Malaria & Filaria) - Dr. R.K. Kumara Swamy/Dr. H.M. Basavana Gowda
(
4.
State Scientific Officer - Mr. K.S. Sudharsan
5.
State Entomologist - Mr. A. Prakash
6.
In-Charge Pf monitoring unit - Dr. C. Nagaraj, Regional Office of H & F W, Bangalore
7. Bangalore Divisional In-Charge - Dr. T. Shankar.
8.
Divisional Joint Director - Dr. Gangadhar Naik (Bangalore Zone)
9. Zonal Entomologist - Mr. N.S.K. Bhagawat (Bangalore Zone)
10. Sr. Regional Director - Dr. P.K. Shome, Regional Office of H & F W, Bangalore.
11. Chief Medical Officer - Dr. K. Ravi Kumar, Regional Office of H & F W, Bangalore.
12. Deputy Commissioner (Tumkur) - Mr. B.R. Jayaramaraj Urs, IAS
13. District Health Officer (Tumkur) - Dr. Chikka Basavaiah
14. District Malaria Officer (Tumkur) - Dr. S. Siddagangaiah
15. District TB Officer -Dr.Chelva Raju
16. District Leprosy Officer - Dr. J. Kishnappa
17. District Health Education Officer - Mr. S.K. Karadi
18. District Deputy Health Education Officer - Mr. R.K. Kolli
19. Administrative Medical Officer, C.N. Halli - Dr. C. Mahadevappa
20. District Women and Child Welfare officer - Dr. C. Prema Kumari (ICDS programme)
■21. District Surveillance Officer - Dr. P.A. Vasanta Kumar
22. Tumkur Municipal Commissioner (Urban Malaria Scheme) - Mr. Balakrishna
23. Taluk Health Officer, C.N. Halli - Dr. P.R. Chidanandappa
24. DMO of Chitradurga District - Dr. R.S. Gopal Naik
25. DMO of Hassan District - Dr. Uma Shankar
26. DMO of Chickmagalore District - DR. N.D. Shama Rao
27. Deputy Director (NAMP), Mysore Zone -Dr. P.K. Srinivas
28. DMO of Mysore District - Dr. P.K. Srinivas
29. Community Health Cell (CHC), Bangalore - Dr. Ravi Narayan
30. Voluntary Health Association of Karnataka - Ms. T. Neerajakshi
Position: 1010 (5 views)