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MALARIA

MALARIA. PRESENTER: Dr. PRACHETH.R. GUIDE: Dr. PUSHPA PATIL. INTRODUCTION HISTORY MAGNITUDE OF THE PROBLEM GLOBAL INDIA PREVALENT EPIDEMIOLOGICAL TYPES IN INDIA. HISTORY. Ayurveda - “ Vishama Jwara ” 5000 years ago: Nei Ching

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MALARIA

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  1. MALARIA PRESENTER: Dr. PRACHETH.R. GUIDE: Dr. PUSHPA PATIL

  2. INTRODUCTION • HISTORY • MAGNITUDE OF THE PROBLEM • GLOBAL • INDIA • PREVALENT EPIDEMIOLOGICAL TYPES IN INDIA

  3. HISTORY • Ayurveda- “ VishamaJwara” • 5000 years ago: NeiChing • 6th Century B.C.: Greeks and Romans- fever to swamps, low lying water • Italian word “bad air” • Herodotus: nets – protection against mosquito bites

  4. Contd… • 1885: Laveran - parasite Nobel Prize: 1907 • 1885-86: Celli and Golgi- different species, clinical features,erythrocyticschizogony, • 1891: Romanowsky-staining method • 1894: Patrick Manson- theory of life cycle • 1897-98:Ross - life cycle Nobel : 1902 • 1948-49: Strott: pre -erythrocyticschizogony • Paul Miller- DDT Nobel Prize

  5. Contd… • Chemotherapy • Artemisia annua- China • Quinine: 1stantimalarial- early 19th century • During World War II • D.D.T • Chloroquine • Talks of eradication- DDT

  6. Contd…. • Following World War II: • WHO- plan for world wide eradication • DDT • By 1958- campaign underway • Early efforts- successful • Africa – nothing attempted

  7. Contd… • By mid 1960s - failure: • Logistic and operational needs too much • Anopheline resistance to insecticides • Parasite resistance to antimalarials • Resurgence of malaria

  8. PROBLEM STATEMENT- WORLD

  9. Contd… • World Malaria report,2011: prevalent in 106 countries • Compared to a century earlier: risk reduced - 53 to 27% of earth’s land surface • No. of countries : 140 to 106 • 216 million cases in 2010 • 91%- P. falciparum

  10. Contd… • P. vivax: • 95 countries • 2.6 billion people • India, China, Indonesia, Pakistan, Vietnam, Philipines, Brazil, Myanmar, Thailand, Ethiopia • Annual infection estimates: 70 to 390 million

  11. Contd.. P. falciparum: • Africa, Central America, South Easia P. malariae: • Sub Saharan Africa, South East Asia- Indonesia, some islands of Western pacific P. ovale: • Tropical Africa, Vietnam P.knowlesi: • Malaysia, Thailand,Vietnam, Philipines, Myanmar

  12. Contd… • World Malaria report 2011: • 6,55,000 deaths world wide – 2010 • 7,81,000 – 2009.

  13. Contd… • About 86% deaths due to malaria globally- children under 5 years • 8% of total under 5 mortality • Maximum deaths- African region (16% of total under 5 mortality) • 3%- Eastern Mediterranean • 1% -SEAR

  14. Contd… • Underreporting of cases • P.falciparum resistance: 4- aminoquinolones and sulfadoxine- pyrimethamine • Mefloquineresistance- Myanmar , Thailand • Mono to multi drug resistance • Chloroquine resistant P.vivax: India, Indonesia, Myanmar • IRS coverage: 42%

  15. MALARIA IN INDIA • Atharvaveda, CharakaSamhita • During latter parts of 19th and early 20th century: • ¼ th of population • Annual incidence: 75 million cases – 1953 • 7-8 lakh deaths annually

  16. At independence: 75 million people, mortality 0.8 million • National Malaria Control Programme- 1953 • Number of cases declined – 100,000 in 1964 • National Malaria Eradication programme- 1958 • By 1961- 50,000 cases per year • Setbacks: technical, operational, adminsitrative reasons • By 1965: 1,00,000 cases per year • 1971: 1.2 billion

  17. DDT shortage, resistance to chloroquine • Resurgence • In late 1960s: Urban areas • 1976: 6.45 million cases • Urban Malaria Scheme: 1971-72, Modified Plan Operation- 1977 • Cases reduced – 2 million • 1980: API – 11.24 1986: 3.22

  18. Rising trend of cases- developments in various sectors • Vector resistance to insecticides • Exophilic vector behaviour • Vector breeding grounds • Resistance of P.falciparum to chloroquine and other antimalarials

  19. 1997: World Bank assisted EMCP • 1999: Renamed to National Anti Malaria Programme • 2002: National Vector Borne Disease Control Programme • 2005: Global Fund assisted Intensified Malaria Control Project

  20. PROBLEM STATEMENT- INDIA • 27%- high transmission 58%- low transmission • 95% population- malaria endemic areas • 80% of malaria reported confined to areas consisting 20% of population residing in tribal, hilly, difficult, inaccessible areas

  21. NVBDCP: • 1.5 – 2 million confirmed cases • 1,000 deaths annually • WHO SEAR Office estimates, 2010: • 2.16- 2.83 million cases • 3188-6978 deaths • P.falciparum: 44-60%; >70%- India.

  22. P.falciparum cases per 1000 population

  23. 88% cases and 97% deaths: • North- eastern states, Chattisgarh, Jharkand, Madhya Pradesh, Orissa, A.P, Maharashtra, Gujarat, Rajasthan, West Bengal, Karnataka • Unstable transmission • Most of population: little/no immunity

  24. Orissa: 25% of total annual cases >40.1%- P.falciparum cases 20-30% of deaths in India • Meghalaya, Mizoram, Maharashtra, Rajasthan, Gujarat, Karnataka, Goa, M.P, Chattisgarh, Jharkand

  25. Malaria in Karnataka

  26. Gulbarga Bijapur Raichur A.P.I Koppal Kolar Udupi . DK

  27. Major epidemiological types • Forests, • Forested foot hills and hills, • Forest fringe areas, • Developmental project sites • Forest related malaria: 30% of all cases • Due to exploitation: more accessible

  28. Tribal malaria • Andhra, Madhya Pradesh, Chattisgarh, Gujarat, Maharashtra, Bihar, Jharkand, Rajasthan, Orissa, North Eastern states • 50% of P.falciparum cases of country • High risk groups: infants, young children, pregnant women • Mobile tribal population- forest related activities • Limited health infrastructure • Lack of drugs at village level

  29. Rural malaria • Irrigated areas- arid and semiarid plains- • Haryana, Punjab, Western U.P, Rajasthan, M.P, plain desert areas, coastal areas – Orissa, AP, Tamil Nadu • Moderate- low endemicity • An. culcifacies • Lean period: P.vivax Exacerbations: P.falciparum • Health infrastructure- moderately developed

  30. Urban Malaria • 15 major cities- 4 metros • Nearly 80% of cases – Urban Malaria Control Scheme • Delhi, Mumbai, Chennai, Kolkata, Hyderabad, Bangalore, Ahmedabad, Bhopal, Jaipur, Lucknow, Chandigarh, Vadodara, Vizag, Vijayawada, Kanpur • Moderate- low endemicity • Vivaxpredominance, focal P.falciparumtransmission • An. stephensi

  31. Contd… • Health infrastructure – well developed • Causes: • Migration from rural areas • Urban slums • Inadequate water supply: artificial containers

  32. Malaria in towns

  33. Malaria in Project Areas

  34. Contd… • Large number of cases- disproportionate to small population • One or more major vectors – transmission • Limited health facilities – chloroquine resistant malarial parasite • Specific control strategies required

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