Punjab & W.H.O. launch strategic Plan to eliminate MALARIA BY 2020

The Punjab Government in collaboration with the World health Organization (W.H.O.) today launched the Micro Strategic Plan to eliminate malaria from State by 2020.

Facts :

• Punjab becomes the first state in India where WHO will collaborate for Elimination of Malaria.
• The WHO would provide the technical support to State to achieve the set target.
• India has third highest burden of malaria in the world.
• However Punjab is one of the 15 low transmission States of India where only 0.1 percent cases of malaria had been reported as compared to the rest of the country.
• Earlier Punjab Government has launched the Mission Tandarust Punjab and established the best infrastructure for the De-Addiction Programme.
• CM, Punjab assured the WHO team that the Punjab Government would strictly comply with all the guidelines issued in this regard.
• Punjab can be the first State in country to achive the target to eliminate malaria by 2020.
• Special training would be imparted to the district level monitoring teams under this strategic plan.
• Under the chairmanship of Health Minister, State Task Force would monitor the every reported case regarding the malaria to control the outbreak.
• Malaria has been declared as a notified disease in the state so that the public, as well as, private health institutions have to report each suspected and confirm case of malaria to the department.
• Punjab is also the first state in the country to use malaria treatment card to ensure supervised and complete treatment of each case.
• Quick diagnose and quick treatment would be provided to the effected patient.
• The API (Annual Parasite Incidence) of Malaria in the State is well below 1.0, the target. State has been able to keep ABER (Annual Blood Examination Rate) above the target.
• The target of ABER was more than 10 till 2015. The State had revised the target of ABER in 2016 to 7.0.
• Proportion of Pf (falciparum Malaria) is very low in the State. P-Vivax malaria constitutes 97-99% of the total cases of malaria.

Analysis :

• State of Punjab is committed for micro level surveillance under which each and every reported case of malaria would be investigated and remedial measures will b undertaken to prevent further spread of Malaria.
• Case load of malaria has declined in the State since last year but one third of the cases of malaria are reported from the migratory population.
• There is a need of participation of communities and general public as well for prevention and control of Malaria.
• Punjab would emerge as a model State for other States of country.

Malaria :

• Malaria is caused by the bite of an infected Anopheles mosquito. The Anopheles sitsat an angle on walls and on hard surface and thus can be recognized with naked eye. Anopheles prefers clean water collections like puddles, ponds, wells, small canals, water tanks etc. for breeding.Anopheles mosquitoes bite at night. Some bite shortly after sunset while others bite later, around midnight or the earlymorning. Only the female Anopheles mosquito bites as she requires blood meal (protein) for laying eggs in her life time, while the male mosquito sips plant sap for survival.

Signs and Symptoms of Malaria :

• Typical: Sudden onset of high fever with rigors and sensation of extreme cold followed by feeling of burning, leading to profuse sweating. The febrile paroxysms may occur every alternate day. Headache, body ache, nausea, etc. may be the associated features.
• Atypical: In atypical cases, classical presentation as mentioned above may not manifest. Hence, any fever case without any other obvious cause in the endemic areas during transmission season may be considered as malaria. However, none of the symptoms exclude malaria with certainty therefore a trained clinician has to judge and ensure whether they constitute anyother obvious cause.

Activities being undertaken in Punjab for Prevention and Control of Malaria :

• Surveillance: Malaria surveillance connotes the maintenance of an on-going watch/ vigil over the status of malaria in a group or community. The main purpose of surveillance is to detect changes in trends or distribution in malaria and other vector borne diseases in order to initiate investigative or control measures. The ultimate objective of malaria surveillance is prevention and control of malaria in the community.Surveillance is of two types under NVBDCP:
• a) Active Surveillance: Under this, the fortnightly domiciliary visits are made by MPHW (M)/ ASHA for active search of all fever cases and blood slides are prepared and sent to the laboratory for confirmation of the cases. If found positive for Malaria, MPHW (M)/ASHA provides full radical treatment.
• b)Passive Surveillance: Under Passive Surveillance, blood slide of a fever case is made when he/ she attends the OPD of a health centre, for confirmation of Malaria.Malaria surveillance includes laboratory confirmation of presumptive diagnosis, finding out the source/ site of infection and identification of all cases and susceptible contacts and still others who are at risk in order to prevent further spread of the disease.

• Early Diagnosis & Prompt Treatment (EDPT): EDPT is the main strategy of malaria control -radical treatment is necessary for all the cases of malaria to prevent transmission of malaria. Chloroquine is the main anti-malaria drug for uncomplicated malaria. Treatment of Malaria is recommended in the State as per theNational Malaria Drug Policy 2013 issued by GOI.
• Indoor Residual Spray(IRS) : Since Malaria has declined in the State so the area for IRS has also decreased in the previous years. As per sensitivity and susceptibility tests done in the State, vectors are more sensitive to Malathion 25% wdp than DDT 50%, so Malathion 25% wdp is being used.At present the strategy in the State id to do IRS (Indoor Residual Spray) in all those villages which have API >1. As per epidemiological data of 2016, 65 villages in the State have API >1.
• Urban Malaria Scheme: Urban Malaria Scheme (UMS) was launched in 1971 by GOI under Modified Plan of Operation (MPO) which was designed to tackle the malaria load in both urban and rural areas in the country simultaneously.Under MPO, it was decided to initiate antilarval and antiparasitic measures to abate the malaria transmission in urban areas.The activities undertaken to control malaria in towns was named as Urban Malaria Scheme which was approved during 1971. UMS was started in the State of Punjab in 1977-78 in 5 towns namely Amritsar, Ludhiana, Ferozepur, Jalandhar and Patiala. Three more towns i.e. Malerkotla, Bathinda & Kapurthala were added in the scheme in 1980-81. In 1987-88, five more towns i.e. Rajpura, Nabha, Jagraon, Hoshiarpur and Gurdaspur were included in UMS. In the year 2008, 8 new towns namely Sangrur, Barnala, SAS Nagar, Phagwara, Khanna, Faridkot, Malout and Tarn Taran were included in Urban Malaria Scheme after getting approval from GOI. Under this scheme the GOI supplies the material in kind i.e. Larvicides for eliminating mosquito larvae. Now, Urban Malaria Scheme is operational in 21 towns of Punjab.Although UMS is approved in 21 towns of the State, entomological surveillance is being undertaken in 40 towns of the State from where dengue and other vector borne diseases are being reported with internal adjustment of the staff.

By: Harman Sandhu