Malaria Control in India an Utpian Dream Prof. Dr. S. Elango, MD, - PowerPoint PPT Presentation

Malaria Control in India an Utpian Dream Prof. Dr. S. Elango, MD, DPH,DIH, Director of Public Health & PM (Retd) HOD, Dept. of Community Medicine Sri Muthukumaran Medical College Chennai-69

 Recall Malaria history  Global Burden  Malaria scenario in India  Failures and challenges  New Advances/ Researches  Conclusions 2

How many of you agree that National Malaria Control Programme (NMCP) has made  No Progress  Some progress  Good Progress  Very Good Progress in control of Malaria in INDIA……….. 3

4

The Dark Ages  1500 years ago little knowledge on the cause or treatment of malaria.  During this time malaria spread – in Europe and the New World  New idea came that the disease is related with swamps and marshes.  Led to the belief that malaria was caused by malignant vapors (miasmas) – French term Paludisme roughly translates “of the marshes”  Mal’aria (bad air) was ascribed by Horace Walpole in 1740

Dis isco cover ery y of Qu Quin inin ine e (Early y 17th Ce Cent nt.) .)  Spanish missionaries learned from Indian tribes of a medicinal bark for treating fevers  Wife of the Viceroy of Peru, was cured of her fever.  The bark was then called Peruvian bark and the tree named Cinchona.  Medicine from the bark is now known as quinine.  Like artemisin, quinine still remains one of the most effective anti-malarial drugs available today 6

Dis isco cover ery y of t the M e Malaria ia Parasi site e (1880)  Charles Louis Alphonse Laveran, a French army surgeon was the first to notice parasites in the blood of a patient suffering from malaria.  This occurred on the 6th of November 1880.  For his discovery, Laveran was awarded the Nobel Prize in 1907. 7

NO NOBEL EL PRIZ IZES • Four Nobel prizes have been awarded for work associated with malaria: • Sir Ronald Ross (1902), • Charles Louis Alphonse Laveran (1907), • Julius Wagner-Jauregg (1927), • Paul Hermann Muller (1948). 8

Malaria imposes a staggering worldwide burden High None Level of malaria burden  At least 1 million deaths annually; one child every 30 Death toll seconds  350 to 500 million cases worldwide Incidence  Debilitating fevers, low birth weights, anemia, epilepsy — and death Health impacts  Reduced current productivity resulting from days and often weeks of missed work, reduced foreign direct investment and tourism  Constraints on future growth resulting from reduced Economic impacts investments in human capital (missed schooling, higher fertility rates) Source: World Malaria Report 2005, expert interviews 9

Di Distr tributio ibution n of of Mal alar aria ia (a Tropic ical l Dis isea ease se ?) Hay, et al. 2004 10

Current global estimates of population at at risk by WHO Region Approximately 0.95 billion at risk (Source: WHO regional offices, Kicewski, 2007) 11

Glo lobal al Mal alar aria ia Bu Burde den • 3.3 billion people (half the world’s population) live in areas at risk of malaria transmission in 109 countries and territories. • 35 countries (30 in sub-Saharan Africa and 5 in Asia) account for 98% of global malaria deaths. • WHO estimates that in 2008 malaria caused 190 - 311 million clinical episodes, and 708,000 - 1,003,000 deaths. • 89% of the malaria deaths worldwide occur in Africa. • Malaria is the 5th cause of death from infectious diseases worldwide (after respiratory infections, HIV/AIDS, diarrheal diseases, and tuberculosis). • Malaria is the 2nd leading cause of death from infectious diseases in Africa, after HIV/AIDS . 12

Glo lobal al Mal alar aria ia Bu Burden en Cont…. • Feared since the days of the Roman Empire, malaria remains a major health problem. • Globally, approximately 225 million malaria cases and 781,000 deaths reports each year, mostly in African children (WHO, 2010) • India contributes about 70% of malaria cases and 50% of mortality in the South East Asian Region of WHO 13

 Malaria means “bad air”  A life-threatening parasitic disease  40% of the world’s population is at risk  90% of the deaths due to Malaria occur in Sub-Sahara Africa, mostly among young children.  Around 400-900 million people are affected  At least 2.7 million deaths annually.  It is one of the major public health concerns 14

In India dia • TREND nearing eradication in 1960s (< 100,000 cases) to resurgence in the mid-1970s (~6.4 million cases) and stabilizing trend to ~2 million cases in the1990s • over 10 crore suspested malaria cases, but only 15.9 lakh could be confirmed last year (8.3lakh -P. Falciparum, 7.6 lakh-P.Vivax) • Annual deaths: 30, 014 and 48, 660 • Over 70% of India's population, or 100.41 crore face the risk of malaria infection. • Around 31 crore, however, face the "highest risk" of getting infected by the vector-borne disease. • Indo-gangestic plains and northern hilly states, northwestern India and southern Tamil Nadu state have < 10% P. falciparum, and the rest are P. vivax infections; in the forested areas inhabited by ethnic tribes, the situation is reversed, and the P. falciparum proportion is 30 – 90%, and in the remaining areas, it is between 10% and 30% Source:World Malaria report 2011 WHO 15

Epidemiological demiological Situat ation ion in India( ia(199 995-20 2010) 0) -- --Nvbdc dcp P.falcip lcipar arum um Popu pula lati tion on Total tal Malari ria a Deaths s due to Year cases Pf % API ( in ‘000) Cases (mil illi lion) n) mala laria ria (mil illio ion) 1995 888143 2.93 1.14 38.84 3.29 1151 1996 872906 3.04 1.18 38.86 3.48 1010 1997 884719 2.66 1.01 37.87 3.01 879 1998 910884 2.22 1.03 46.35 2.44 664 1999 948656 2.28 1.14 49.96 2.41 1048 2000 970275 2.03 1.05 51.54 2.09 932 2001 984579 2.09 1.01 48.20 2.12 1005 2002 1013942 1.84 0.90 48.74 1.82 973 2003 1027157 1.87 0.86 45.85 1.82 1006 2004 1040939 1.92 0.89 46.47 1.84 949 2005 1082882 1.82 0.81 44.32 1.68 963 2006 1072713 1.79 0.84 47.08 1.66 1707 2007 1087582 1.51 0.74 49.11 1.39 1311 2008 1119624 1.53 0.77 50.81 1.36 1055 2009 1150113 1.56 0.84 53.72 1.36 1144 2010 1151788 1.49 0.77 52.12 1.3 767

Malaria ia Ca Case ses, s, Pf ca case ses( s(in in mil illio ions ns) & Dea Deaths hs (2000 to 2010) Source: Nvbdc dcp

Total al Malar aria ia Cases es, , Pf %, , Dea eaths hs & MCDR Total tal Year Malari aria cases P f % Deaths MCDR % Duration tion (Mil illi lions) ns) 1995 2.93 38.84 1151 0.03 1996 3.04 38.86 1010 0.03 4 Years 1997 2.66 37.87 879 0.03 1998 2.22 46.35 664 0.03 1999 2.28 49.96 1048 0.05 2000 2.03 51.54 932 0.05 2001 2.09 48.20 1005 0.05 2002 1.84 48.74 973 0.05 7 Years 2003 1.87 45.85 1006 0.05 2004 1.92 46.47 949 0.05 2005 1.82 44.32 963 0.05 2006 1.79 47.08 1707 0.09 2 Years 2007 1.51 49.11 1311 0.09 2008 1.53 50.81 1055 0.07 2 Years 2009 1.56 53.72 1144 0.07 2010 1.49 52.12 769 0.05 1 Year

Anal alysis sis and Interpre erpretatio tion n of PF% and MCDR% R% ‘Z’ Cases in ‘Z’ Significe Year PF% MCDR% Significa million BASE END BASE END BASE END BASE END 1995 1996 2.93 3.04 38.84 38.86** -2.506 P<0.001 0.0393 0.0332* 54.175 P<0.001 1996 1997 3.04 2.66 38.86 37.87* 24.486 P<0.001 0.0332 0.0330* 8.765 P<0.001 1997 1998 2.66 2.22 37.87 46.35** -189.594 P<0.001 0.0330 0.0299* 13.319 P<0.001 1998 1999 2.22 2.28 46.35 49.96** -76.409 P<0.001 0.0299 0.0460** -89.202 P<0.001 1999 2000 2.28 2.03 49.96 51.54** -31.091 P<0.001 0.0460 0.0459* 0.495 P>0.05 2000 2001 2.03 2.09 51.54 48.20* 66.976 P<0.001 0.0459 0.0481** -10.547 P<0.001 2001 2002 2.09 1.84 48.20 48.74** -9.897 P<0.001 0.0481 0.0529** -21.715 P<0.001 2002 2003 1.84 1.87 48.74 45.85* 54.01 P<0.001 0.0529 0.0538** -3.857 P<0.001 2003 2004 1.87 1.92 45.85 46.47** -11.714 P<0.001 0.0538 0.0494* 19.364 P<0.001 2004 2005 1.92 1.82 46.47 44.32* 42.71 P<0.001 0.0494 0.0529** -15.364 P<0.001 2005 2006 1.82 1.79 44.32 47.08** -53.397 P<0.001 0.0529 0.0954** -154.258 P<0.001 2006 2007 1.79 1.51 47.08 49.11** -36.229 P<0.001 0.0954 0.0868* 27.00 P<0.001 2007 2008 1.51 1.53 49.11 50.81** -29.64 P<0.001 0.0868 0.0690* 57.917 P<0.001 2008 2009 1.53 1.56 50.81 53.72** -51.027 P<0.001 0.0690 0.0733** -14.648 P<0.001 2009 2010 1.56 1.49 53.72 52.12* 27.983 P<0.001 0.0733 0.0515* 78.533 P<0.001 1995 2010 2.93 1.49 38.84 52.12** -266.779 P<0.001 0.0393 0.0515** -59.498 P<0.001 * Decrease ** Increase

in Ma Malar laria ia Tr Tren ends ds in 3.5 120 3 100 2.5 80 2 60 1.5 40 1 20 0.5 0 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Malaria cases in million PF% MCDR/100000 20

Elements of malaria control strategies Human Drugs and diagnosis at health centre and community level Universal LLIN STOP STOP coverage Parasite Infected Infecting vector STO STOP vector P Universal LLIN coverage/ IRS 21