G.P.%20CHATTERJEE%20MEMORIAL%20AWARD%20LECTURE%202003-2004%20%20Malaria%20Control%20in%20India%20by%20Dr.%20V.P.%20Sharma%20%2091st%20Session%20of%20the%20The%20Indian%20Science%20Congress%20Session%20Chandigarh%204th%20January%202004

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G.P. CHATTERJEE MEMORIAL AWARD LECTURE
2003-2004Malaria Control in IndiabyDr. V.P.
Sharma91st Session of the The Indian Science
Congress SessionChandigarh4th January 2004
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Burden of Malaria in the World

• 300-500 million malaria cases in the world
• 1.5 to 2.7 million deaths due to malaria
• 90 disease burden in Africa, South of Sahara

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Estimated Burden of Disease in Disability
Adjusted Life Years (DALYs)(WHO Report 2001)
Total DALYs
Eastern Mediterranean
(70 of SEAR DALYs)
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SITUATION ANALYSIS OF MALARIA IN INDIA

• 1 BILLION POPULATION AT RISK OF MALARIA
• 10 MILLION POPULATION UNDER SP TREATMENT
• 2 MILLION CASES REPORTED BY NAMP
• 800-1000 MALARIA DEATHS REPORTED BY NAMP
• 6 MAJOR VECTORS-RESISTANT, EXOPHILIC AND OR
  ENDOPHILIC BEHAVIOR
• NEW MALARIA ECOTYPES IDENTIFIED
• SPRAYING PRODUCES TRANSIENT CONTROL
• WIDESPREAD MONO-DRUG RESISTANCE, MULTI-DRUG
  RESISTANCE IN P. falciparum
• INADEQUATE RESOURCES
• 1 BILLION US DOLLARS LOSS DUE TO MALARIA

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HUMAN MALARIA PARASITES

• Plasmodium vivax
• Plasmodium falciparum
• Plasmodium malariae
• Plasmodium ovale

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Chronology of drug resistance in SEA Region

• CHLOROQUINE
• 1962 Thailand 1969 Myanmar 1970 Bangladesh 1973
  India Indonesia 1981 East Timor 1984 Nepal Sri
  Lanka 1985 Bhutan
• SULFADOXINE-PYRIMETHAMINE
• 1979 India Indonesia 1980 Myanmar Thailand 1985
  Bangladesh 1997 Nepal
• QUININE
• 1983 Thailand 1986 India
• MEFLOQUINE
• 1989 Thailand

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DEATHS DUE TO ARF/ARF COMPLICATIONS
IN SEVERE MALARIA IN ISPAT GENERAL HOSPITAL,
ROURKELA, ORISSA 1995-97 2000-03
Total Deaths in Severe Malaria Cases 61/431
(14.15) 236/996 (23.69) Deaths Due to
ARF/ARF Complications 14/62 (22.58) 117/265
(44.15) Deaths Due to Complications without ARF
47/369 (12.74) 119/731 (16.28)
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MALARIA TREATMENT COST OF

AN ADULT IN INDIA Drugs Cost
(Rs.)  Chloroquine 3.50-10.00 Chloroquine
injection fluids 200.00 Sulfadoxine
Pyrimethamine 7.00-30.00 Mefloquine
240.00-300.00 Artemether injections
390.00-1000.00 Arteether
injections 275.00 Artesunate injections
1120.00 Quinine tables Tetracycline 270.00
-210.00 Quinine injectionsIV fluidTetracycline
800-910  Antipyretics _at_ Rs. 5.00-10.00 per
treatment I/V fluid may be required during
Artemisinin treatment
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MALARIA INCIDENCE AND DRUG CONSUMPTION IN INDIA
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Malaria in Pregnancy

• Pregnant women attract twice the number of
  mosquitoes than non-pregnant women
• There is a greater susceptibility to P.
  falciparum than P. vivax during pregnancy
• Low birth weight babies in malarious areas are 2
  to 4 times more likely to experience failure in
  school.

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Endless Vicious Cycle of Malaria

• Malaria is the leading cause of anemia
• Malaria affects cognitive development and
  learning abilities of children
• Malaria is a risk factor of neuro-sensory and
  behavioral development in children
• Malaria-one clinical febrile episode of malaria
  consumes 5,000 k Cal.

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Role of Vectors in Malaria Transmission in India
Broad categorization based on 1996 NAMP data.
Low Medium
High
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Status of Insecticide Resistance in An.
culicifacies
Status of Insecticide Resistance in An.
culicifacies
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Distribution of An. culicifacies species A,B,C,D
and An. fluviatilis Species S,T, and U
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Biological Variations Among members of An.
culicifacies Sibling Species Complex
Peak Biting Time
Non-vector
Resistance to HCH
Fast (4-5 yrs.)
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MAJOR MALARIA ECOTYPES FOUND IN INDIA

• RURAL MALARIA
• URBAN MALARIA
• FOREST MALARIA
• IRRIGATION MALARIA
• PROJECT MALARIA
• MIGRATION MALARIA
• BORDER MALARIA

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Time taken in days (approx) for 50 per cent of
the human population to become infected at
different reproduction rates with an initial
parasite rate of 0.1 per cent
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• FACTORS THAT WILL INCREASE MALARIA
• Irrigation
• Urbanization
• Industrialization
• Migration
• Natural disasters
• Resistance in vectors and parasites
• Global warming
• Malaria control costs
• Political instability/war

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Everything about malaria is so molded by local
conditions that it becomes a thousand
epidemiological puzzles. Like chess, it is played
with a few pieces but is capable of an
infinitevariety of situations.
- L.W. Hackett (1937)
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PERSISTENT ORGANIC POLLUTANTS

• Eight Pesticides
• Aldrin, chlordane, DDT, dieldrin, endrin,
  heptachlor, mirex and toxaphene
• Two Industrial Chemicals
• PCBs and hexachlorobenzene
• Two unwanted by-products of combustion and
  Industrial Processes
• Dioxins and furans

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TIMES OF INDIA24 November 1944(On the
introduction of DDT on December 2, 1944)

• It should be stressed that it is a
  re-enforcement and not a substitute for existing
  well tried systems of malaria control, which
  should on no account be relaxed. But we believe
  that DDT is going to have a big future in the
  fight against malaria and dysentery in post-war
  India

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IRRIGATION IN INDIA
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An.culicifacies Breeding Sites on the Margins of
Bargi Dam, M.P.
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Malaria Outbreak in Bargi Dam area in Narayanganj
PHC, M.P.
Dam impounded
Dam
Dam completed
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SSP Command area in Gujarat
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Stagnant Water in Canals of the Sardar Sarovar
Project