nvbdcp - final

8/12/2019 Nvbdcp - Final

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GUIDED BY PRESENTED BYDR SANJAY DIXIT

SHIVANI DUADR BHAGWAN WASKEL

SHRADDHA JAINDR HARISH SHUKLASHREYA MISHRASONAL BANZALSURBHI GODHA


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Vector Borne Diseases like Malaria and Filaria pose

immense public health concern and continue to be major

causes of significant morbidity and mortality in India.

These diseases are prevalent both in rural and urban

areas mostly among lower socio-economic groups of the

population, the marginalized and disadvantaged.

The dynamics of these diseases are largely determined by

eco-epidemiological, socio-economic and water

management systems.

Children, young adults, representing economically

productive sections and pregnant women are the most

vulnerable groups, although all age groups are affected.


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WHO HEALTH DAY

THEME 2014 : VECTORBORNE DISEASES

SMALL CREATURES, BIG

THREAT


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DISEASES INCLUDED UNDER NVBDCP

Earlier the Vector Borne Diseases were managed

under separate National Health Programmes,

but now NVBDCP covers all 6 Vector borne diseases

namely:

1. Malaria

2. Dengue

3. Chikungunya

4. Japanese Encephalitis 5. Kala-Azar

6. Filaria (Lymphatic Filariasis)


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MALARIA

Malaria is a potentially life threatening parasiticdisease caused by parasites known as P.vivax,P.falciparum, P.malariae andP.ovale. (Plasmodium isa protozoan parasite)

It is transmitted by the infective bite of female

Anophelesmosquito There are two types of parasites of human malaria, P.

vivax, P. falciparum, which are commonly reportedfrom India.

The parasite completes life cycle in liver cells (pre-erythrocytic schizogony) and red blood cells(erythrocytic schizogony)

Infection withP.falciparumis the most deadly form of

malaria.


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DENGUE

Dengue is a viral disease

It is transmitted by the infective bite of AedesAegypti mosquito

Man develops disease after 5-6 days of beingbitten by an infective mosquito

It occurs in two forms: Dengue Fever and DengueHaemorrhagic Fever(DHF)

Dengue Fever is a flu-like illness Dengue Haemorrhagic Fever (DHF) is a more

severe form of disease, which may cause death.


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FILARIA Filariasis is caused by several round, coiled and thread-like

parasitic worms belonging to the family filaridea.

These parasites after getting deposited on skin penetrate ontheir own or through the opening created by mosquito bites to

reach the lymphatic system.

The disease is caused by the nematode worm, eitherWuchereria bancroftiorBrugia malayiand transmitted byCulex andMansonia respectively.

The disease manifests often in bizarre swelling of legs, andhydrocele and is the cause of a great deal of social stigma.


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KALA AZAR

Kala-azar is a slow progressing disease caused by aprotozoan parasite of genus Leishmania

In India Leishmania donovani is the only parasitecausing this disease

The parasite primarily infects reticuloendothelialsystem and may be found in abundance in bonemarrow, spleen and liver.

Post Kala-azar Dermal Leishmaniasis (PKDL) is acondition when Leishmania donovani invades skincells, resides and develops there and manifests asdermal leisons.


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JAPANESE ENCEPHALITIS

Japanese Encephalitis is a viral disease

It is transmitted by infective bites of female

mosquitoes mainly belonging to the culex

family.

JE virus is primarily zoonotic in its natural cycle

and man is an accidental host.

JE virus is neurotorpic arbovirus and primarily

affects central nervous system.


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Chikungunya is a non-fatal, viral illness that is spread by the bite

of infected mosquitoes. It resembles dengue fever and therefore

differentiating between the two is important.

Chikungunya is caused by the Chikungunya virus, which is

classified in the family Togaviridae, genus Alphavirus.

Chikungunya is spread by the bite of Aedes mosquito, primarily

Aedes aegypti. Humans are thought to be the major source, or

reservoir, of chikungunya virus for mosquitoes.

Chikungunya starts suddenly with fever, chills, headache, nausea,

vomiting, joint pain, and rash. Chikungunya" means "that which

contorts or bends up". This refers to the contorted (or stooped)

posture of patients who are afflicted with the severe joint pain and

artheritis which is the most common feature of the disease.


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www.drsarma.in 16

Aedes Aegypti

Aedes albopictus


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www.drsarma.in 17

Mosquitoes dwell and get drawn to the

following :

Dark clothes

Ponds and puddles

Still or stagnant water that is contaminated Grass and weeds that are long and not

trimmed

Dirty garbage cans and drain pipes

Damp soil in gardens, farms, or even in

potted plants


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How can we control mosquito bites? Use insect repellent on exposed skin.

Wear long sleeves & pants Have secure screens on windows and doors, using insecticide treated

bed-nets and impregnated nets.

Get rid of mosquito breeding sites by

Emptying standing water from flower pots, buckets etc.,

Change the water in pet dishes in bird baths weekly

Drill holes in tires so that the water drains out

Cover all tanks, barrels, containersRemove old tires, tins, buckets and bottles

Clogged gutters and drains need to be cleared

Tanks need to be covered and cleaned - 2 weeks

Weeds and tall grass to be cut shortto decrease hiding spots


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LYMPH TICFIL RI SISPresented By:-

SHRADDHA JAINRoll No. 92


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INTRODUCTION Lymphatic Filariasis is a parasitic disease caused by thread

like nematode worms.

Infection is transmitted to man by the bites of infective

mosquitoes.

The adult worms settle in lymph nodes and the female

worm give birth to millions of young ones known as

microfilariae (Mf).

The mf circulate in peripheral blood system of infected

people and lead to further transmission of Filariasis.


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PROBLEMSTATEMENT It is a global problem (mainly Africa, Asia, West

pacific & Americas) About 95% of cases of lymphatic filariasis are caused

by infection with W. bancrofti; other parasites includeBrugia malayi and B. timori.

An estimated 600 million people are at risk oflymphatic filariasis infection in 250 endemic districtsin 20 states/UT in India.

Lymphatic filaria is prevalent in 18 states and union

territories. Bancroftian filariasis is widely distributedwhile Brugian filariasis caused by Brugia Malayi isrestricted to 6 states- UP, Bihar, Andhra Pradesh,Orissa, Tamilnadu, Kerala, and Gujarat.


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EPIDEMIOLOGIC DETERMINANTS

AGENT :-1. W. bancrofti

2. Brugia malayi

3. Brugia timori

Periodicity:-

The maximum density of mf in the blood is

between 10pm -2 am


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HOST FACTORS

AGE:-All ages are susceptible to infection butInfection rates rises with age upto 20-30 years and

then level off.

SEX:- Higher prevalence in males.

Immunity:-man may develop resistance to infection

only after many years of exposure.

SOCIAL FACTORS:- Urbanization, Industrialization,

migration of people, Illiteracy, Poverty and Poor

sanitation.


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ENVIRONMENT FACTORS

Favourable temperature for Culex is between 2238 deg C with relative humid environment.

Also associated with bad drainage as the vector

breed profusely in polluted water.

Inadequate sewage disposal and lack of town

planning have aggravated the problem in India.

The common breeding place are cesspools, soakage

pits, ill maintained drains, septic tanks, open ditches,

burrow pits, etc.


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CLINICAL MANIFESTATIONS

TYPES

1. LYMPHATIC

FILARIASIS

2. OCCULT

FILARIASIS


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LYMPHATIC FILARIASIS

(i) Asymptomatic amicrofilaraemia :-

- No symptom & no microfilariae.

(ii) Asymptomatic microfilaraemia:-

- No symptom but mf present in the blood.(iii)Stage of Acute manifestation:-

- Filarial fever, lymphangitis, lymphadenitis

and lymphoedema.(iv)Stage of Chronic Obstructive Lesions:-

- Hydrocele, Elephantiasis and chyluria.


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Elephantiasis Hydrocele


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WHY FILARIA CAN BEELIMINATED ???

Because :-

Parasite does not multiply in the insect vector.

Infective larva cantmultiply in the human host.

Life cycle of the parasite is very long (15 yrs or more).

The breeding place of the mosquito specific is dirtycontaminated stagnant water.

The parasite doesnthave any animal host in India.

The maximum density of the microfilaria in blood isduring 10pm to 2 am & mosquito bites only in thenight.


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NATIONAL FILARIASIS CONTROPROGRAMME

Operational since 1955 Operated through 206 filarial units,199 filarial

clinics, 27 survey units , primarily in endemic urbantownunder the District Health Officer.

National health policy 2002 envisages Eliminationof Lymphatic Filariasis (ELF) by 2015

In 1998 the operational component was mergedwith Urban Malaria Scheme.

In 2003-04 it was merged with NVBDCP.

The disease has been targeted for eliminationglobally by 2020.


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Objectives

Reduction of the disease in un surveyed

areas.

Control in urban areas through recurrentanti-larval and anti-parasitic measures.


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CONTROLSTRATEGY

CHEMO-THERAPY

VECTOR CONTROL STRATEGY


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CHEMOTHERAPY

1.(a) DEC(Diethyl carbamazine)Dosage:- 6mg/kg body wt. per day orally for 12 days.

Effective in killing the microfilariae.

(b) FILARIA CONTROL IN COMMUNITY

- Mass Drug Administration

- Selective treatment

- DEC Medicated salt(1-4 g of DEC/kg mixed with common salt.)

2. IVERMECTIN

Dosage:- 20-400ug/kg body wt. per day orally for 7 days.


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ANTI ADULT MEASURES

- Vector mosquitoes have become resistant to DDT and

Dieldrin.

- Though it is sensitive to pyrethrum, use only fortemporary protection and has no value in present day

vector control programme.

PERSONAL PROPHYLAXIS

-The most effective preventive measure is avoidence of

mosquito bite(reduction of man mosquito contact) by using

mosquito nets. Screening of houses can be substantially

reduce transmission, but it is expensive.


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Revised Filaria Control Strategy

The National Health Policy 2002 aims at Eliminationof Lymphatic Filariasis by 2015

REVISED STRATEGY

Annual Mass Drug Administration with single

dose of Diethyl carbamazine(DEC)was taken up asa pilot

During 2004 about 400 million population werebrought under MDA.

This strategy is to be continued for 5 years ormore to the population excluding children belowtwo years, pregnant women and seriously illpersons in affected areas to interrupt transmissionof disease.


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Filaria Control Strategies

Morbidity management of cases


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Presented By :-

Shreya Mishra

Roll No. 93


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PROBLEM STATEMENT

India and neighbouring Nepal, Bangladesh, Sudan &Brazil are the four largest foci of KALA AZAR.

Currently it is endemic in:

31 districts of Bihar

4 districts of Jharkhand

11 districts of West Bengal

6 districts of Uttar Pradesh


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MASSIVE SPLENOMEGALY


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POST-KALA-AZAR DERMALLEISHMANIASIS (PKDL)

About 5 to 10% of persons treated for visceralleishmaniasis in India develop Postkala-azar dermalleishmaniasis (PKDL).

Characterised by a macular, maculopapular andnodular rash in a patient who has recovered fromKALAAZAR and who is otherwise well.

The rash usually starts around the mouth fromwhere it spreads to other parts of the body.


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E


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KALA AZAR CONTROL PROGRAMME

Launched in 1990-91.

National Health Policy 2002 set the goal of Kala-azar

elimination by 2010.

GOI also signed a tripartite memorandum of

understanding with Nepal and Bangladesh in May

2004 for elimination of Kala-Azar from South-eastAsian regions by 2015


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The Programme sponsored by the central government,launched in endemic areas, provided kala-azar medicines,

insecticides and technical support and the State governments

implemented the programme through primary health care

system and State malaria control organizations and providedother costs involved in strategy implementation


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HOW TO USE

75% of DDT of 1 kg can be mixed in 3 gallons

of water or 50% of DDT of 1.5 kg can be mixed

in 3 gallons of water, to cover an area of 6000

sq. feet.

3 DIAGNOSIS


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3. DIAGNOSISOn the basis of clinical and lab. findings

A case of fever of more than 2 weeks duration not responding

to antimalarials and antibiotics.

Laboratory findings include anemia, progressive leucopenia,

thrombocytopenia,hypergammaglobulinemia.

Aldehyde test-1-2ml of serum is added to adrop of 40% formalin.Jellification to milky white opacity

within 2-20min. Is strongly positive.

Has the drawback of becoming positive only 2-3

months after disease onset.Non specific


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Direct agglutination test ELISA

Indirect fluorescent antibody test (IFAT)

Leishmanin test-0.1ml of leishmanin preparation is injectedintradermally on flexor surface of forearm.After 48-72hrs induration

of 5mm or more is considered positive. Negative during the active phase of kala azar,because of impaired

cell mediated immunity.

Rapid dipstickrK39,based on recombinant k 39 protein .

An immunochromatographic assay for qualitative detection of

antibodie.s to L.donovani in human serum Gold standard for diagnosis is visualisation of amastigotes in

splenic aspirate


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a) Using fine bednets

b)avoid sleeping on floor

c)All cracks and crevices should be closed by

cement.d) Cleaning of environment & clean shelters

e) Animal house, cow-shed & dairy should

be kept clean.f) Water well should be kept closed.

g) Wear full clothing while sleeping.

5. IEC


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Programme Achievements

Within 3 years of intensification (1995 as

compared to 1992)

70.66% decline in annual incidence

80.48% decline in deaths

By 2003 as compared to 1992

76.38% decline in incidence

85.20% decline in deaths.


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Dengue is an arboviral disease and its virus has 4 serotypes.


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3/23/2014 Dr. KANUPRIYA CHATURVEDI 66

Dengue is an arboviral disease and its virus has 4 serotypes.

Vectors-Aedes Aegypti. And aedes albopictus.

The peak biting times of these mosquitoes are early in the

morning or late in the evening.

Breeding sites- water collections in containers or tanks

disposable junk material- discarded buckets, utensils, tyres

flower pots etc.

The disease mainly occurs in hot and humid climate.

Man develops disease after 5-6 days of being bitten by aninfective mosquito .

There was a major out break of Dengue /DHF in Delhi in 1996

Since than many focal outbreaks have been reported from

different areas of the country mainly from urban areas.


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P e e tio a d o t ol


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Prevention and control

a) Surveillance:disease and entomological surveillance

b) Case management :Early diagnosis and treatment

c) Vector control: environmental m/m for source reduction,

chemical control, personal protection and legislation.

d) Outbreak response: epidemic preparedness and media m/m

e) Capacity building: training, strengthening human resource

and occupational research.

f) Behavior change communication:social mobilization and

I.E.C

g) Intersectoral coordination: with ministries of urban dev,rural

dev. panchayati raj and educational sector

h) Monitoring and supervision: analysis of reports, review, field

visit and feedback


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VECTOR SURVEILL NCELarval surveys:-Four Indices commonly used :

1.House Index (HI)

2.Container Index (CI)

3.Breteau Index (BI)4.Pupae Index (PI)

Adult surveys

1.Landing/biting collection2.Resting collection

3.Ovi -position traps


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VECTOR CONTROL MEASURES1. PERSONAL PROPHYLATIC MEASURES

Use of mosquito repellent creams, liquids, coils etc.

Wearing of full sleeved shirts and pants with socks

Use of bednets for sleeping infants and young

children during day time to prevent mosquito bites.

2.BIOLOGICAL CONTROL

Use of larvivorous fishes in ornamental tanks,

fountains, etc.

Use of biocides

3.CHEMICAL CONTROL


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Use of chemical larvicides like abate in breeding containers

Aerosol space spray during day time

4. ENVIRONMENTAL MANAGEMENT & SOURCE

REDUCTION METHODS

Detection & elimination of mosquito breeding sources

Management of roof tops, porticos and sunshades Proper covering of stored water

Reliable water supply

Observation of weekly dry day

5.HEALTH EDUCATION Impart knowledge to common people regarding the disease

and vector through various media sources like T.v., Radio,Cinema slides, etc.


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JAPANESE ENCEPHALITIS

JE is a mosquito borne encephalitis caused by


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JE is a mosquito borne encephalitis caused byflavivirusthat is transmitted by culicine mosquitoes.

It is also the leading cause of v.encephalitis in Asia

primarily zoonotic. (birds and pigs)

Vectors- Culex tritaeniorhynchus

Culex vishnui

Culex gelidus

Breeding sites : rice fields and standing water. Majority of infections occur in rural areas and between

July and Oct (monsoon and post-monsoon period)


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It is primarily a childhood disease(


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JE IN INDIA

JE viral activity has beenwidespread in India. The firstevidence of presence of JEvirus dates back to 1952.

First case was reported in1955

it is becoming a rising healthproblemand is endemic in14 States especially in Assam,Bihar, Haryana, UP, TN andKarnataka (80%).

Year wise occurrence-

2010-5167 cases and 679deaths.

2011-7838 C and 1137 D.

i i


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Transmission

Two cycles- Pig-mosquito-pig-

Pigs play an important role in the natural cycle and

serve as anamplifierssince they do not show any

symptoms but circulate the virus so that mosquitoesget infected and can transmit virus to man

Ardeid bird-mosquito-Ardied bird

Man is an

incidental dead-end hostto whom the

disease has been transmitted by bite of the infected

mosquitoes.

CYCLES


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CYCLES-


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STRATEGIES


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1) Strengthening the surveillance activities2) Early diagnosis and proper case management.

3) Behavior change communication of

community

4) Integrated vector control measures

5) Capacity building

6) Development of a safe & standard

indigenous vaccine.

STRATEGIES


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VACCINATION


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VACCINATION

There are 3 types of vaccines-

1)Mouse brain derived- purified and inactivatedvaccine.

Based on nakayama or beijing strains.

Dosage-2 doses 4 wks apart and booster 1 yr laterand then at 3 yr intervals upto 10-15 yrs of age.

Route-s.c 0.5ml (


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2)Cell cultured derived live attenuated vaccine

Based on SA-14-14-2 strain

Dosage- single dose of 0.5 ml subcutaneouslyfollowed by a booster 1 year later.

Integral part of UIP in 83 endemic districts of india

3)Cell culture derived inactivated JE vaccine

Based on P3 strain

Vaccination is used in the inter-epidemic

period to younger population of 1-15 yr.

of age.

Vaccination with killed JE vaccine is notrecommended for the control of an outbreak.


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hank you


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MILESTONES OF MALARIA


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MILESTONES OF MALARIA

CONTROL ACTIVITIES IN INDIA

National Malaria Control Program (NMCP) - 1953

spectacular success

National Malaria Eradication Program (NMEP) -1958

Urban Malaria Scheme (UMS) - 1971

resurgence

Modified Plan of Operations (MPO) - 1977

E h d M l i C l P (EMCP) 1997


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National Anti Malaria Program (NAMP) - 1999

NVBDCP

Intensified Malaria Control Project (IMCP) -2005

New Drug Policy -2010

Enhanced Malaria Control Program (EMCP) -1997


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NATIONAL MALARIA

CONTROL PROGRAMME1953OBJECTIVES:

To hold down malaria transmission at low level

STRATEGIES:Indoor residual spray (IRS)

Malaria control teams to survey and monitor incidence.

ACHIEVEMENTS:Decline in incidence from 75 million to only 2 million in 1958

NATIONAL MALARIA


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NATIONAL MALARIA

ERADICATION PROGRAMME1958

OBJECTIVES:

To eradicate malaria from India in 7 to 9 years

ACTIVITIES:Spraying operation

Fortnightly active case detection

Radical treatmentInvestigation of positive cases and remedial measures

ACHIEVEMENTS :Lowest ever incidence of 0.1 million in 1965

No reported deaths due to malaria


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RESURGENCE OF MALARIA -

1965 Sudden withdrawal of assistance and insecticides led to steep rise in

malaria incidence.

URBAN MALARIA SCHEME -


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URBAN MALARIA SCHEME

1971Involved 139 towns in 19 states and Union Territories.

OBJECTIVES:a) To prevent deaths due to malaria.

B) Reduction in transmission and morbidity.

NORMS:The towns should have a minimum population of 50,000.

The API (Annual Parasite Incidence) should be 2 or above.

METHODOLOGY:It Comprises vector Control by intensive antilarval measures and drug

treatment.


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RE-CLASSIFICATION OF ENDEMIC AREAS

It is based on annual parasite incidence (API)

API less than 2 API greater than 2

MODIFIED PLAN OF

OPERATION 1977

OBJECTIVES:Prevention of death due to malaria

Reduction of morbidity due to malariaRetention of achievements gained so far.


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Control in AREAS WITH API > 2:

Spraying insecticidesEntomological assessment

Surveillance

Treatment of cases

Decentralisation of laboratory services at- PHC

Establishment of drug distribution centres (DDC)

and fever treatment depots (FTDs)

Control in AREAS WITH API < 2:

Focal spraying of insecticides

Surveillance and treatment

Follow up

Epidemiological investigation


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MALARIA CONTROL STRATEGIESd NVBDCP


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under NVBDCP1.SURVEILLANCE AND CASE MANAGEMENT:

Case detection(passive and active) Early diagnosis and complete treatment

Sentinal surveillance

2.INTEGRATED VECTOR MANAGEMENT

Indoor residual sprays(IRS)

Insecticide treated bed nets(ITBN) / Long lasting insecticidalnets(LLINs))

Anti larval measures including source reduction

3.EPIDEMIC PREPAREDNESS AND EARLY RESPONSE

4.SUPPORTIVE INTERVENTION

Capacity building

Behaviour change communication(BCC)

Intersectoral collaboration

Monitoring and evaluation

Operational research and applied field research

SURVEILLANCE


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SURVEILLANCE

AIM:Case detection through lab services

To provide facilities for proper treatment

Active

Types

Passive

ACTIVE SURVEILLANCE

Carried out by surveillance workers

PASSIVE SURVEILLANCE

Search for cases by local health agencies

Cases those escaped active surveillance are screened


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INTEGRATED VECTOR

MANAGEMENT

The IVM includes safe use of insecticides and

monitoring of insecticide resistance. Themeasures of vector control and protection

include:


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ANTI-LARVAL MEASURESoSource reduction

ochemical control

oBiological control

ANTI -ADULT MEASURESoResidual sprays

oSpace sprays

GENETIC CONTROL

PROTECTION AGAINST MOSQUITO

BITESoMosquito net

oScreening

oRepellents


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Biolarvicides


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Certain strains of Bacillus sphaericus (Bs) and Bacillusthuringiensis israelensis (Bti) produce mosquitocidal

toxins

Biolarvicides

Bacillus sphaericus Bacillus thuringiensis israelensis


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Residual insecticidal spray

The indoor residual insecticidal spraying operation shouldbe started simultaneously along with indoor space spray.

The insecticide of choice will be the insecticide to which

the local vector is amenable to control.

Apply the recommended dose of insecticide chosen.

Insecticides for IRS


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Insecticides for IRS

Insecticide-formulation Dosage/m2 Efficacy(Wks)

Rounds

DDT-50% WP 1 gm 10-12 2

Malathion-25% WP 2 gm 6-8 3

Deltamethrin-2.5% WP 20 mg 10-12 2

Cyfluthrin-10% WP 25 mg 10-12 2

Lambda Cyhalothrin-

10% WP

25 mg 10-12 2


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Space spray

Two forms of space-sprays, namely thermal fogsand

cold fogscan be dispensed by vehicle-mounted or hand-

operated machines (Weekly application).

Commonly used insecticides for space spray: Pyrethrum-extract(2%), Malathion, Fenitrothion, Pirimiphos methyl,

Permethrin, Deltamethrin, Lambda-cyhalothin and

Cyphenothrin.

These insecticides instantly kill the mosquitoes, but lackany residual effects.

B h i h


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Behaviour change

communication (BCC)

BCC is a systematic process that motivates individuals,

families and communities to change their inappropriate

or unhealthy behaviour.BCC is directed at:

Early recognition of signs and symptoms of malaria.

Early treatment seeking from appropriate provider.

Adherence to treatment regimens.

Ensuring protection of children and pregnant ladies.Use of insecticide treated bed nets (ITNs).

Acceptance of indoor residual sprays (IRS), etc.

INTENSIFIED MALARIA


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CONTROL PROJECT

Launched in July 2005 with assistance of global fund for AIDS,TB

and malaria in NE states, Orissa ,Jharkhand and WB

OBJECTIVES:

1-Increase access rapid diagnosis and treatment throughcommunity participation

2-Reduce transmission by use of insecticide treated bed nets and

larvivorous fishes.

3-Enhance awareness about malaria control4-To promote community, NGO and private sector participation


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nvbdcp - final

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