Malaria: Bringing Down The Burden In Odisha. Dr. MM Pradhan Dy. Director, NVBDCP, Odisha

Transcription

1 Malaria: Bringing Down The Burden In Odisha Dr. MM Pradhan Dy. Director, NVBDCP, Odisha MMV Stakeholders Meeting, Delhi (India), 8 th Nov, 212

2 Odisha at a glance Area: 156, sq kms (4% of India s land area) Popln: 42 million (3% of India) Rural : 82%, Urban : 18% Tribal - 22% + sch. caste -16% ( St & SC = 36%) Out of 75 Primitive Tribal Groups in India,13 are in Odisha. There are 3 district with 314 blocks and >51, villages Favourable geo-ecotypes: Perennial streams in forest areas -Forest area are also rich in minerals with mining activities and high migratory population Average temperature : 15 to 35 С (extreme: 5 С to 48 С) Rain fall : 1452 mm with high humidity (>6%)}

3 Death 21 - Death Death 29 - Cases Transmission seasonality Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

4 No of cases Transmission is perennial with one peak in forested districts (mostly tribal dominated) Kandhamal ( Pf > 9%) Forest covers 34.2% Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Malaria cases Pf cases Death

5 Malaria Epidemiological Situation, Year Total Tested +ve PF Death ABER SPR Pf% API upto Sept. 211 upto Sept. 212 upto Sept Malaria cases decreased by 2% & deaths by 3% (211 vs 212 by September)

6 There is a decrease in API 27 Status of Malaria API of Odisha from Year wise distribution of Districts with API Year >

7 A. Primary: Malaria control strategy: As per the National program with state specific appropriation 1. Early diagnosis (Microscopy & RDT) and completer treatment with effective & appropriate Antimalaria drugs 2. Integrated vector control : LLIN, IRS, source reduction B. Supportive: Monitoring & evaluation, capacity building IEC & BCC PPP & Social mobilisation advocacy, Operational research

8 Structure of health services in Odisha 3 Districts with 32 Dist Hospital 314 Blocks (125K pop per block) Malaria surveillance, Diagnosis & treatment available free of cost at each Health facility Primary Health Center (2-3K pop) 4-5 PHCs per block Sub-center (5K pop) (4-5 SCs per PHC) 51, villages (.5-1K pop per village) (8-1 villages per SC)

9 Inputs & interventions for malaria control from 29 onwards LLIN ITN 247 MO-Mashari RDT RDT(Bi-valent) procure by State 7.13 RDT(Monovalent) procure by Sate ACT 5 5 ASHA Capacity building API Death

10 Surveillance and Early Diagnosis & Complete Treatment (RDT + ACT) at village level Out of ASHAs, >38 have been trained (92% ) 646 AYUSH doctors & around 2 tribal school teachers have been trained on EDCT Around 5 Forest (VSS) Animators have been trained as FTD to provide EDCT service in Forest villages in four tribal districts (Rayagada, Gajapati, Kandhamal and Koraput)

11 No of in patients Sentinel Site Malaria laboratories-211 Characteristics of IPD patients at SSL, Characteristics of OPD cases at SSL, Total In Patient (6.59%) In patient suspected as malaria 723 (1.89%) Confirmed Malaria cases 51 1 Total New OPD Cases (8.1%) Suspected malaria Cases (.57%) Confirmed Malaria cases

12 Jan - March Apr - Jun Jul - Sep Oct - Dec Seasonality of IPD cases in 211 Total IPD 14 Total In patients suspected as malaria Total Positive

13 Integrated Vector Control: IRS IRS 2 rounds protect high risk population ( API > 5) - around 8.7 million in 22 districts Hand Compression Sprayer Pumps (HCSP) have been introduced

14 Integrated Vector Control : LLIN Total Lakhs LLIN distributed in 29-1 and another 19 Lakh in (total around 38 lakh LLIN) - protect around 9 lakh population, State specific LLIN guidelines adopted for LLIN distribution LLIN distribution was done through GKS (village health sanitation committee),followed by intensified IEC & BCC

15 Angul Bargarh Bolangir Dhenkanal Gajapati Ganjam Jharsuguda Kalahandi Kandhamal Keonjhar Koraput Malkangiri Mayurbhanj Nawarangapur Nuapada Rayagada Sambalpur Sonepur Sundargarh API trend after 1 st phase LLIN distribution ( around 19 lakh) LLIN Distribution 29-1 API API

16 No. of Positive casese Encouraging results after the new interventions: positive pf pv LLIN in 29 along with ACT Special awareness campaign- NIDHI RATH Nil reported death pf K. Nagar Sub. Divisonal Hospital catering the population of a High Endemic Tribal block of Dhenkanal district

17 State initiative Mo Mashari (my mosquito net) In 2 phases 2.24 Lakh LLINs have been provided to Pregnant mothers in 7 high burden tribal districts to protect pregnant mothers Besides, pregnant mothers, Tribal school boarders and inmates are protected by ITN/LLIN Lakh Single size ITN/ LIIN provided to these vulnerable group. Study findings: 91% of pregnant women slept under LLIN last night (n=89). 88% of pregnant women slept under LLIN last night with their child under 2 years (n=89). But in general / cluster distributed areas (n=2925), 7% of family members slept under LLIN last night

18 Innovative IEC &BCC Use of traditional folk theatre, Jatra etc. Partnership with GKS & CBOs Advocacy & Inter-sectoral coordination Involvement of School teacher & student, Traditional / Faith healers Nidhi Mausa Adalat

19 NGO/PPP and Inter Sectoral Co-ordination NGOs engaged under NRHM are involved in screening of malaria cases, impregnation of bed nets, laboratory diagnosis and community mobilization and monitoring. Other departments: Women & Child Development., Forest and Environment, Schedule Caste & Schedule Tribe, School and Mass Education, Panchayati Raj Institutions, ICMR institutes

20 Lot Quality Assurance Sampling: LQAS LQAS : ME tool in malaria program. Conducted twice a year at present conducted in 21 districts. The LQAS findings from 29 to 211 on % of people protected either by ITN/LLIN. Sundargarh Mayurbhanj Nabarangpur Kandhamal Mon Target 7% 6% 5% 4% 3% 2% 1% % Nov (29) Aug (21) Nov(21) Aug(211) Nov (211) Sundargarh Mayurbhanj Nabarangpur Kandhamal Mon Target

21 Research & Documentation Operational research (Dfid support): Vector study by VCRC in 1 southern districtspublication awaited Mo-Mashari (my mosquito nets) by T & MST (of Dfid) report released LLIN impact study by ICMR institutes reports awaited Guidelines and reports: LLIN state Guidelines Operational manuals Annual Activity report used for advocacy Training manuals for doctors, Health workers, ASHA FAQs for school students and others

22 Comprehensive case management- (Pilot): MMV-NIMR - Odisha 3Ts: test, treat & tract Rationale: Case management of malaria, beyond treating the sick, could reduce the infectious reservoir. The size of the infectious reservoir is an important determinant of malaria transmission in low & medium endemic areas Universal vector control is difficult and expensive where large populations are at variable risk

23 Objectives of the Study Primary To assess the impact of CCM for uncomplicated malaria on its incidence/ transmission in different transmission settings in the state of Odisha, India Secondary Determine the mix of interventions and related costs needed for scale-up of comprehensive case management Develop a community based surveillance model for reporting and timely action Better define the burden and epidemiological profile of malaria in the area Identify challenges in the radical cure of malaria, particularly P. vivax Strengthen the pharmaco-vigilance system to generate community level data on adverse events

24 Intervention / Control Intervention / control Intervention / Control Project design Operational research project with NVBDCP Total study population 8, 3 year study period (October ) High transmission (API: 18) Medium transmission (API: 8) Low transmission (API: 3) Low vivax (1%) High case load (ca. 2 patients p.a) Mixed vivax (3%) Medium case load (ca. 1 patients p.a.) High vivax (5%) Low case load (ca. 3 patients p.a)

25 I want to play at school - help me for no malaria Challenges: Tribal areas - cultural and language barrier Forest villages Inaccessibility and poor health services Inadequate health staff Increased mining and developmental activities Urban set ups with migratory population & poor health structure for public health activities Thanks Challenges: More research for newer interventions Health system research -functioning of ASHA & other health volunteers -Community based organizations (GKS) -Community mechanism - Role of Traditional healers in tribal areas -Role of general practitioners, chemists, private and other sectors