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Control of malaria in Central India (Madhya Pradesh): hope or hype?
Transactions of the Royal Society of Tropical Medicine and Hygiene (2009) 103, 209—211
available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/trst
CORRESPONDENCE Control of malaria in Central India (Madhya Pradesh): hope or hype? Recent records (http://news.webindia123.com) show that larvivorous fish and drugs have cut the malaria burden in Madhya Pradesh (MP), which was until recently the second highest malarious state in India after Orissa1 , steadily from 2005 to 2007. Malaria cases fell from 104 317 in 2005 to 96 042 in 2006 and 90 829 in 2007; the number of Plasmodium falciparum cases reduced from 32 223 in 2005 to 29 053 in 2006, however it increased to 36 622 in 2007 (http://www.health.mp.gov.in/malaria.htm). This decline in malaria cases was the result of appointing 4000 malaria link workers in 20 malaria-affected districts, the establishment of drug distribution centres for free distribution of chloroquine, and the release of a large number of larvivorous fish by the government of MP (http://news.webindia123.com). Effective malaria control leading to reduced malaria incidence has also recently been reported using larvivorous fish in Bangalore2 and Assam.3 However, in MP the number of deaths due to malaria is on the increase, mainly due to the frequent occurrence of outbreaks that cause high morbidity and mortality (http://www.health.mp.gov.in/malaria.htm). For instance, an outbreak in Sidhi district in 2005 and 2006 caused 25 deaths annually due to P. falciparum. The actual death toll was estimated to be much higher as these deaths were recorded only in the district hospital, which many patients could not reach because of inaccessibility and lack of a transport system. A rapid fever survey conducted in Sidhi by the National Institute of Malaria Research Field Station (NIMRFS), Jabalpur, during 2006 revealed a high prevalence of malaria (298/875), particularly P. falciparum (248/875). All age groups were affected, including infants aged <1 year (4/11). The infant parasite rate (IPR) was 36% (P. vivax:P. falciparum 50:50), indicating intense malaria transmission. A similar high prevalence was also recorded in 2007 from Sidhi (1022/3091) with a 20% IPR, indicating that control measures were inadequate. In 2008, a malaria outbreak was recorded in Shivpuri. Rapid fever surveys carried out by the NIMR-FS Jabalpur revealed a high prevalence of malaria (597/1820), with 78% P. falciparum and an IPR of 28% (25/90), of which 60% were P. falciparum. The presence of two highly efficient vectors (Anopheles culicifacies and A. fluviatilis) in an area where both P. falci-
parum and P. vivax are prevalent, a thinly populated, poorly clothed ethnic tribe scattered in fields and forest, a high degree of mobility, a poor health infrastructure and increasing drug resistance among P. falciparum are some of the factors that maintain malaria as an important public health problem in MP. Efforts are now being made to control malaria using all existing tools, such as indoor residual spraying with synthetic pyrethroid, provision of insecticide-treated bednets for high-risk groups, rapid diagnostic tests for onthe-spot diagnosis, and prompt and effective treatment using arteether or artemisinin-based combination therapy to contain drug-resistant malaria. To establish effective control, a rigorous assessment of the geographical distribution of the disease is needed. Without high quality data, it would be impossible to monitor the programme and to focus efforts to protect new tools. We must remember that resistance to the pesticide DDT and the drug chloroquine contributed to abandoning the malaria eradication campaign in the 1960s. Acknowledgements: The authors are thankful to Dr J.C. Paliwal, State Vector Borne Disease Control Programme, Bhopal (M.P.), India, for sharing state data and other technical details. Funding: Indian Council of Medical Research (ICMR), Ansari Nagar, New Delhi 110029, India. Conflicts of interest: None declared. Ethical approval: Not required.
References 1. Singh N, Dash AP, Barun BM, Kataria O. Tribal malaria. ICMR Bull 2004;34:1—10. 2. Ghosh SK, Dash AP. Larvivorous fish against malaria vectors: a new outlook. Trans R Soc Trop Med Hyg 2007;101:1063—4. 3. Dev V, Dash AP, Hojai D. Fishing out malaria in Assam, northeastern India: hope or hype? Trans R Soc Trop Med Hyg 2008;102:839—40.
Neeru Singh a,b,∗ M.M. Shukla b A.P. Dash c
0035-9203/$ — see front matter © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
210 a
Correspondence
Regional Medical Research Centre (ICMR), Nagpur Road, Garha, Jabalpur, Madhya Pradesh 482003, India b National Institute of Malaria Research (NIMR) Field Station, RMRCT Campus, Nagpur Road, Garha, Jabalpur, Madhya Pradesh 482003, India c National Institute of Malaria Research (NIMR), 22 Sham Nath Marg, Delhi 110054, India ∗
Corresponding author. Tel.: +91 761 267 2239; fax: +91 761 267 2900. E-mail addresses: [email protected], [email protected] (N. Singh) Available online 5 November 2008
doi:10.1016/j.trstmh.2008.09.017
Rolling back malaria initiative in India In India, just a few states, including Orissa, Jharkhand, West Bengal (Eastern India), Madhya Pradesh and Chhattisgarh (Central India) and the states of the northeast, contribute 65% of reported malaria cases (National Vector Borne Disease Control Programme, Delhi, India). With climate change high on the agenda, there is increased risk of development and spread of multidrug-resistant strains of Plasmodium falciparum, particularly in marginalised population groups living in poverty and remote forest fringe areas of these states. Owing to fragmented disease surveillance, inadequate interventions and poor healthcare services in the periphery, these pockets are prone to focal outbreaks characterised by a high morbidity and death toll, as reported by Singh et al. (this issue) in Central India. Now with the present global commitment owing to increased allocation of resources by donors, there is a window of opportunity for partnership against malaria and other vector-borne diseases. What is needed is the scaling-up of the existing tools available, such as long-lasting insecticidal nets, rapid diagnostic test kits and artemisinin-based combination therapy, and above all healthcare services that should be strengthened at the periphery where there is most need.1 The control programme should be focused and community-oriented, with intersectoral convergence of non-governmental organisations, civic societies, and public and private sector establishments with the common goal of combating malaria illness. What is vital for effective control is the prioritising of interventions in high-risk areas, improved disease surveillance, and sound data management and monitoring in order to have appropriate interventions in place and time for averting impending disease outbreaks and saving lives. Taking advantage of newer tools, rolling back malaria is now a reality. Malaria cases are reportedly on the decline in pockets of Assam, northeastern India, which were once considered hard-core, characterised by persistent transmission and contributing most cases and deaths, so much so that study projects had to be abandoned due to lack of cases.2 It is truly the situation-specific integrated approach based on local ecological, environmental and behavioural determinants that should be implemented in the right earnest in accordance with recommendations of the WHO/SEARO Regional Committee.3 Larvivorous fish, which is one such
eco-friendly intervention that has been a proven success in the south Indian state of Karnataka, should be promoted or be considered for evaluation in different epidemiological paradigms. Lastly, it is the continued effort, increased political commitment for equity in healthcare access, and partnership with communities that would bring a sea change in making poverty and malaria ‘history’. Funding: None. Conflicts of interest: None declared. Ethical approval: Not required.
References 1. Greenwood BM. Control to elimination: implications for malaria research. Trends Parasitol 2008;24:449—54. 2. Dev V, Doley GC, Dash AP. Rolling back malaria is possible. Indian J Med Res 2008;128:82—3. 3. Narain JP. Malaria in the South-East Asia region: myth & the reality. Indian J Med Res 2008;128:1—3.
V. Dev ∗ National Institute of Malaria Research (ICMR), Chachal, Guwahati 781 022, Assam, India ∗
Tel.: +91 361 213 0934; fax: +91 361 213 0920. E-mail address: [email protected] Available online 3 December 2008
doi:10.1016/j.trstmh.2008.10.037
Larvivorous fish against malaria vectors The use of larvivorous fish to control malaria is an old strategy that has recently been revived.1 Prof. Christopher F. Curtis, from the London School of Hygiene & Tropical Medicine (LSHTM), London, UK, showed great interest in this approach when he saw our work in Karnataka, South India. In January 2004 he was invited to the ‘Third Global Meet on Parasitic Diseases’ in Bangalore, India, and after our presentation expressed an interest in seeing one of our study areas. He visited one village and was amazed to see that two exotic poeciliid species, guppy (Poecilia reticulata) and mosquitofish (Gambusia affinis), were flourishing and coexisting with the native fish Aplocheilus. He searched for larvae in the fish-infested water bodies with a larval dipper and quipped ‘no larvae, only fish’. Chris was delighted to see these familiar aquarium fish playing an important role in a malaria control programme. He asked the local villagers about the reasons for the disappearance of malaria in their village, to which they replied that it was due to the release of ‘malaria meenu’ (malaria fish). He even asked one local fisherman, present during the visit, about the effects of these fish on the native ones. The fisherman promptly replied ‘no side effects’. Chris included mention of this in a chapter of a book that has yet to be published.2 After this visit, Chris was actively associated with our work and initiated a programme to document all vector breeding habitats using the global positioning system
available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/trst
CORRESPONDENCE Control of malaria in Central India (Madhya Pradesh): hope or hype? Recent records (http://news.webindia123.com) show that larvivorous fish and drugs have cut the malaria burden in Madhya Pradesh (MP), which was until recently the second highest malarious state in India after Orissa1 , steadily from 2005 to 2007. Malaria cases fell from 104 317 in 2005 to 96 042 in 2006 and 90 829 in 2007; the number of Plasmodium falciparum cases reduced from 32 223 in 2005 to 29 053 in 2006, however it increased to 36 622 in 2007 (http://www.health.mp.gov.in/malaria.htm). This decline in malaria cases was the result of appointing 4000 malaria link workers in 20 malaria-affected districts, the establishment of drug distribution centres for free distribution of chloroquine, and the release of a large number of larvivorous fish by the government of MP (http://news.webindia123.com). Effective malaria control leading to reduced malaria incidence has also recently been reported using larvivorous fish in Bangalore2 and Assam.3 However, in MP the number of deaths due to malaria is on the increase, mainly due to the frequent occurrence of outbreaks that cause high morbidity and mortality (http://www.health.mp.gov.in/malaria.htm). For instance, an outbreak in Sidhi district in 2005 and 2006 caused 25 deaths annually due to P. falciparum. The actual death toll was estimated to be much higher as these deaths were recorded only in the district hospital, which many patients could not reach because of inaccessibility and lack of a transport system. A rapid fever survey conducted in Sidhi by the National Institute of Malaria Research Field Station (NIMRFS), Jabalpur, during 2006 revealed a high prevalence of malaria (298/875), particularly P. falciparum (248/875). All age groups were affected, including infants aged <1 year (4/11). The infant parasite rate (IPR) was 36% (P. vivax:P. falciparum 50:50), indicating intense malaria transmission. A similar high prevalence was also recorded in 2007 from Sidhi (1022/3091) with a 20% IPR, indicating that control measures were inadequate. In 2008, a malaria outbreak was recorded in Shivpuri. Rapid fever surveys carried out by the NIMR-FS Jabalpur revealed a high prevalence of malaria (597/1820), with 78% P. falciparum and an IPR of 28% (25/90), of which 60% were P. falciparum. The presence of two highly efficient vectors (Anopheles culicifacies and A. fluviatilis) in an area where both P. falci-
parum and P. vivax are prevalent, a thinly populated, poorly clothed ethnic tribe scattered in fields and forest, a high degree of mobility, a poor health infrastructure and increasing drug resistance among P. falciparum are some of the factors that maintain malaria as an important public health problem in MP. Efforts are now being made to control malaria using all existing tools, such as indoor residual spraying with synthetic pyrethroid, provision of insecticide-treated bednets for high-risk groups, rapid diagnostic tests for onthe-spot diagnosis, and prompt and effective treatment using arteether or artemisinin-based combination therapy to contain drug-resistant malaria. To establish effective control, a rigorous assessment of the geographical distribution of the disease is needed. Without high quality data, it would be impossible to monitor the programme and to focus efforts to protect new tools. We must remember that resistance to the pesticide DDT and the drug chloroquine contributed to abandoning the malaria eradication campaign in the 1960s. Acknowledgements: The authors are thankful to Dr J.C. Paliwal, State Vector Borne Disease Control Programme, Bhopal (M.P.), India, for sharing state data and other technical details. Funding: Indian Council of Medical Research (ICMR), Ansari Nagar, New Delhi 110029, India. Conflicts of interest: None declared. Ethical approval: Not required.
References 1. Singh N, Dash AP, Barun BM, Kataria O. Tribal malaria. ICMR Bull 2004;34:1—10. 2. Ghosh SK, Dash AP. Larvivorous fish against malaria vectors: a new outlook. Trans R Soc Trop Med Hyg 2007;101:1063—4. 3. Dev V, Dash AP, Hojai D. Fishing out malaria in Assam, northeastern India: hope or hype? Trans R Soc Trop Med Hyg 2008;102:839—40.
Neeru Singh a,b,∗ M.M. Shukla b A.P. Dash c
0035-9203/$ — see front matter © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
210 a
Correspondence
Regional Medical Research Centre (ICMR), Nagpur Road, Garha, Jabalpur, Madhya Pradesh 482003, India b National Institute of Malaria Research (NIMR) Field Station, RMRCT Campus, Nagpur Road, Garha, Jabalpur, Madhya Pradesh 482003, India c National Institute of Malaria Research (NIMR), 22 Sham Nath Marg, Delhi 110054, India ∗
Corresponding author. Tel.: +91 761 267 2239; fax: +91 761 267 2900. E-mail addresses: [email protected], [email protected] (N. Singh) Available online 5 November 2008
doi:10.1016/j.trstmh.2008.09.017
Rolling back malaria initiative in India In India, just a few states, including Orissa, Jharkhand, West Bengal (Eastern India), Madhya Pradesh and Chhattisgarh (Central India) and the states of the northeast, contribute 65% of reported malaria cases (National Vector Borne Disease Control Programme, Delhi, India). With climate change high on the agenda, there is increased risk of development and spread of multidrug-resistant strains of Plasmodium falciparum, particularly in marginalised population groups living in poverty and remote forest fringe areas of these states. Owing to fragmented disease surveillance, inadequate interventions and poor healthcare services in the periphery, these pockets are prone to focal outbreaks characterised by a high morbidity and death toll, as reported by Singh et al. (this issue) in Central India. Now with the present global commitment owing to increased allocation of resources by donors, there is a window of opportunity for partnership against malaria and other vector-borne diseases. What is needed is the scaling-up of the existing tools available, such as long-lasting insecticidal nets, rapid diagnostic test kits and artemisinin-based combination therapy, and above all healthcare services that should be strengthened at the periphery where there is most need.1 The control programme should be focused and community-oriented, with intersectoral convergence of non-governmental organisations, civic societies, and public and private sector establishments with the common goal of combating malaria illness. What is vital for effective control is the prioritising of interventions in high-risk areas, improved disease surveillance, and sound data management and monitoring in order to have appropriate interventions in place and time for averting impending disease outbreaks and saving lives. Taking advantage of newer tools, rolling back malaria is now a reality. Malaria cases are reportedly on the decline in pockets of Assam, northeastern India, which were once considered hard-core, characterised by persistent transmission and contributing most cases and deaths, so much so that study projects had to be abandoned due to lack of cases.2 It is truly the situation-specific integrated approach based on local ecological, environmental and behavioural determinants that should be implemented in the right earnest in accordance with recommendations of the WHO/SEARO Regional Committee.3 Larvivorous fish, which is one such
eco-friendly intervention that has been a proven success in the south Indian state of Karnataka, should be promoted or be considered for evaluation in different epidemiological paradigms. Lastly, it is the continued effort, increased political commitment for equity in healthcare access, and partnership with communities that would bring a sea change in making poverty and malaria ‘history’. Funding: None. Conflicts of interest: None declared. Ethical approval: Not required.
References 1. Greenwood BM. Control to elimination: implications for malaria research. Trends Parasitol 2008;24:449—54. 2. Dev V, Doley GC, Dash AP. Rolling back malaria is possible. Indian J Med Res 2008;128:82—3. 3. Narain JP. Malaria in the South-East Asia region: myth & the reality. Indian J Med Res 2008;128:1—3.
V. Dev ∗ National Institute of Malaria Research (ICMR), Chachal, Guwahati 781 022, Assam, India ∗
Tel.: +91 361 213 0934; fax: +91 361 213 0920. E-mail address: [email protected] Available online 3 December 2008
doi:10.1016/j.trstmh.2008.10.037
Larvivorous fish against malaria vectors The use of larvivorous fish to control malaria is an old strategy that has recently been revived.1 Prof. Christopher F. Curtis, from the London School of Hygiene & Tropical Medicine (LSHTM), London, UK, showed great interest in this approach when he saw our work in Karnataka, South India. In January 2004 he was invited to the ‘Third Global Meet on Parasitic Diseases’ in Bangalore, India, and after our presentation expressed an interest in seeing one of our study areas. He visited one village and was amazed to see that two exotic poeciliid species, guppy (Poecilia reticulata) and mosquitofish (Gambusia affinis), were flourishing and coexisting with the native fish Aplocheilus. He searched for larvae in the fish-infested water bodies with a larval dipper and quipped ‘no larvae, only fish’. Chris was delighted to see these familiar aquarium fish playing an important role in a malaria control programme. He asked the local villagers about the reasons for the disappearance of malaria in their village, to which they replied that it was due to the release of ‘malaria meenu’ (malaria fish). He even asked one local fisherman, present during the visit, about the effects of these fish on the native ones. The fisherman promptly replied ‘no side effects’. Chris included mention of this in a chapter of a book that has yet to be published.2 After this visit, Chris was actively associated with our work and initiated a programme to document all vector breeding habitats using the global positioning system