Common Diseases

Malaria

Malaria is an acute parasitic illness caused by Plasmodium falciparum or Plasmodium vivax. Mosquitoes, of which there are 9 major species, transmit malaria in India. At the time of independence, there were an estimated 75 million malaria cases and 0.8 million deaths annually. GOI launched the National Malaria Control Programme (NMCP) in 1953. DDT spraying resulted in a sharp decline in the incidence of malaria in all areas under spray. In 1958, NMCP was converted to the National Malaria Eradication Programme (NMEP) with a view to eradicate malaria from the country. The strategy was highly successful and the cases were reduced to about one lakh and deaths due to malaria were eliminated by 1965-66. However, operational, financial and administrative constraints led to a countrywide increase in the number of cases after 1967 and in 1976, a total of 6.47 million malaria cases were recorded.

In 1977 the Modified Plan of Operation (MPO) was launched with the immediate objective of preventing deaths and reduce morbidity due malaria. The programme was integrated with the primary health care delivery system. The blanket approach of insecticidal spraying was changed to selective indoor residual spray by stratifying areas based on cases per 1,000 populations in a year i.e. the Annual Parasite Incidence (API) of 2 and above. The cases were reduced subsequently from 6.47 million in the year 1976 to around 2.5 to 3 million cases annually till 1996. Since 1997, a declining trend has been recorded. API declined to less than 2 for the first time in 2002 and since then it is reported to be less than 2.

The areas vulnerable to malaria are largely tribal, difficult, remote, forested and forest fringe inaccessible areas with operational difficulties. The high transmission areas are the North Eastern States and largely tribal areas of Andhra Pradesh, Chhattisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Odisha and Rajasthan.

The State governments are responsible for the planning, implementation, supervision and monitoring of the programme. North Eastern states are being provided 100 per cent support by Cetre for implementation of the programme including operational cost.

A Grant Agreement was signed with Global Fund for AIDS, Tuberculosis and Malaria (GFATM) on 27 June 2005 for the implementation of Intensified Malaria Control Project (IMCP) in NE States (except Sikkim), selected high risk areas of Odisha, Jharkhand and West Bengal with the objectives to increase access to rapid diagnosis and treatment in remote and inaccessible areas through community participation and to encourage use of bed nets treated with insecticides (ITNs) to reduce the risk of malarial transmissions and enhance awareness about malaria control and promote community, NGO and private sector participation.

In 100 districts in 8 states, namely Andhra Pradesh, Chhattisgarh, Jharkhand, Gujarat, Madhya Pradesh, Maharashtra, Odisha and Rajasthan, 1045 PHCs predominantly inhabited by tribals were also provided 100 per cent support including operational expenses under the Enhanced Malaria Control Project (EMCP) with World Bank assistance, since 1997. World Bank New Project on "Malaria Control and Kala-azar Elimination" for a period of 5 years w.e.f. 2008-09 (commencing from 1st September, 2008) has been approved by World Bank.

Filaria

Lymphatic Filariasis is a serious debilitating and incapacitating disease. The transmission of filaria is through mosquitoes called Culex quinquefasciatus. This disease has been reported from over 250 districts in 20 States and UTs wherein over 500 million people live. The disease is targeted for Global Elimination by 2020 through annual Mass Day Administration (MDA) of single dose of anti-filarial drug. In this context, a pilot project on single dose annual mass DEC drug administration was undertaken during 1997 in 13 districts of 7 endemic states, covering a population of about 41 million. By 2003, 31 districts were brought under MDA. The National Health Policy (2002) envisaged a goal of Lymphatic Filariasis Elimination from the country by the year 2015. In pursuance to this, Government of India launched the campaign of an annual mass drug administration (MDA) with a single dose of Diethycarbamazine citrate tablets - the anti-filarial drug in the year 2004, to the eligible population living in the risk of lymphatic filariasis. In the year 2004, 202 endemic districts of 20 states in the country with a target population of 407 million were targeted for MDA. A population of 276.7 million was covered against eligible population of 378.1 (excluding pregnant women, children below 2 years and seriously ill persons) million indicating the coverage rate of 73.19% (against eligible population).

Dengue Fever/Dengue Haemorrhagic Fever

Dengue fever is a viral disease, which is transmitted by the Aedes aegypti mosquitoes. The Aedes mosquitoes breed in clean water in man made containers such as water coolers, discarded tyres, disposable cups, flower vases and other water storage containers. The first out break of Dengue fever/DHF was reported from Kolkata in 1963. All the four serotypes of dengue are prevalent in India.

In recent years, Dengue is increasingly being reported from peri-urban and rural areas, due to expanding urbanization and lifestyle changes. The most affected areas are West Bengal, Delhi, Kerala, Tamil Nadu, Gujarat, Karnataka, Maharashtra, Rajasthan, Punjab and Haryana. As there is no specific treatment for Dengue, the emphasis is on avoidance of mosquito breeding conditions in homes, workplaces and minimizing the man-mosquito contact. Community awareness and participation as well as inter-sectoral collaboration are crucial for effective control of Dengue. In addition, enactment and enforcement of appropriate Civic bye-laws and Building bye-laws should also stressed upon in all urban areas to prevent mosquitogenic conditions in line with the Delhi, Mumbai, Goa and Chandigarh health administrations.

Chikungunya

Chikungunya is a debilitating non-fatal viral illness which has occurred in outbreak form in India during 2006 after a gap of 32 years. It resembles dengue fever. It is caused by Chikungunya virus. It is spread by the bite of female Aedes mosquitoes, primarily Aedes aegypti.

Japanese Encephalitis (JE)

Japanese Encephalitis is an acute viral illness with high case fatality and long term complications. The vector breeds in large paddy fields and similar large water bodies. The vector is an outdoor rester and feeder. The disease has acquired serious magnitude in the states of Uttar Pradesh, Andhra Pradesh, West Bengal, Assam, Tamil Nadu, Karnataka, Kerala, Bihar, Goa, and Haryana. There is no specific treatment for JE. Efforts were made by states and Govt of India to contain JE outbreaks by instituting various public heath measures including selective JE vaccination. Considering the value of vaccination in prevention of JE, the Centre launched a JE vaccination programme during 2006 for children between 1 and 15 years of age in 11 districts of the 5 states of Uttar Pradesh, Bihar, Assam, Karnataka and West Bengal with using single dose live attenuated SA-14-14-2 vaccine. The programme expanded to 27 districts in 9 states during 2008.

Kala-Azar

Kala-azar is a parasitic disease caused by Leishmania donovani transmitted by sandflies Phlebotomus argentipes. The disease is prevalent among socio-economically poorer sections of the society living in rural areas. The disease is chronic and if not treated, leads to death. Kala-azar is endemic in Bihar, Jharkhand, West Bengal and parts of Uttar Pradesh. The Central Government initiated Kala-azar control Programme from 1990-91 incorporating assistance for procurement of insecticides and anti-leishmanial drugs. The National Health Policy 2002 envisaged a goal of Kala-azar Elimination by the year 2010. To pursue the goal of elimination of Kalaazar by the year 2010, the Govt of India is providing 100% support to endemic states since 2003, apart from regular technical guidance. Timely and quality Indoor Residual Spraying with DDT for vector control, complete treatment of patients as well as intensive social mobilization is being stressed upon. Govt. of India has accelerated the Kala-azar elimination by taking the following renewed efforts.

• Intensification of Kala-azar Case Search through Kala-azar Fortnight.
• Patient Coding Scheme initiated in all treatment centres to ensure complete treatment compliance.
• Introduction of rapid diagnostic test (rk39) and oral drug miltefosine for early detection of Kala-azar and better treatment compliance.
• Identification of Kala-azar activist amongst the affected communities and mobilization of the community for early reporting and treatment compliance.

Tuberculosis

Tuberculosis is a major public health problem in India. India accounts for one-fifth of the global TB incidence and is estimated to have the highest number of active TB cases amongst all the countries of the World. Every year there are approximately 18 lakh new cases in the country of which approximately 8 lakh are new smear positive and therefore infectious. Each sputum positive case if not treated, on an average, infects 10-15 persons in a year. Two persons die from TB in India every three minutes more than 1,000 people every day.

To control TB, National Tuberculosis Control Programme (NTCP) is in operation in the country since 1962. This could not achieve the desired results. Therefore, it was reviewed by an expert committee in 1992 and based on its recommendations, Revised National TB Control Programme (RNTCP), which is an application to India of WHO recommended strategy of Directly Observed Treatment Shortcourse (DOTS), was launched in the country on 26 March 1997. The objectives of RNTCP are (i) to achieve and maintain a cure rate of at least 85% among newly detected infectious TB cases and (ii) achieve and maintain detection of at least 70% of such cases in the population. RNTCP was implemented in the country in a phased manner and by 23rd March 2006 the entire country had been covered under RNTCP. The Programme is being implemented with assistance from World Bank, DFID, USAID, GDF and GFATM.

Overall performance of the RNTCP for the country has been excellent with cure/treatment completion rate consistently above 85% and death rate among patients registered for treatment reduced to less than 5%. More than ninety per cent of the new smear-positive cases detected are being put under DOTS. Till date, the RNTCP has placed more then 86.4 lakh patients under treatment, averting more than 15.5 lakh deaths. Every month, more than 1,00,000 patients are placed under treatment. In 2007 alone, India placed around 14.75 cases on DOTS, more than any country in a single year in the world. The Programme envisages to develop an effective partnerships with the health care providers outside the public health system including NGOs, Private Practitioners (PPs), Corporate sectors etc