> Disease Burden

MALARIA

• Malaria in? Tamil Nadu has been greatly? reduced .?? However? malaria? still continues to be one of the major Public health problem in certain pockets of TamilNadu. The following factors contribute for the persistence of malaria.

1. Migration of population for various reasons.
2. Rapid urbanisation.
3. Tremendous developmental activities especially construction of buildings, overbridges etc.

WHAT IS MALARIA?

• Malaria is known as a disease of "High fever".?

• It is caused by the infection of a tiny organism known as Malaria parasite.??

• The Malaria parasite is transmitted from a person suffering from Malaria to another healthy person by certain variety of mosquitoes.

• All mosquitoes are not capable of transmitting malaria.?

• Infection occurs following a bite of an injected female anopheles mosquito which contains the malaria parasite in the salivary glands.?

• The parasite spends a part of its life in man and a part in mosquito.??

• When a female anopheles mosquito bites a sick person, it picks up malaria parasite.??

• These parasites enter into the stomach of mosquito which become infective for malaria.

• When this infective mosquito bites a healthy person malaria parasites are injected in his blood.?

• The man within 14-21 days gets the fever.? One malaria patient give rise to large number of cases.

• SYMPTOM OF MALARIA

  A typical attack of malaria comprises of three distinct stages.

  1. COLD STAGE:
  Begins with the feeling of cold, shivering and headache.? The individual covers himself with quilts the blankets.? Fingers and lips become bluish with dry skin.? Hairs on skin are raised.? It may continue for 15 minutes to 1 hour.
  2. HOT STAGE:
  The fever rises very high so the patient feels burning heat.? He takes off the cloths.? The patient feels intense headache with nausea? and vomiting.? This stage lasts from 2-6 hours.? Pulse is heavy and bounding, feels intense thirsty.
  3. SWEATING STAGE:
  In this stage, fever comes down with profuse sweating.? Patient normally goes into deep sleep, on awaking feels weak.? This stage lasts 2-4 hours.

• There are four types of malaria existing in the world.? Usually we found three types in our country.?

• Out of? three, two major varieties causes concern to us.??

• They are vivax malaria (a common variety of malaria) and falciparum malaria (severe form of malaria).

• The later variety is also known as general malaria which is a dangerous one.? If prompt treatment is not given the patient will die within 2-3 days.

  HOW TO TREAT MALARIA

• According to National Anti Malaria Programme, all fever cases should be considered as Malaria cases unless otherwise diagnosed by medical person.? Accordingly we must administer the tablet chloroquine as per the following schedule mentioned under suspected cases.

• When a malaria is confirmed after blood examination a complete treatment with another drug "Primaquine" is necessary in addition to the chloroquine.

• The following table is given for the drug schedule as per the age group.

• Primaquine should be given with the consultation of a Medical Officer.?

• Children below one year and pregnant women should not be given this drug.? Drugs should not be taken in empty stomach.?

• In case of severe form of malaria i.e. P.falciparum, the tablet primaquine should be given as a single dose as per table given along with chloroquine.? A single dose treatment with 600 mg? chloroquine and 45 mg primaquine given for an adult suffering from P.falciparum malaria.? Dosage for chloroquine and primaquine for the treatment of P.falciparum malaria should be reduced suitable to lower age group as mentioned in the above table.

• For the treatment of Malaria, drugs are available in all Hospitals, Dispensaries, Primary Health Centres and Sub-centres throughout the country.

• Chloroquine tablets are also available with local chemist shops.

• Malaria can be cured through proper treatment.? There are several medicines used in treatment of Malaria.? In most cases chloroquine is still useful medicine for malaria.

MALARIA SITUATION IN TAMILNADU:

• In Tamil Nadu State during? 90's a total of 1,20,029 cases were recorded? out of which 59.6 % were recorded from the urban areas and 40.4% in rural.?

• The? coastal villages of Ramanathapuram, Paramakudi and Nagapattinam and riverine villages of Dharmapuri,Krishnagiri and Tiruvannamalai were endemic for malaria.?

• Due to the intensive control measures? like active? and passive surveillance, vector control measures? etc. taken up by the PH dept the malaria case incidence has been drastically brought down to 43053 in 2000.

• At present? the coastal villages of Nagapattinam which were once endemic are almost free from malaria.??

• The incidence of malaria in Ramanathapuram and Tiruvannmalai show a decreasing trend.? However, Malaria is emerging as a problem in Nagerkoil.

• The factors contributing for the persistence of malaria in rural areas are

1. Numerous breeding places in the river beds, puddles, rocky pits, sandy pits casuarina pits etc.

2. Migration of the population for fishing ( Ramanathapuram ), as labourers for construction and as quary workers to other endemic states.

3. Non acceptance for indoor residual spray.

Out of the total malaria cases reported in the State, 74% are occurring in Chennai City and another 8.4% in Tuticorin, Erode, Vellore, Dindigul, Salem, Tiruchengode, Tiruvallur and Tiruvottriyur.? The following problems attribute for the increase of malaria in urban areas.

1. Population migration in search of employment.

2. Lack of adequate water supply leading to storage of water for use, creating breeding source of Malaria vector.

3. Developmental activities especially construction of buildings, overbridges etc.

4. Non closure of wells, cisterns, overhead tanks etc.

5. Inaccessible overhead tanks causing hindrance to the anti-larval work.

IMPORTED CASES:

A total of 145 cases are imported from Kerala during 2000,121 from Andhra Pradesh and 99 cases from Karnataka.? The importation of cases are due to

1) Migration of Labourers and fishermen.
2) Pilgrimage? population.
3) Movement of people from one place to another seeking jobs,business,etc.

CONTROL STRATEGY:??

The control strategies adopted in the Public Health dept are:

1) Malaria case detection is being carried out by house to house visit by collection of blood smears from fever cases and giving treatment for those who are found positive for malaria.

2) Two rounds of residual insecticidal spray during transmission period using synthetic pyrethroid in malaria endemic areas.

3) Passive surveillance and anti-larval work in? urban.

4) Creating awareness among the community for their participation.

5) Whenever imported cases recorded , the same is cross notified by the concerned Medical Officer to the respective Health Authorities of State for further remedial action at their end.

6) Mass and contact Blood survey are? being carried out to prevent the occurrence of secondary cases.

7) Whenever necessary, focal spray is being carried out.

Active surveillance has become a problem all over the country in the recent past.? In Tamil Nadu, IEC activities have made a great impact on surveillance, that more number of cases are being identified under passive surveillance than Active surveillance.

Geographical Information system (GIS) is being developed in Tamilnadu for carrying out epidemiological mapping of the villages and for identifying vulnerable areas and seasonal pattern of disease outbreak.

In the present scenario in Tamil Nadu, it is feasible to wipe out malaria if we succeed in bringing out a change in the Perception, Approach and Practice at large.? Malaria? is a man-made problem only and that by the above changes these will be source reduction in mosquito breeding? and complete elimination of parasite from human circulation.

MALARIA INCIDENCE IN RURAL AND URBAN AREAS OF TAMILNADU