ANTIMALARIA CONTROL

PROGRAMME

Mrs. Shubhada A Kulkarni

Assistant Professor
SYIPER
Globally in 2023,there were an estimated 263 million
malaria cases and 597000 malaria deaths in 83 countries.
The WHO African Region carries a disproportionately high
share of the global malaria burden.
In 2023, the WHO African region was home to 94% of
malaria deaths.
Children under 5 accounted for about 76% of all malaria
deaths in region.
In India, nine anopheline vectors are involved in
transmitting malaria in diverse geo-ecological paradigms.
About 2 million confirmed malaria cases and 1000 deaths
are reported annually, although 15 million cases and
20,000 deaths are estimated by WHO South East Asia
Regional Office.
India contributes 77% of the total malaria in Southeast Asia.
Causative agents – Plasmodium falciparum and
Plasmodum vivax.
NATIONAL ANTI-MALARIA
PROGRAMME

NATIONAL ANTI-MALARIA PROGRAMME

(NMCP) was launched in India in April 1953.
It was based on indoor residual spraying with
DDT ( 1 g per sq. metre of surface area ) twice a
year in endemic areas where spleen rates were
over 10 percent.
The NMCP was in operation for 5 years
(1953-58).The results of the programme were
highly successful in that of the incidence of
malaria is has declined sharply from 75 million
cases in 1953 to 2 million cases in 1958, an
estimated 80 per cent reduction of malaria
CONTD….
According to the international standards, the
programme was divided into
a. preparatory phase
b. consolidation phase
c. maintenance phase
The annual incidence of malaria case in India
escalated from 50,000 in 1961 to a peak of 6.4
million cases in 1976.
 MILESTONES OF MALARIA CONTROL
PROGRAMME
1953 National Malaria Control Programme(NMCP)

1958 National Malaria Eradication Programme (NMEP)

1977 Modified Plan of Operation (MPO)

1979 Multipurpose Worker Scheme (MPW Scheme)

1995 Implementation of Malaria Action Plan-1995 (MAP-95).

1997 Launching of World Bank Assisted Enhanced Malaria Control Project

in tribal districts of the State (EMCP)

2000 National Anti Malaria programme (NAMP)

2004 National Vector Borne Disease control programme (NVBDCP)

MODIFIDED PLAN FOR OPERATION

1. OBJECTIVES
The modified plan of operation under the
NMEP in to force from 1st April 1977 with the
following objectives.
To prevent death due to malaria
To reduce malaria morbidity
To maintain agricultural and industrial
production by undertaking intensive
antimalarial measures.
To consolidate the gains so far achieved.
CONTD….

2. RECLASSIFICATION OF ENDEMIC AREAS

The report of consultative committee indicated
in order to stabilize the malaria situation in the
country ,areas with annual parasite incidence 2
and above should taken up for spray operation
.
This led to the abolition Of the earlier phasing
of antimalaria unit as attack, consolidation and
maintenance areas and reclassification of area
according to annual parasite incidence.
CONTD….
3. AREAS WITH API MORE THAN 2
a. spraying –
All areas with API and above are brought under
regular insecticidal sprays with rounds of DDT
unless vector is refractory
when vector is refractory to DDT,3 rounds of
malathion are recommended.
Areas refractory both to DDT and Malathion are to
be treated with 2 rounds of synthetic pyrethroids
sprays at regular intervals of 6 weeks .
DDT, malathion and pyrethroids applied are 1.0,2.0,
and o.25 g per square meter surface respectively.
CONTD..
b. Entomological assessment- This is done by
entomological [Link] carry out
susceptibility tests and suggest appropriate
insecticide to be used in particular areas.
c. surveillance – The collection and examination
of blood smears is a key element of the
modified plan of operation.
d. Treatment of cases- Great emphasis on
radical treatment.
CONTD..
4. AREAS WITH API LESS THAN 2
a. spraying- These area will not be under
regular insecticidal spraying. however ,focal
spraying is to be undertaken only around p.
falciparum cases detected during
surveillance .
b. surveillance – Active and passive
surveillance operations will have to be carried
out vigorously every fortnight.
c. Treatment – All detected cases should
receive radical treatment as prescribed.
CONTD.,.

d. Follow up.- blood smear should collected

from all positive cases on completion of
the radical treatment and monthly interval
for three months.
e. Epidemiological investigation - All
malariaey positive cases are to be
investigated. This may include mass survey.
CONTD…
5. DRUG DISTRIBUTION CENTRES AND FEVER
TREATMENT DEPOTS
With the increasing number of malaria cases ,
the demand for antimalarial drugs has
increased.
This led to the establishment of wide network
of drug distribution centers and fever
treatment depots
Fever treatment depots collect the blood
slides in addition to distribution of antimalarial
drugs.
About 3.57 lakhs of such centers are
CONTD…

6. URBAN MALARIA SCHEME

This scheme was launched in 1971 to
reduce or interrupt the malaria
transmission in town and cities .
The urban component of NMEP,covers
181 cities and towns, including New Delhi ,
Mumbai, Kolkata, and Chennai.
It is implemented in 131 countries.
CONTD…

7. [Link] CONTAINMENT
[Link] containment programme
was introduced from October 1977.
The specific purpose of this component to
prevent or control the spread of p.
falciparum malaria.
CONTD..

8. RESEARCH
Six monitoring teams are now working in
di erent parts of country to identify the p.
falciparum sensitivity to cholroquine.
Studies by the Indian council of medical
research have [Link]
resistance foci in several states.
CONTD..
9. HEALTH EDUCATION
Health education of the public to enlist their
cooperation in malaria control activities.
10. REORGANIZATION
Laboratory services are decentralized to
minimize the time lag between collection of
blood smears and their examination.
Epidemiological teams have been attached
to all the 72 zones in the country.
 SURVEILLANCE

A) Active surveillance
[Link] is carried out by the workers known as “Surveillance
workers “ who are n now replaced by the multipurpose
workers
[Link] surveillance workers for 8000 population and one
surveillance inspectors for 32,0000 population.
3. The surveillance workers will visit each house once a fortnight
and enquire
a. Whether fever cases in the houses including guest or
visitors in the house
b. fever cases in between the previous visit and present
visits.
4. The surveillance workers collects a blood film and administer
a single dose 600 mg of chloroquine drug according to NMEP
schedule .This is known as presumptive treatment.
CONTD…

B. Passive surveillance
The search for the malaria cases by the
health agencies such as sub centres , primary
health centres, Hospitals ,dispenseries and
local medical practitioners is known as
passive surveillance.
The passive agencies collect the blood smear
from all the fever cases and single dose of
treatment for malaria is administered.
.
CONTD…

Parameters of malaria surveillance

❖ Annual parasite incidence rate(API)

❖ Annual blood examination rate (ABER)

❖ Annual falciparum incidence(AFI)

❖ Slide positive rate (SPR)

❖ Slide falciparum rate (SFR)

MALARIA CONTROL THROUGH
PRIMARY HEALTH CENTRES
❑ A new approach to malaria control was
approved by WHO in [Link]
of malaria context in primary health
centers.
❑ This is because many of the malaria
control activities are carried it by
peripheral centers
❑ The voluntary health workers in the local
community was selected for supplies of
drugs and to collect blood smear for fever
ENHANCED MALARIA CONTROL
PROJECT.
The anti- malaria activities have been intensified
with input of 100 cities. The total project cost is
about Rs 891 crores for 5 years.
The selection of PHC was based on following
criteria
The annual parasite incidence is more than 2
years for past 3 years.
The p. falciparum cases being more than 30
percent of malaria cases.
20 per cent of population PHC is tribal people
Reported death due to malaria from the PHC
COMPONENTS UNDER THE MALARIA
PROJECT.
✔ Early detection of cases and treatment
✔ Selective vector control and personal protective
methods including insecticide and treated
mosquito nets.
✔ Epidemic planning and rapid response.
✔ Intersectoral coordination and strengthening
institution.
✔ Use of lavivorous fish.
NATIONAL ANTI MALARIA PROGRAMME
In 1999 Government of India decided to drop the national
malaria eradication programme and renamed as
National malaria eradication programme.
The present strategies for prevention and control of
malaria are .
Early case detection and prompt treatment.
Integrated vector management –residual spraying in
selected areas .the bed nets are provided for free of
costs . The priority benefit.
Use of larvirous fish is being promoted in local water
bodies in selected urban and rural areas.
Epidemic preparedness and epidemic control measures.
ICE activities in creating awareness.
URBAN MALARIA SCHEME

Control of urban malaria primarily implementation of civil

by laws to prevent mosquito breeding in the domestic
and pre domestic areas.. This scheme is presently
protecting the 96.7 million from malaria and other
mosquito borne disease .
ANTI MALARIA MONTH CAMPAIGN

Anti malaria month is observed in every year in the

month of June in every country prior to monsoon and
transmission season .
Enhancing the level of awareness and community
participation through mass media campaign
interpersonal communication with other department
and voluntary agencies.
PRESUMPTIVE TREATMENT

Age group Chloroquine tablets

Below 1 year 75 mg (1/2 tablet)

1 to 4 years 150 mg (1 tablet)

5 to 8 years 300 mg (2 tablets)

9 to 14 years 450 mg (3 tablets)

Above 15 years 600 mg (4 tablets)