Retrospective study of chikungunya outbreak in urban areas of India.

Background & objectives: A retrospective study on chikungunya outbreak in India in five States viz. Delhi, Madhya Pradesh, Orissa, Maharashtra and Kerala was conducted in 2007-2008 to know the distribution and determinants of chikungunya fever outbreak in India. Methods: On the basis of high and low incidence of chikungunya fever, two districts from each State and two wards from the selected district were taken for random selection of 1000 households from 10 districts and 5 States. Semi-structured questionnaires were administered to individuals, patients, qualified health professionals and to stakeholders for collecting information. Results: The educational background and occupation of the respondents showed variations across the study States. Only in high incidence ward of Maharashtra, water storage period for 3-6 days and emptying, drying of water containers on weekly basis was noted. The study through knowledge, attitude, belief, practice (KABP) obtained individual's perception of chikungunya fever, its prevention and control. Patients’ expenditure on treatment was mainly recorded less than Rs 500 across study States. Health facility survey obtained an overview of the capacity of local health facilities. Stakeholders’ perception regarding chikungunya fever was also noted. Interpretation & Conclusions: The study revealed differences in awareness of chikungunya, cause of the disease, vector responsible, mode of transmission, biting time and elimination of breeding of mosquitoes statistically significant among high and low incidence wards of all the States. Expenditure on treatment was independent of economically active status and loss of man-days across all the States. Education and occupation did not have any relation with emptying/drying of water containers in high incidence wards. Strengthening of surveillance, information, education and communication (IEC) activities along with case management facilities may be provided by the State health department for prevention of chikungunya outbreaks in future. Stakeholders should be more involved in outbreak management and future planning.

NLEP--current situation and strategy during the 11th plan period (2007-2012).

National Leprosy Control Programme was established in 1955 based on dapsone domiciliary treatment. The multidrug therapy came into wide use from 1982. Based on the recommendations of the high power committee established by the Government of India, the NLEP was launched in 1983 with the objective to arrest the disease activity in all the known cases of leprosy. In order to strengthen the process of elimination of the disease in this country, the first World Bank supported project was introduced in 1993. The 2nd phase of the elimination project was started in 2001-02 and ended in December 2004. The prevalence rate of leprosy was found to be 0.95/10,000 population by December 2005, a success in the elimination of leprosy. On 30th September 2006 the rate on record is 0.89/10,000 population, a further decline. During 2005-06 the annual new case detection rate was 14.27 per 100,000 population which was 23.4 during 2004-05, a reduction of 39.0%. During the 11th plan period (April 2007 to March 2012) the government proposes to carry on the leprosy programme with the same intensity further to achieve annual new case detection rate less than 10 cases per 100,000 population.

National Leprosy Eradication Programme and progress towards elimination of leprosy in India.

The World Health Assembly in May 1991 made the declaration to eliminate leprosy at global level by the year 2000. Complete coverage of all the districts with MDT was possible in the year 1996. Very good results were obtained and the case lead came down to 0.51 million by December 2000. A new goal has been set to reach leprosy elimination at national level in India by December 2005. The challenges to eliminate leprosy and to bring prevalence rate 0.9/10,000 by December 2005 are to be taken at epidemiological, operational and at administrative levels.

Epidemiology and control of malaria.

Malaria is essentially a local and focal disease since its transmission depends greatly on local eco-environmental conditions. In India, the incidence of total malaria cases has been contained to around 2-3 million cases per year. However, with the occurrence of outbreaks in different parts of the country since 1994, mortality due to malaria has increased. The challenges posed by changing epidemiological paradigms of malaria, occurrence of outbreaks, increasing trends of P. falciparum cases, spreading resistance to available anti-malarials and development of resistance of vectors to insecticides are areas for major concern. The National Anti-Malaria Programme has made necessary modifications/adjustments in the malaria control strategy with the adoption of the Global Malaria Control Strategy.

Process indicators for malaria control.

Malaria Control efforts are existing in India since antiquity. Organised malaria control interventions were initiated in 1953 by launching of National Malaria Control Programme (NMCP) which was soon converted to eradication in 1958. The initial success achieved was short-lived as malaria resurged in sixties. In 1977, Modified Plan of Operations was launched and the malaria decreased to 2-3 million cases in 1984 and was maintained at the same level. In 1994, after large scale epidemics were experienced, deaths due to malaria increased. WHO recommended a process-based approach to malaria control involving community with decentralized planning in the Global Malaria Control Strategy. Decentralised requires redefining the role and responsibilities at each level of implementation. To facilitate this and monitor the implementation of malaria control detailed process indicators have been developed.

'Anti-malaria month'--a step forward in multisectoral collaboration and community involvement in malaria control.

For a long time malaria control in India has largely been a government responsibility with little involvement of the community at large, and other sectors of the economy in the control efforts. There is now increasing realisation that involvement of the community and a multi-sectoral approach should be essential components of the malaria control strategy. The National Malaria Eradication Programme is accordingly laying greater emphasis on coordination with other sectors of the economy, and changing community perceptions and health-related behaviour. A massive programme of community mobilisation with this objective in view has been taken up since 1997. A major component of this community mobilisation programme is the observance of an 'Anti-Malaria Month', during which, country wide awareness campaigns are undertaken at all levels of implementation, to promote inter-sectoral collaboration and community action for malaria control. The present paper summarises the rationale and messages of the 'Anti-Malaria month'.

Operational research in malaria--why and how?

Research studies conducted so far have had little bearing on the National Malaria Eradication Programme implementation for want of operational component. In India there is no dearth of scientific knowledge and technical know-how but dearth of operational research of direct relevance to the programme. The rationale for research under the operational conditions of the NMEP is discussed in this paper.

Visceral leishmaniasis control in India through primary health care system--a successful experiment of district level planning.

A model district action plan for control of Visceral Leishmaniasis a serious public health problem in north-east Bihar was developed in late 1989 and implemented in 1992 in district Vaishali. A two years implementation resulted in decline in cases and deaths due to Visceral Leishmaniasis to the extent of 65.32% and 46.51% respectively in 1993 as compared to 1992 and 41.13% and 44.93% respectively in 1994 as compared to 1993 with an overall decrease of 79.58% in case and 70.54% in deaths in 1994 as compared to 1992. The implementation of action plan not only established declining trends in morbidity and mortality due to Visceral Leishmaniasis in the district but also successfully contained the cases unresponsive to first line treatment with Sodium Stibogluconate by reducing the prevalence of such cases from 12.42% in 1992 to 8.59% in 1994. Various components of the action plan, implementation strategy and consequent impact on disease situation are presented in this paper.