NVBDCP-GUJARAT

• 1. National Vector Borne Diseases Control Programme-GujaratPresentation ofStatus Report DR.G.C.SAHU ROH&FW GOVT OF INDIA AHMEDABAD

2. MOSQUITOS OF PUBLIC HEALTH IMPORTANCE AEDES-- DENGUE ANOPHELES-MALARIA CULEX--FILERIA .AND THE TYPE OF EGGS THEY LAY . ANO. AED. CUL. 3.

• State Goals

• Reduction in Annual Parasitic Incidence by 30%.

• Preventing deaths due to malaria.

• Reduction in morbidity due to Dengue and Chikungunya by 50%.

• Reducing Micro Filaria Rate by 50%.

Overall Goals1. To reduce malaria morbidity and mortality by 50 % in 5 years. 2. To bring down LF transmission by achieving more than 90 % reduction in Mf rate in five years. 3. To reduce incidence of Dengue as well as Chikungunya by more than 50%.

• Objectively verifiable indicators

• Annual parasitic Incidence to be reduced by 50% at the end of the project period.

• Reduction in micro filaria rate to less than 1.

• Reduction in mortality due to malaria and dengue.

• Reduction in sero positivity rate for Dengue and Chikungunya.

4. Organizational chart of NVBDCP in Gujarat. BHO Department of Health & Family Welfare Honorable Health Minister Additional Chief Secretary Health & FW Commissioner Health, Medical Services &Medical education Additional Director Health Services 5. LIFE CYCLE OF MALARIA PARASITE AS IT PROCEEDS IN HUMAN & VECTOR MOSQUITO LIFECYCLEOF MAL.PARASITEP.VIVAX LIFECYCLEOF MAL.PARASITE PF. 6. Malaria paradigms in Gujarat The peculiar geo-ecological conditions in Gujarat Statewhich consists of diverse topographic features, climatic conditionsand other favorable factors such as rapid industrialization and urbanization have facilitated the formation of different malaria paradigms Valsad, Navsari, Bharuch,Jamnagar and Junagadh Coastal malaria Surat, Valsad, Bharuch,Kutch, Jamnagar. Industrial malaria Surat,Vadoadara, Ahmedabad, Bharuch. Urban malaria Surat city, other urban areas. Migration malaria Central Gujarat :Kheda, Anand, Panchamahal, Vadodara Irrigation malaria 4 districts in the Kutch and North Gujarat region Epidemic prone semi arid and arid area 11 districts of South, Central and North Gujarat. Tribal malaria Areas/districts covered Malaria paradigm 7. Malaria situation in India 8. Endemic areas for malaria(based on API 2 as baseline) 9. Malaria situation in Gujarat 1967 to 2006 10. 11. Significant increase in Malaria from 32 nd to 37 thweek 12. Rise in falciparum incidence From 32 nd week to 37 thweek 13. Drug resistant blocks identified in Gujarat Matar, mahudha,Mehmdabad Nadiad Kheda Olpad, Choryasi,Kamrej Suart city Surat Harij, Radhanpur, Patadi, Rapar Sami Patan Limkheda, Dhanpur Devgadhbaria Dahod Anand Umreth Anand Nakhatrana, Mundra, Mandvi, Anjar Bhuj Kutch Santrampur, Lunawada, Khanpur Kadana Panchmahal Adjoining blocks Block in which drug resistance detected District 14. Dr.G.C.Sahu/ROH&FW/GoI/A'bad Khavada-Gorewali/ Kachchh-bhuj Kadana/ Panch mahals PHCs where alternatrive drugpolicyisinplace.GUJARAT Pansora/Anand Degawada/Dahod Lolada/Patan Surat city(CHQ&ACT) Khanvel-D&NH 15. Dengue Control..need for an..Integrated Strategy 16. 17. 18. 50 %Contribution by the Corporations 19. AMC reported more cases in 2010 20. 21. 22. Surat, Valsad and Navsari reported more cases 23. Jamnagar corporation Reported significant riseIn cases 24. Bhavanagar district and corporation Reported more cases. 25. During 2009 a total of 68confirmed Chikungunya caseshave been reported fromA,bad (6), Kheda(15), Anand (4), SK (2), Vadodara (10), PM (2),Bharuch (2), Narmda (6), Rajkot (3) Junagadh (5), Porbandar (1), VMC (1), SMC (11) 26. 27. AS Fauci GLOBAL EXAMPLES OF EMERGING AND RE-EMERGING INFECTIOUS DISEASES 28.

• • Integrated Strategy

Social Communication Epidemiological Surveillance Entomology Patient Care Laboratory IntegratedStrategy Components 29. 30. 31. Filaria situation of Gujarat State: 2006-2009 Year BSE MF cases MF rate 2006 73379 142 0.20 2007 80664 112 0.14 2008 71224 81 0.11 2009 64531 45 0.10 32. District wise Lymphoedema and hydrocele cases reported in Gujarat State Sr. No Name of District/Corporation No. of Patients Total Lymphoedema Hydorcele 1 Surat 1422 879 2301 2 SMC 470 157 627 3 Tapi 247 266 513 4 Valsad 65 37 102 5 Navsari 449 457 906 6 Rajkot 45 3 48 7 RMC 28 0 28 8 Jamnagar 169 0 169 9 JMC 250 3 253 10 Junagadh 59 0 59 11 Jun-Cor. 59 4 63 12 Porbandar 55 3 58 13 Amreli 64 3 67 14 Vadodara 11 148 159 Total 3393 1960 5353 33. 85.05 28427530 11587201 13624583 TOTAL 91.35 131985 52381 57339 Vadodara 8 86.66 1174632 503067 580500 Porbandar 7 85.43 4880904 2006956 2349131 Rajkot 6 84.23 3041789 1292624 1534570 Amreli 5 84.29 7061983 2681194 3181020 Surat City 4 85.78 6348576 2580704 3008681 Surat3 85.05 2581470 1113545 1309288 Navsari 2 84.58 3206191 1356730 1604054 Valsad 1 % Cov. Consumption of DEC tablets Population covered Total Pop. District Sr. No MDA coverage - 2006 34. 35. Coverage under MDA during 2009 Sr. No. District/Corporation Total Population Eligible population Pop. Covered No. of tablets administered % pop. Covered DEC Alb 1 Surat 1658762 1490395 1394526 3738824 1394526 84.07 2 Surat Muni.Corp. 4530348 4077313 3992472 10877376 3992472 88.13 3 Tapi 835279 751749 689250 1880495 697819 82.52 4 Valsad 1661890 1488650 1489881 3665965 1418742 89.65 5 Navsari 1380170 1200153 1144648 2872825 1144648 82.94 6 Rajkot 2461984 2142686 2150124 5368556 2150124 87.33 7 Rajkot Muni.Corp. 1504606 1361830 1163527 3146086 1163527 77.33 8 Jamnagar 1705501 1557330 1519045 3776086 1519045 89.07 9 Jamnagar Muni.Corp. 588013 470410 445308 1168659 445308 75.73 10 Junagah 2768982 2428643 2373654 5940261 2373654 85.72 11 Junagadh Muni.Corp. 262600 223210 192760 515870 192760 73.40 12 Amreli 1431227 1428000 1295827 3356178 1332259 90.54 13 Porbandar 590717 502109 534121 1298614 534121 90.42 14 Vadodara(Dabhoi) 58332 57447 56587 147032 56587 97.01 TOTAL 21438411 19179925 18441730 47752827 18415592 86.02 36.

• Integrated Vector Management:

• • Anti larval measures

• Introduction of larvivorous fish in identified water bodies

• • Insecticide treated bed nets

• • Indoor Residual Spraying

• Parasite elimination:

• • Early case detection and prompt, complete treatment

• • Quality Assurance of laboratory diagnosis of malaria

• • Strengthening of referral services

• Cross-cutting interventions :

• • Capacity Building through integrated training approach

• • Communication for Behavior Impact

• • Inter-sectoral collaboration

• • Operational research

• Close monitoring and supervision with periodic reviews/evaluations

STRATEGIES UNDER NVBDCP:MALARIA CONTROL 37. STRATEGIES UNDER NVBDCP:DENGUE/CHIKUNGUNYA CONTROL

• Integrated Vector Management:

• Anti larval measures/source reduction

• Introduction of larvivorous fish in identified water bodies.

• Indoor space Spraying/fogging

• Case management and surveillance

• Sentinel surveillance

• Early diagnosis for confirmation and to facilitate preventive steps

• Strengthening of referral services for case management

• Cross-cutting interventions:

• Capacity Building through integrated training approach

• Communication for Behaviour Impact

• Inter-sectoral collaboration

• Operational research

• Close monitoring and supervision with periodic reviews/evaluations

38. Indicators monitored on a regular basis

• Fever rate in the OPD/community.

• SPR, SFR ,MPI and MBER

• Sero Positivity rate for Dengue and Chikungunya

• Room coverage under IRS.

• Larval indices viz. HI, BI and CI

• Time lag between BSC and complete treatment.

• Case fatality rate for Dengue and falciparum cases.

39.

• EARLY DETECTION OF WRANING SIGNALS THROUGH REGULAR WEEKLY AND MONTHLY MONITORING..FOR PREVENTING OUTBREAKS. A CONTINUOUS PROCESS

40. Monitoring of comparative malaria situation is useful to identify vulnerable spots. 41. 42. 43. 44. 45. 46. 47. Year 2006. GIS mapping of village wise malaria situation helped to identify high risk villages and to plan containment measures accordingly. 48. Facilities/institutions available for training in the State

• Regional Office for H&F.W, Ahmedabad.

• Health & F.W Training center- State level (1)

• Divisional Training center (4)

• District Training Team (17)

• Medical colleges (8)

• National Institute of Malaria Research- field station, Nadiad

Technical experts working in the above institutions are capableof imparting training for the batches proposed in the training. 49. Training modules available

• MOPHC

• Technical Supervisor

• Laboratory Technician

• ASHA

• Case management protocol for Dengue and malaria

50. Prevention and controlof Vector Borne Diseases (Preparedness activities)

• Series of review meetings are organized at the State level which are chaired by Honorable Chief Minister, Health Minister, Additional Chief Secretary Health and Commissioner Health during the pre transmission period.

51. Surveillance and Case Management.

• All the 18000 villages were screened for fever cases during the months of March, April, May and June 2006 by campaign mode.

• Additional manpower ( 2772 Malaria Link Volunteers and419 Vector Control Teams of 6 members) was deployed.

• Surveillance was also intensified through the volunteers ofFever Treatment Depots, Drug Distribution Centers and ICDS workers.

52.

• 3000 Arogya Melas were organized in all the districts of the state.

• More than 10.0 lakh people took the benefit out of these camps.

• 8 Government Medical Colleges and 2 Private Medical Colleges were involved and the services of the Specialists from the Departments of Medicine, Pediatrics and Gynecology was utilized for treating the patients in the Arogya Melas..

Surveillance and Case Management. 53.

• AlternateSystems of Medicine were actively involved in the campaign against Chikungunay and 25 lakh people were provided with Ayurvedic Preparation as a prophylactic measure.

• Suspected Chikungunya patients were provided with treatment at their doorsteps through surveillance teams .

54.

• Management of severely ill patients was ensured in all the major hospitals of the state by providing them with free treatment. These patients were subsequently followed up.

• The Hospitals and Dispensaries functioning under ESIS were also opened to the General Public, more than 30,000 peoples benefited.

Surveillance and Case Management. 55.

• Larvae eating fishes were introduced in 67956 permanent water bodiesout of 150267 ( 45.22%). This activity which was initiated from February 2006.

• Biolarvicide ( 9000 Kg) was made available to each Corporation, Districts and Nagarpalikas for anti larval measures.

Vector Control - Biological 56. Demonstration of Guppyfishesto school children 57. Vector Control - Chemical (Insecticides used: Malathion 25 % WDP , Deltamethrine 2.5 % WP & Alphacypermethrine 5 % WP).

• Indoor Residual Spray commenced in 63.58 lakh population in May 2006 to protect the high risk population.

• 13.50 lakh population covered under Malathion 25% and 50.08 lakh population covered under Synthetic Pyrethroid.

• Room coverage achieved-89.78%

58. Fogging operations.

• Indoor fogging operation was undertaken in 40 lakh houses for adult vector control.

• Outdoor fogging was undertaken in Surat and Ahmedabad cities in closed mills and other public places tominimize vector density .

• Fogging machines (100 no.s) provided by UNICEF have been put in to operation in the worst affected areas of the State.

59. Vector Control- Insecticide Treated Mosquito Nets

• 403508 community owned bed nets were treated with insecticide in addition to the 138448 insecticide treatedbed nets distributed under various projects.

• Insecticide Treated Bed nets were provided in Hospitals to prevent the transmission of vector borne diseases.

60. Vector Control Source reduction.

• 419 Vector Control Teams ( each team comprising 6 members) were deployed on daily wages basis to intensify vector control measures.

• Elimination of breeding places mainly intra domestic wastaken up on a large scale in the worst affected areas.

• 1.49 Lakhs breeding places were eliminated during the house to house drive that was undertaken

61.

• Chemical Control

• Environmental Management

Biological Control INTEGRATED VECTOR MANAGEMENT An Evidence-based decision making process, rationalizing the use of vector control methods and emphasizing the engagement of communities JUDICIOUS USE & SELECTION OF VECTOR CONTROL OPTIONS 62.

• Peoples Participation

• Health Minister wrote letters to all the Sarpanches of the Village Panchayats and other elected representatives of the District Panchayat, Nagarpalikas and Municipal Corporations.

• Health Minister addressed the people of Gujarat through Doordarshan during anti Malaria Month .

63.

• Peoples Participation

• Messages through Doordarshan, EtV and Zee TV was relayed for generating community awareness.

• Messages through All India Radio and Radio Mirchi were also relayed.

• Exhibition/ road shows were organized.

• Rallies were organized .

64. TABLO ORGANISED DURING REPUBLIC DAY PARADE ON 26 THJANUARY 2006 AT GANDHINAGAR 65. GATE ON MAIN TRAFFIC CIRCLES OF GANDHINAGAR TOWN. NO ENTRY MALARIA,DENGUE, CHIKUNGUNYA 66.

• School children and NCC cadets were involved in source reduction activities.

• Hoardings and posters were displayed.

• 10 lakhs of handbills were printed and distributed.

• Social mobilization through NGOs, and other sectors was also ensured.

• Community was educated during Krushi Mahotsav and Anti Malaria Month.

67. Highlights of the innovative steps undertaken. 68.

• Areas reporting increase in fever incidence as per IDSP reports and also the weekly reports from the districts are being monitored on a day to day basis by deploying surveillance teams.

• Intensive surveillance in high risk areas and follow of malaria cases detected during 2005 and 2006 was being carried out as a pre transmission drive in all the districts.

• Biological control and other source reduction activities were intensified by deploying additional vector control teams on daily wages basis.

Innovative steps undertakenby the State. 69.

• Treating community owned mosquito nets and making available more mosquito nets out of various sources was taken up as a priority.

• Additional vector control teams deployed in Dengue prone areas like Gandhinagar and Ahmedabad for Dengue prevention and control activities.

• Timely commencement of Indoor Residual Spray.

• Awareness generation activities implemented as a part of Krushi Mahotsava and Anti Malaria Month.

• Permission given to all districts to outsource the work of laboratory Technicians by paying Rs. 3/ slide considering the vacancies.

• To overcome the problem of entomological staff, the work will also be outsourced through Indian Red Cross.

70. This completes the current presentation. Dr.G.C.Sahu/ROH&FW/GoI/A'bad 71. THANK YOU Dr.G.C.Sahu/ROH&FW/GoI/A'bad