Malaria well set to retain its lead over efforts to curb its resurgence

The recrudescent malarial mosquito, once again roaming the subcontinent in blood-thirsty hordes, enjoyed itself spreading alarm and despondency throughout the Indian countryside during 1974 and 1975.In addition to injecting half-forgotten malaria parasites into the populace, it also extracted from almost all authorities concerned the abject admission that the states' execution of the follow-up phase of the National Malaria Eradication Programme had been typified more by complacence than by the needed vigilance.As the sun rose on 1976, with 99 deaths chalked up for the previous year, it looked as if the mosquito was well set to retain its lead over efforts to curb malaria resurgence. But the NMEP's drive to build a countrywide medicated web by educating and equipping the grass-roots population of hard-hit areas to fight the malaria menace is now steadily gaining ground.Proposals to drum up active community support for such measures usually elicit little more than scepticism, because it is popularly supposed that 'The People' take a long time to wake up to their own needs. The state-level authorities are generally considered only slightly less prone to inertia. Not so in the case of malaria. The NMEP had recently worked out a plan to involve 'panchayat' leaders in the distribution of chloroquine and quinine tablets at village level.As in most cases, some states are more responsive than others - and the graph of activity apparently has little to do with the varied state-to-state graph of resurgence. The performance of Andhra Pradesh in training and motivating teachers and the rural citizenry in carrying out simple diagnosis and cure operations has already won praise from the NMEP experts at the centre of the nascent anti-malaria web. Distribution of chloroquine through these new recruits is already under way in A.P. The state had 11,807 cases last year.In Assam and the eastern hill-states, the NMEP's spider-like strategy is depending heavily on the little panchayats of remote villages. People in this part of the country are the worst hit by the Falciparum strain of malaria and Assam accounted for two-thirds of the country's 99 malaria deaths last year.Since the Falciparum infection - which frequently leads to the lethal cerebral malaria - prefers to zero in on children, perhaps it is not surprising that the northeastern villagers have energetically joined in the anti-malarial operations. They have seen enough of the resurgence right in their homes.Well aware that the July to October period is the peak transmission time for malaria, the NMEP effort over the past weeks has been to reach as much chloroquine and quinine as possible to these remote areas before heavy rains made bulk transportation virtually impossible. With floods beleaguring much of the Falciparum-prone territory, much will depend on how well the 'panchayati' distribution of medicines progresses in the remaining months of the monsoon.Quantified in purely numerical terms, the incidence in the north-east is misleading. Tripura, for example, had only 8,056 cases last year. Meghalaya had just 7,357 and Manipur only 1,710. It is the percentage rise that reveals the grim truth. For Tripura, the 1975 figure was 126 per cent higher than the total for the year before.In the cases of Meghalaya and Manipur, the percentage rise was 25 and 33 per cent over the 1974 totals. Assam's 94,182 cases were 89 per cent more than it had in 1974; incidence in Arunachal Pradesh rose by 109 per cent from 1973 to 1974 - and inched up a further 10 per cent in 1975, with the year's total coming to 22,262 cases.The graph is nowhere near being reversed yet. Assam had 3,146 cases in the first six months of 1975; it has had 3,713 cases in the first half of the current year. And it is in some pockets of this north-eastern area that the dread Falciparum strain is showing resistance to the customary chloroquine medication.The old standard cure - quinine - is the only alternative for these disturbing pockets, and the medical profession today is not really happy about the possible side-effects that heavy quinine dosage can have, particularly on the sense of hearing.Chloroquine resistance has not appeared to harass remedial control efforts in other states where Falciparum malaria has crept in, but the appearance of this vicious strain of the disease is alarming enough in itself.In the so-called days gone by, when malaria was malaria and 750,000 people a year could die of its weakening effects, as they did in 1952, death was more often due to debilitation resulting from chronic infection and recurrent attacks of fever.That is the way the better known Plasmodium vivax malaria goes. But Plasmodium Falciparum does not need to attack repeatedly to break down the body's resilience; the cerebral form of it progresses frighteningly fast. Once a negligible factor in the sub-continent, Falciparum last year accounted for 25 per cent of the roughly 8 million malaria cases estimated to have occurred in the country.For India's children, more than for anyone else, this is not good news. It is one of the ironies of improved curative medication that the anti-malarial medicines of today are so harsh that they wipe out both infection and nascent anti-bodies from the patient's system. All the young Indians born after the early 1960's - when the National Malaria Eradication Programme began to have a marked impact - have absolutely no natural resistance to the infection of either Vivax or Falciparum strains.Thanks to the radical effect of the improved drugs, they are not likely to develop any acquired resistance either. Cured of one nasty bout of illness, they are soon as susceptible to further infection as they were before treatment. Those teenage girls who have already become young mothers also have in them the tragic tendency to bear dangerously non-immune babies, who are particularly prone to Falciparum infection. In the case of these hapless infants the disease has already earned itself the awesome nickname of 'cogenital malaria".What happens next? By common consent, and common realization of reality, no one speaks in terms of malaria eradication - no one could find the massive funding it would require, and the manpower force of the NMEP is already confronting the unfair odds of a ratio of one worker to 10,000 population which is just about tenfold of what it should be (1 :1,000). Effective control will cost at least Rs. 80 crores a year with insecticide prices still riding high and chloroquine prices pushed up by a rising Afro-Asian competition for world stocks. Even selective containment costs will work out at around Rs. 56 crores a year. As things are, the total Health Ministry budget for 1976-77 is just Rs. 57 crores - and the NMEP's generous share of Rs. 33 crores out of it is not sufficient to meet the needs of the day.With these constraints, what the NMEP and health authorities are aiming at is to prevent malaria deaths and to avert manpower losses and consequent loss of productivity.Meanwhile, the incidence is still rising, and there is no room for complacency even in the few states where 1975 figures were lower than those of the year before. The essence of the challenge lies in the clinically sound projection that one single untreated case can trigger as many as 1,120 new malaria cases. With national incidence already back in the millions, this kind of geometric progression must not be allowed to establish itself.Published By: AtMigration Published On: Jun 12, 2014 14:08 IST--- ENDS ---

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Malaria well set to retain its lead over efforts to curb its resurgence

As the sun rose on 1976, with 99 deaths chalked up for the previous year, it looked as if the mosquito was well set to retain its lead over efforts to curb malaria resurgence.

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