National Vector Borne Disease Control Research Articles

Prevalence of malaria and anemia among pregnant women residing in malaria-endemic forest villages in India

India has the highest burden ofmalaria in Southeast Asia, accounting for 61% of confirmed cases in the region in 2011 [1]. Furthermore, more than one-fifth (22.6%) of Plasmodium falciparum and 42% of Plasmodium vivax infections globally occur in the country [2]. The prevalence of malaria is increased among the ethnic tribal population residing in areas of India affected by long-term conflicts of low intensity [3]. Malaria in pregnancy is the most common yet preventable cause of maternal and perinatal morbidity and mortality. Additionally, anemia is a major public health problem among pregnant women in India; about 80% of maternal deaths in South Asia are related to this condition [4]. The aim of the present study was to assess the prevalence of malaria and anemia among pregnant women from ethnic tribes in Andhra Pradesh and Chhattisgarh. Datawere used that had been previously collected byMedecins Sans Frontieres India for 1222 pregnant women residing in adjoining forest villages who attended one of seven mobile prenatal-care clinics between January 1 and December 31, 2012. Rapid diagnostic tests were performed to detect malaria among pregnant women with a history of fever. To detect anemia in the pregnant women, hemoglobin levels were estimated using HemoCue (HemoCue AB, Angelholm, Sweden). For the present study, only the secondary data pertaining to the total number of pregnant women and whether results were positive or negative were obtained; other information such as type of malaria was not collected. Ethical clearance was not necessary, because data were obtained from a retrospective review of records. The overall prevalence of malaria was 20.6%, ranging from 13.3% in Tippapuram to 47.6% in Maita (Table 1). The proportion of pregnant women with anemia was 73.2% (Table 1). In spite of the National Vector Borne Disease Control Programme and the introduction of artemisinin-based combination therapy, insecticide treated bed nets, and a longlasting insecticidal net, the prevalence of malaria in the study area is alarmingly high. Similarly, although the National Nutritional Anemia Control Programme has been implemented for more than three decades, anemia continues to be a severe public health problem. Access to modern health care is poor in the region, not because of geographic isolation, but as a result of constant conflictrelated issues leading to security restrictions for health staff. Therefore, individuals seek healthcare services from traditional healers, untrained individuals, and dais (traditional birth attendants). Sustainable intervention strategies—e.g. health and nutrition education through information, education, and communication activities, and behavior change communication—need to be implemented, with a focus on women of reproductive age. In India, local health workers and the community could be mobilized to prevent and control anemia and malaria among the women of reproductive age from ethnic tribes in general and those who are pregnant in particular.

Current status of dengue and chikungunya in India.

Dengue, a Flavivirus and chikungunya, an Alphavirus, transmitted by Aedes mosquitoes, are a cause of great concern to public health in India. Every year, thousands of individuals are affected and contribute to the burden of health care. Dengue outbreaks have continued since the 1950s but severity of disease has increased in the last two decades. Chikungunya outbreaks started in the 1960s and dwindled to sporadic cases until a resurgence in 2006. Based on the data of National Vector Borne Disease Control Programme (NVBDCP), the number of cases reported in 2013 was about 74 454 for dengue with 167 deaths and 18 639 for chikungunya. The number of cases reported is increasing, probably because of the availability of IgM detection kits produced and distributed by National Institute of Virology through NVBDCP and better reporting. In the absence of well-structured epidemiological studies, this review attempts to summarize reports on dengue and chikungunya outbreaks from various regions of India. For dengue, young adults are the major group affected; the severity of disease in India is still lower than that reported elsewhere in South-East Asia; and paediatric cases of dengue haemorrhagic fever have a high mortality. For chikungunya, all age groups are affected but severe manifestations are more often seen in children. Persisting arthralgia, neurological syndromes and non-neurological manifestations are recorded. Changes in the genotype and mutations in the genome have been detected for both dengue and chikungunya viruses. The review ends with a short summary of the most recent vector-control studies.

Economic burden of malaria in India: The need for effective spending.

About 95%of India's population resides in malaria-endemic areas and, according to government sources, 80%of malaria reported in the country is confined to populations residing in tribal, hilly, difficult and inaccessible areas. Using a nationally representative sample, this study has estimated the economic burden of malaria in India by applying the cost-of-illness approach, using the information on cost of treatment, days lost and earnings foregone, from the National Sample Survey data. A sensitivity analysis was carried out, by presenting two alternative scenarios of deaths. The results indicate that the total economic burden from malaria in India could be around US$ 1940 million. The major burden comes from lost earnings (75%), while 24%comes from treatment costs. Since mortality is low, this is not a major source of economic burden of malaria. An analysis of the trend and patterns in public expenditure by the National Vector Borne Disease Control Programme shows a declining focus of the central government on vector-borne diseases.Also, allocation of financial resources among states does not reflect the burden of malaria, the major vector-borne disease in the country.

Clinico-epidemiological profile of patients with febrile illness attending malaria clinic at medical college hospital of Surat, Gujarat, India

Background: Febrile illnesses are pre-eminent contributors to morbidity and mortality. As one of the common cause, malaria is a potentially life threatening parasitic disease. Passive surveillance of malaria is carried out by primary health centers, malaria clinics, community health centers and other secondary and tertiary level health institutions that patients visit for treatment. Early diagnosis and complete treatment is one of the key strategies of national vector borne disease control programme. Aims & Objective: A study was undertaken to study the clinico-epidemiological and laboratory profile of the fever cases. Materials and Methods: It is a descriptive, cross-sectional hospital based study conducted at malaria clinic at medical college hospital of Surat, Gujarat, India. Results: The most common symptom as reported by the patients was fever with rigor (32.37%). Proportion of body ache, cough, headache and fever constituted 17.40%, 13.95%, 11.81% and 11.35% symptoms as reported by the study population. Analysis of the result of PS for MP reveals that large number of the patients (84.0%) did not show malaria parasite in their blood smear. Out of positive slides, 84 % were Plasmodium vivax whereas less than 16 % P. falciparum. Conclusion: Malaria clinic functioning at New civil hospital, Surat can act as one of the important surveillance center for malaria in Surat city as well as in South Gujarat. Relationship of different symptoms with peripheral blood smears positive for malaria is not found.

When do vertical programmes strengthen health systems? A comparative assessment of disease-specific interventions in India

Disease-specific programmes have had a long history in India and their presence has increased over time. This study has two objectives: first, it reports on the interaction between local health systems and key disease-specific programmes in India—National AIDS Control Program (NACP) (HIV/AIDS), Revised National Tuberculosis Control Program (RNTCP) (TB) and National Vector Borne Disease Control Program (NVBDCP) (Malaria), and second, it examines which factors create an enabling environment for disease-specific programmes to strengthen health systems. A total of 103 in-depth interviews were conducted in six states in 2009 and 2010. Key informants included managers of disease control programmes and health systems, central and state health ministry and staff from peripheral health facilities. Analytical themes were derived from the World Health Organization (WHO) building block and the Systems Rapid Assessment framework. Disease-specific programmes contribute to strengthening some components of the health system by sharing human and material resources, increasing demand for health services by improving public perceptions of service quality, encouraging civil society involvement in service delivery and sharing diseasespecific information with local health system managers. These synergies were observed more frequently in the RNTCP and NVBDCP compared with the NACP. Disease-specific programmes in India are widely regarded as having made a substantial contribution in disease control. They can have both positive and negative effects on health systems. Certain conditions are necessary for them to have a positive influence on health systems—the programme needs to have an explicit policy to strengthen local health systems, and should also be embedded within the health system administration.

First indigenous transmission of Japanese Encephalitis in urban areas of National Capital Territory of Delhi, India

Until 2010, no Japanese encephalitis (JE) had been reported from Delhi. Upon report of four confirmed cases of JE in September 2011, detailed investigations were carried out to determine whether the cases were imported or indigenous. Entomological surveys were carried out and all mosquito pools were tested for the detection of JE virus by ELISA method using specific monoclonal antibody. Human blood samples from contacts of the patients were tested by IgM-captured ELISA method. Pig's blood samples were also tested for the detection of JE virus. Culex tritaeniorhynchus, Culex vishnui and Culex pseudovishnui mosquitoes were found. In contrast to rural areas, their breeding habitats were different in the city. 19 pools were tested. JE virus was detected in two pools of Cx.tritaeniorhynchus females reared from field-collected larvae, indicating vertical transmission. One pool of Cx.vishnui was also positive. This is the first report for the detection of JE virus in mosquitoes from Delhi. JE IgM antibodies in five contacts/residents indicate recent infection. JE virus was also detected in pigs. Present analysis shows that of four reported JE cases, three were confirmed indigenous, indicating that the virus is multiplying in the city. Mapping of infected JE vector mosquitoes in the cities is required for preventive measures to contain further spread of the disease.

Fight against dengue in India: progresses and challenges

At the end of the last century, India has faced resurgence of many infectious diseases, of which dengue is one of the most important in terms of morbidity and mortality. The National Vector Borne Disease Control Program data show that dengue is established in India and is becoming endemic to many areas (dengue cases have increased steadily from ∼450 to ∼50,000 from 2000 to 2012). Despite extensive efforts being made in developing the effective dengue control measures, the number of dengue cases, their severity, and geographical boundaries are expanding alarmingly and posing dengue as one of the deadly disease. Recently, the increasing burden of dengue in the country has attracted the scientific as well as Indian Government's administrative attention; however, a lot remain to be achieved for managing the disease under threshold level. Like other vector-borne diseases, better management of the dengue needs balanced approach involving various aspects like disease prevention, cure/treatment, and the vector control, simultaneously. We have briefly discussed here the situation of dengue in India and have tried to highlight the worrying facets of dengue control and its implementation in Indian perspective. The review on various aspects of dengue control has revealed an urgent need for permanent surveillance programs, coupled with improvised disease diagnostics, effective anti-dengue treatment measures, and controlling the disease transmission by following an effective implementation of vector control programs.

High Prevalence of Asymptomatic Malaria in a Tribal Population in Eastern India

Asymptomatic infection by Plasmodium falciparum is an important obstacle to eliminating malaria. Asymptomatic carriers do not seek treatment for infection, and therefore they become a reservoir for the parasite. For this reason, these carriers pose a real public health risk. The systematic identification and treatment of asymptomatic infections should reduce the parasite reservoir. A large reduction in this pool will lower the chance of transmission of the disease. In this study, we screened a tribal population of 1,040 individuals in the Purulia district of West Bengal by using a dual-antigen rapid diagnostic kit (RDK), microscopy, and species-specific PCR. All positive individuals were treated with artemisinin-based combination therapy (ACT) (artesunate plus sulfadoxine-pyrimethamine) and followed for 42 days. Polymorphisms in candidate genes were screened by DNA sequencing. A significant proportion (8.4%) of the study population was infected with P. falciparum but showed no clinical manifestations. The PCR method was more sensitive in detecting infection than the RDK or microscopy. The efficacy of the ACT was 97%. In the pfcrt gene, the mutation K76T (the mutated amino acid is indicated by bold type) was found in 100% of the cases. In the pfmdr1 gene, the mutations N86Y and Y184F were noted in 55.5% and 11% of the cases, respectively. Six different haplotypes were identified in the pfdhfr-pfdhps genes. Most importantly, the quintuple mutant A(16)I(51)R(59)N(108)I(164)-S(436)G(437)E(540)A(581)A(613) was found in 10% of the isolates, which is potentially important for the development of sulfadoxine-pyrimethamine resistance. A significant proportion of the study population harboring P. falciparum does not seek treatment and therefore serves as a reservoir for the parasite, maintaining the natural cycle. If the National Vector Borne Disease Control Programme (NVBDCP) of India is to eliminate malaria, then this hidden parasite burden needs to be addressed properly. Similar study in other parts of the country could help to determine the magnitude of the problem.

Operational Scaling-Up use of Larvivorous Fishes and its Impact on Prevalence of Malaria in Mandvi Taluka of District Kutch Gujarat

Use of larvivorous fish in mosquito control has been well established specially the effectiveness of fishes like Gambusia affinis, Poecilia reticulata and some indigenous fishes in different mosquito breeding habitats [1-4]. However, reports on operational level scaling up or largescale use of fishes are scanty [5-7]. In India, use of larvivorous fishes has become an element in vector control policy of the National Vector Borne Disease Control Programme (NVBDCP). We used a systematic approach of scaling-up of use of the larvivorous fishes in Mandvi taluka (Sub-District), District Kutch, Gujarat in 2008–2009 selected on the basis of high prevalence of malaria during 2007 and suitable ecological conditions for use of larvivorous fishes. We trained the vector control staff in catching of fishes from natural habitats, transportation and release into mosquito breeding habitats and monitoring impact of this intervention on mosquito larval densities and malaria prevalence. In order to initiate the work in district Kutch meetings with CDHO and DMO were organized. The Malaria situation in the district was reviewed. Considering the rising trend of malaria in Madvi taluka, it was decided to take up the Mandvi taluka comprising of four PHCs to begin with the scaling-up use of larvivorous fishes. The Medical Officers of all the PHCs were invited for the briefing up of project activities and to extend their cooperation in achieving the targets. The Performa of fish application in different habitats on monthly basis in their PHCs were provided for recording the monthly progress. They were also taken to the field for demonstrations and showing the collection sites of Aphanius fishes on the outskirts of Mandvi city and other natural habitats. The field and other staff at the district, PHCs and Block Health Officer (BHO) level in the district were given necessary training on technical aspects, operational issues such as collection, transportation,

A Leader’s Fight Against Malaria in Kolkata, India

Malaria is an age-old public health problem in Kolkata City, the cultural capital of India. In 2010, a popular political leader, Atin Ghosh, became the Member of the Mayor-in-Council (Health) of Kolkata Municipal Corporation at the behest of the Hon’ble Chief Minister of West Bengal, Ms Mamata Banerjee. Unlike his predecessors, Mr Ghosh took several unprecedented initiatives to fight against malaria and implemented them religiously. As a result of which, the situation improved remarkably. The number of malaria cases here downslided from a dispiriting 96,693 in 2010 to a comfortable 32659 in 2012 through 41,642 in 2011. No death due to malaria occurred in the city after 2010. The extent of decline in the number of Pf cases was from 14,226 in 2010 to a mere 3403 in 2012. The World Health Organization and the Directorate of National Vector Borne Disease Control Programme, Government of India, have officially appreciated the achievement of KMC in the field of malaria prevention. Truly, a new era of mosquito control activities so needed to prevent malaria and other mosquito-borne diseases began in KMC area soon after Atin Ghosh had taken over the charge of the health department of KMC as the MMIC. He proved himself to be a trendsetter. Political leaders around the country can learn a lesson from this leader of Kolkata.

Health-seeking behaviour for febrile illness in malaria-endemic Kolasib district, Mizoram, India

Early diagnosis and complete treatment (EDCT) is an important strategy for malaria control in India's National Vector Borne Disease Control Programme. The success of this strategy is closely linked to people's health-seeking behaviour. A study was conducted to determine the treatment-seeking behaviour of suspected malaria patients in Kolasib, a highly malaria-endemic district in Mizoram, India. Approximately one-third of the 540 fever patients interviewed sought initial treatment from public health facilities, whilst the majority either took self-treatment or purchased medicines from private pharmacies. Approximately 20% of patients sought treatment after 48 h of fever onset. Patients aged >14 years and those who had an income ≥Rs 5000 (US$104) were more likely to receive treatment from non-governmental health facilities. Patients aged >14 years and those residing in difficult locations were more likely to take treatment after 48 h of fever. To improve implementation of the EDCT strategy, it is necessary to conduct health education campaigns in the district (i) about seeking early treatment from public health facilities, including the fever treatment depots established in all villages, and (ii) discouraging the practice of self-treatment.

Efficacy of oral miltefosine in visceral leishmaniasis in rural West Bengal, India

Context:Visceral leishmaniasis (VL), also known as Kala-azar (KA) is a public health problem of tropical and subtropical countries, which infects about 12 million people annually, out of which about 1.5 million are new cases. India contributes a major share of the global burden of VL. For many years leishmaniasis has been treated with pentavalent antimonials. Antimony resistance is a problem in India and in other different geographic areas of the world. Amphotericin B deoxycholate and pentamidine isethionate are effective by parenteral administration and associated with toxicities. The quest for an effective, orally administered, non-toxic and less expensive alternative resulted in the identification of miltefosine (hexadecylphosphocholine). In India, therapeutic efficacy of miltefosine in VL was assessed by many groups of scientists, mainly from Bihar and Uttar Pradesh. No such data is available from West Bengal.Aims:The present study was designed to observe the efficacy of miltefosine in VL in rural West Bengal.Materials and Methods:A total of 71 parasitologically proven VL patients participated in the study who received miltefosine in accordance with the National Vector Born Disease Control Programme (NVBDCP) of India and were followed up for the following one year.Results:The overall efficacy of the drug was 93% and no significant adverse side effects were observed during the study period.Conclusions:The study concludes that miltefosine is effective, well tolerated, and easily administrable drug in the treatment of visceral leishmaniasis at the field levels.

Malaria in India: The Center for the Study of Complex Malaria in India

Malaria is a major public health problem in India and one which contributes significantly to the overall malaria burden in Southeast Asia. The National Vector Borne Disease Control Program of India reported ∼1.6 million cases and ∼1100 malaria deaths in 2009. Some experts argue that this is a serious underestimation and that the actual number of malaria cases per year is likely between 9 and 50 times greater, with an approximate 13-fold underestimation of malaria-related mortality. The difficulty in making these estimations is further exacerbated by (i) highly variable malaria eco-epidemiological profiles, (ii) the transmission and overlap of multiple Plasmodium species and Anopheles vectors, (iii) increasing antimalarial drug resistance and insecticide resistance, and (iv) the impact of climate change on each of these variables. Simply stated, the burden of malaria in India is complex. Here we describe plans for a Center for the Study of Complex Malaria in India (CSCMi), one of ten International Centers of Excellence in Malaria Research (ICEMRs) located in malarious regions of the world recently funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health. The CSCMi is a close partnership between Indian and United States scientists, and aims to address major gaps in our understanding of the complexity of malaria in India, including changing patterns of epidemiology, vector biology and control, drug resistance, and parasite genomics. We hope that such a multidisciplinary approach that integrates clinical and field studies with laboratory, molecular, and genomic methods will provide a powerful combination for malaria control and prevention in India.

Malaria and National Vector Borne Disease Control Programme

Malaria is a major vector borne disease in India with significant morbidity and mortality. The official figure of 1.5 million cases annually is a gross under-estimation of the true incidence and the actual figures are estimated to be 10-100 times higher. The National Vector Borne Disease Control Programme (NVBDCP) directorate is the main body responsible for malaria control in India. Newer strategies including insecticide treated bednets, longlasting insecticidal bednets and rapid diagnostic tests have been used for malaria control in the last decade. Global assistance has come from the World Bank and Global fund in the form of Enhanced Malaria Control Programme(EMCP) and Intensified Malaria Control Programme(IMCP) respectively. Despite years of concerted global and national efforts, control of malaria continues to be a challenge. The emergence of drug resistance to anti-malarial drugs has been a major hurdle in its control. The NVBDCP has formulated new treatment guidelines for malaria in 2010 which recommend artemisinin based combination therapy (ACT) as the first-line drugs for P. falciparum malaria in the country. The article discusses the recent national drug policy for malaria and the rationale for its use.

Efficacy of Chloroquine and Sulphadoxine-Pyrimethamine either alone or in combination before introduction of ACT as first-line therapy in uncomplicated Plasmodium falciparum malaria in Jalpaiguri District, West Bengal, India

In India, till recently, Chloroquine was used as first-line therapy in areas with Chloroquine sensitive Plasmodium falciparum malaria cases. The National Vector Borne Disease Control Programme (NVBDCP) has introduced artemisinin combination therapy (ACT) as first-line option to treat all P. falciparum cases in the country. This study was carried out to ascertain the efficacy of Chloroquine and Sulphadoxine-Pyrimethamine, either alone or in combination, before the launch of ACT by NVBDCP. A total of 300 P. falciparum malaria cases were enrolled randomly in three study arms, Chloroquine (CQ), Sulphadoxine-Pyrimethamine (SP) and Chloroquine plus Sulphadoxine-Pyrimethamine (CQ + SP). All patients were followed up for 28 days as per WHO (Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated Falciparum Malaria, Geneva, 2003) Protocol. Paired blood samples of treatment failure cases were collected and subjected to MSP 1, MSP 2 and GLURP genotyping for differentiation between re-infection and recrudescence. The data were analysed by Kaplan-Meier survival curve according to WHO standard procedures. The overall failure rate including both early treatment failure (ETF) and late treatment failure (LTF) of CQ, SP and CQ + SP were 61%, 14% and 8%, respectively, in the study area. Of 60 recurrent malaria cases, genotyping was successful in 49 cases, revealing that most of the (46/49; 94%) cases of recurrent malaria were due to recrudescence. In Jalpaiguri District the overall failure rate of CQ was 61% and of SP 14%, which was well above the WHO recommended cut-off threshold level (10%) for change of drug policy.

World bank EMCP malaria project in Orissa, India - A field reality

Background:Under the National Vector Borne Disease Control Program, the Enhanced Malaria Control Project (EMCP) with World Bank assistance was implemented in India, in the eastern state of Orissa.Aims:This article tries to analyze the possible reasons for the poor performance of EMCP in a few states of India.Settings and Design:The eastern state of India is taken as a case study for looking into systemic, human resource, and logistics related issues that could explain the poor performance of EMCP in a few states of India.Materials and Methods:Field visits were made to some selected EMCP areas in the state of Orissa. Operational issues-related implementation of various components of the project were scrutinized.Statistical analysis:Not Applicable.Results:While the project was highly successful in a few states of India, it had limited success in some states. It was learnt that the honorarium meant for Fever Treatment depot [FTD] work was divided among all the malaria workers. In high-risk areas, presumptive radical treatment was being carried on by malaria workers for every case of fever. Using Rapid Diagnostic Tests (RDTs) in such areas seemed to have no relevance. The laboratory technician ignored malaria work, due to a high work load and no additional incentive. In the Primary Health Centers (PHCs) the Medical officers had either not visited the village under indoor residual spray or symbolically visited only five to six houses. Cement tanks had to be built for larvivorus fish breeding. However, they had not been mad.Conclusions:The success of a public health program is dependent more on project implementation, management, monitoring, and evaluation of project activities than the volume of financial resource allocation.

Mass drug administration to eliminate lymphatic filariasis in Southern India

Background Lymphatic filariasis is an important public health problem in India. Inspite of National filarial control programme (NFCP) being in place for lymphatic filariasis (LF) elimination,several important issues need to be addressed. There is uncertainty about the coverage and compliance to treatment in order to achieve elimination. Method A community based cross-sectional study was conducted as per the National Vector Borne Disease Control Programme (NVBDCP) directions. The study included survey of 200 households of Dakshina Kannada District, South India where the Mass drug administration (MDA) program was conducted. The main objective of the study was to assess the coverage and compliance to MDA. Results Out of the total 1050 eligible people, 876 (83%) received the DEC tablets; so, the coverage was 83%. Among those who received the tablets, only 777 (88.7%) received the adequate dose and only 670 (76.8%) people actually consumed the tablets. Hence, compliance rate was only 76.8%. Conclusion The planning and implementation of MDA programme needs to be strengthened by efficient micro planning, inter sectoral co-ordination and motivating the community to participate in the MDA programme

Public awareness and prevention of malaria in Vanuatu

Malaria still represents a global health burden; according to the World Health Organization, half of the world’s population are at risk from malaria. Vanuatu is an archipelago of 83 islands situated in the South-west Pacific where Plasmodium vivax and falciparum malaria species are endemic. It has a total population of 221,000. Despite the efforts of the National Vector Borne Diseases Control Programme, which reduced malaria morbidity and mortality in Vanuatu significantly in the 1990s, the incidence of malaria has been increasing again recently. Annual parasite incidence (API) decreased from 196 per 1000 in 1990 to 28 per 1000 in 1999; however, in 2003, the incidence of malaria had risen to the same level as it was in 1992, with an API of 74 per 1000, 756 reported severe malaria cases and six malaria-related deaths. It is likely that the actual figure was three times higher due to lack of coverage of diagnostic services in hospitals. Insecticide-treated nets (ITNs) are one of the most effective methods of malaria prevention. Currently, external funding to the Malaria Control Programme from the Global Fund and Australian Government is being implemented in Vanuatu to decrease the incidence of malaria by increasing the coverage

Lymphatic filariasis in India

Lymphatic filariasis caused by Wuchereria bancrofti and Brugia malayi is an important public health problem in India. Both parasites produce essentially similar clinical presentations in man, related mainly to the pathology of the lymphatic system. Filariasis is endemic in 17 States and six Union Territories, with about 553 million people at risk of infection. The Government of India has accorded a high priority for elimination of this infection through mass chemotherapy programme (annual, single dose of Diethylcarbamazine citrate, i.e. DEC - 6 mg/kg of bodyweight, plus Albendazole repeated four to six times). This campaign has become a part of the National Vector-Borne Disease Control Programme in 2003 under the National Health Policy 2002 and aims to eliminate filariasis by 2015. We discuss here the epidemiology and current control strategy for filariasis; highlighting key issues, challenges and options in the implementation of the programme, and suggesting measures for mid-course corrections in the elimination strategy.

Patterns of Plasmodium vivax and Plasmodium falciparum malaria underscore importance of data collection from private health care facilities in India.

BackgroundThis study describes patterns of falciparum and vivax malaria in a private comprehensive-care, multi-specialty hospital in New Delhi from July 2006 to July 2008.MethodsMalarial morbidity by Plasmodium species (Plasmodium falciparum, Plasmodium vivax, or Plasmodium sp.) was confirmed using microscopy and antigen tests. The influence of seasonal factors and selected patient demographics on morbidity was evaluated. The proportions of malaria cases caused by P. falciparum at the private facility were compared to data from India's National Vector Borne Disease Control Programme (NVBDCP) during the same period for the Delhi region.ResultsIn New Delhi, P. faciparum was the dominant cause of cases requiring treatment in the private hospital during the period examined. The national data reported a smaller proportion of malaria cases caused by P. falciparum in the national capital region than was observed in a private facility within the region. Plasmodium vivax also caused a large proportion of the cases presenting clinically at the private hospital during the summer and monsoon seasons.ConclusionThe proportion of P. falciparum malaria cases tends to be greatest during the post-monsoon season while the proportion of P. vivax malaria cases tends to be greatest in the monsoon season. Private hospital data demonstrate an under-reporting of malaria case incidences in the data from India's national surveillance programme during the same period for the national capital region.