National Vector Borne Disease Control Programme Research Articles

Unveiling spatio-temporal mysteries: A quest to decode India's Dengue and Malaria trend (2003-2022)

Dengue and malaria are two mosquito-borne diseases that are dangerous globally, especially in tropical and subtropical regions. In India, these two diseases pose severe health issues as they account for 74.37 % of the total vector-borne disease burden in the country. The present study examined the spatio-temporal patterns of prevalence of dengue and malaria across all states in India. Data related to epidemiological statistics were obtained from the Central Bureau of Health Intelligence (CBHI) and the National Vector Borne Disease Control Program (NVBDCP) for 2003–2017 and 2018–2022, respectively. In this study, we have utilized the Mann-Kendall test, Modified Mann-Kendall test, Sens's slope, Innovative trend analysis, and Percent Bias for trend analysis. Furthermore, a hotspot analysis was conducted to compare and examine the evolving patterns of these diseases over space and time. The Mann-Kendall test showed a significant increase in dengue cases throughout India, with Sen's slope showing the fastest growth in Punjab. West Bengal exhibited the most significant ITA slope increase. The PBIAS slope showed a gradual rise from the southern to the northern and north-eastern states. Mann-Kendall results indicated a statistically significant decline in malaria cases, dropping mostly in Odisha, followed by the northern, southern, and north-eastern states. Only Mizoram displayed an insignificant upward trend in malaria cases. Hotspot analysis revealed that dengue fever hotspots expanded in India's central, western, and northern regions, affecting 66.72 % of the country, whereas significant coldspots remain unchanged. Malaria hotspots covered 47.46 % of north-eastern, eastern coastal, and northern areas, while coldspots almost remained unchanged. This study provides valuable insights for health authorities to prioritize and identify the regions that need immediate intervention regarding these two mosquito-borne diseases.

Dengue Seroprevalence in Different Geographic Zones of India: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

Dengue is a highly prevalent mosquito-borne disease that is endemic in over 100 countries. It has a wider impact in terms of severity of illness and mortality risk in the absence of an effective vaccine as yet. The purpose of this study was to use meta-analysis to find out how common the dengue virus (DENV) is in India based on public data and to figure out how much of a problem. We searched, read, and reviewed about DENV in India that were available online. Forty-four cross-sectional studies were selected from the 178 records. There were reports of dengue cases in 14 out of the 28 states. Out of the patients presenting with symptoms of Dengue 27% of people were confirmed to have DENV infection with 82.29% (95% CI. 81-84%), having dengue IgM, 41.67% (95% CI: 40.16-43.43), having dengue IgG, and 23.97% (95% C.I. 14-43%), having both IgG and IgM from positive sample n=27156. Hospital-based cross-sectional studies on suspected Dengue-like illness (DLI) found that 99.48% of people had confirmed dengue out of the patients with features of DLI, and community-based studies found that 0.52% of DLI cases had dengue. The seroprevalence rates for East, South, North, and Western regions were 35.38% (95% C.I.14-31%), 11.57% (95% C.I. 2-69%), 38.10% (95% C.I. 9-61%), and 14.87% (95% C.I. 6-38%) correspondingly. DENV is interestingly spreading across the whole country, and the disease’s frequency varies a lot from place to place and from 2010-2023. However this review does not find appropriate published literature from 50% of the Indian states. The identification of IgG-class antibodies to dengue virus is indicative of prior exposure to this pathogen. Almost all immunocompetent individuals should have developed IgG antibodies against the dengue virus within three weeks of exposure. The presence of dengue virus IgM-class antibodies is indicative of an acute phase of infection. National Vector borne Disease Control Programme (NVBDCP) has some surveillance information, appropriate designed research into prevalence and risk factors for DENV infection would be required to provide adequate information for public health intervention.

Spatiotemporal Epidemiology of Malaria in India from 2007 to 2022.

India is a major contributor to the global burden of malaria, especially Plasmodium vivax infection. Understanding the spatiotemporal trends of malaria across India over the last two decades may assist in targeted intervention. The population-normalized spatiotemporal trends of malaria epidemiology in India from 2007 to 2022 were analyzed using a geographic information system with the publicly available "malaria situation" report of the National Vector Borne Disease Control Program (NVBDCP). The NVBDCP data showed malaria cases to have steeply declined from 1.17 million in 2015 to 0.18 million cases in 2022; this is 10.1 and 18.7 fold lower than the WHO's estimate of 11.93 million and 3.38 million cases in 2015 and 2022, respectively. From 2007 to 2022, Mizoram, Meghalaya, Tripura, Odisha, Chhattisgarh, and Jharkhand consistently reported high caseloads of Plasmodium falciparum. In the same period, the P. vivax caseload was high in Arunachal Pradesh, Mizoram, Nagaland, Jharkhand, Odisha, Chhattisgarh, Goa, Daman and Diu, Dadra and Nagar Haveli, and Andaman and Nicobar Islands. The distribution of forest cover, annual rainfall, and proportion of the Scheduled Tribe population (the most underprivileged in Indian society) spatially correlated with malaria cases and deaths. Mizoram is the only state where cases were higher in 2022 than in 2007. Overall, India has made tremendous progress in controlling malaria and malaria-related deaths in the last decade. The decline could be attributed to the effective vector and parasite control strategies implemented across the country.

Long-Lasting Insecticidal Net Coverage and Utilization in Burla Town of Sambalpur District: A Cross-Sectional Study.

Background Vector-borne diseases continue to significantly contribute to mortality and morbidity, especially in developing nations. Vector management is a key pillar in combating these diseases, and long-lasting insecticidal nets (LLINs) are cost-effective tools. The Government of India, under the National Vector Borne Disease Control Programme (NVBDCP), has distributed LLINs for free to increase coverage and utilization. This study aims to estimate the coverage and utilization of LLINs in Burla town. Method This cross-sectional study was conducted from October to December 2022 in Burla town of Sambalpur in Odisha, India. The estimated sample size was 510 households, assuming 50% coverage. Multi-stage cluster sampling was adopted to select the Anganwadi centers and households. A pretested questionnaire was utilized for data collection by trained personnel through Epicollect5 (Centre for Genomic Pathogen Surveillance, Oxford, UK). Logistic regression was used to identify predictors for LLIN usage. Results The survey covered 516 households with 2,541 individuals and 1,165 nets. Household-level coverage was 94.2%, and regular utilization was 45.74%. Skin reactions (35.7%) were the most common reason for non-usage, followed by low mosquito density (12%). Logistic regression showed that the number of rooms (adjusted odds ratio (AOR) = 0.663, p = 0.012), number of bed nets (AOR = 2.757, p < 0.001), knowledge of malaria (AOR = 2.92, p = 0.04), adopting other measures for mosquito control (AOR = 0.295, p < 0.001), and washing the net (AOR =1.92, p = 0.028) significantly predicted sleeping under mosquito net. Conclusion Our study has depicted high coverage of LLINs in Burla town, but utilization needs further improvement. Counseling regarding proper use can decrease the skin reactions responsible for non-usage. Regular health education programs are required to emphasize the benefits of LLIN use, along with regular monitoring and supervision.

Coverage evaluation of mass drug administration with triple drug regimen in an evaluation unit in Nagpur district of Maharashtra, India.

Triple drug regimen (IDA; Ivermectin, Diethylcarbamazine, Albendazole) recommended for accelerating elimination of lymphatic filariasis was launched in India in December 2018. Nagpur district in Maharashtra was one of the first five districts where this strategy was introduced. The National Vector Borne Disease Control Programme (NVBDCP) at the district reported ~85.0% treatment coverage in the first round of mass drug administration (MDA) with IDA implemented in EU-2 in Nagpur district in January 2019. As per the national guideline, a coverage evaluation survey was carried out and both quantitative and qualitative data were collected to assess the treatment coverage, the level of community preparation and identify the gaps, if any, for improvement. A Coverage Evaluation Survey (CES) following the WHO recommended protocol was conducted in one of the two evaluation units (EU-2) in Nagpur district in March 2019. Coverage Sample Builder (CSB) V2.9 tool was used to calculate the sample size, select sites and estimate drug coverage. The CSB tool followed a two-stage cluster sampling procedure to select 30 primary sampling units (ward/village as a cluster) and a list of random numbers for selecting households (HHs) in each cluster. The results were analyzed for operational indicators. Stata ver. 14.0 software was used to construct the 95% confidence limits accounting for clustering. A total of 1601 individuals aged 5-85 years of both gender from 328 HHs were surveyed from the 30 randomly selected clusters in EU-2. The mean age was 33.8±17.6 years. Among the surveyed population, 78.0% received the drugs (programme reach) and 66.1% consumed the drugs (survey coverage). Survey coverage was significantly higher in rural (82.6%) than in urban (59.4%) and peri-urban (58.6%) areas (P<0.001). Directly observed treatment (DOT) among the surveyed population was 51.6%. Adverse events were reported among 6.9% respondents who reported to have consumed the drugs. The IDA based MDA strategy could achieve just the required level of treatment coverage (~65%) in EU-2, Nagpur district, which had previously undergone several rounds of DA-MDAs (Diethylcarbamazine, Albendazole). Having achieved an effective treatment coverage of >80% in rural areas, the coverage in urban and peri-urban areas need to be improved in order to attain the impact of IDA-MDA. It is imperative to strengthen drug delivery and community preparation activities along with improved DOT especially in urban and peri-urban areas to achieve the required level of treatment coverage. Addition of ivermectin did not have any additional perceived adverse events.

Semantic web-based diagnosis and treatment of vector-borne diseases using SWRL rules

Vector-borne diseases (VBDs) are a kind of infection caused through the transmission of vectors generated by the bites of infected parasites, bacteria, and viruses, such as ticks, mosquitoes, triatomine bugs, blackflies, and sandflies. If these diseases are not properly treated within a reasonable time frame, the mortality rate may rise. In this work, we propose a set of ontologies that will help in the diagnosis and treatment of vector-borne diseases. For developing VBD’s ontology, electronic health records taken from the Indian Health Records website, text data generated from Indian government medical mobile applications, and doctors’ prescribed handwritten notes of patients are used as input. This data is then converted into correct text using Optical Character Recognition (OCR) and a spelling checker after pre-processing. Natural Language Processing (NLP) is applied for entity extraction from text data for making Resource Description Framework (RDF) medical data with the help of the Patient Clinical Data (PCD) ontology. Afterwards, Basic Formal Ontology (BFO), National Vector Borne Disease Control Program (NVBDCP) guidelines, and RDF medical data are used to develop ontologies for VBDs, and Semantic Web Rule Language (SWRL) rules are applied for diagnosis and treatment. The developed ontology helps in the construction of decision support systems (DSS) for the NVBDCP to control these diseases.

Coverage of mass drug administration (MDA) and operational issues in elimination of lymphatic filariasis in selected districts of Jharkhand, India.

Despite annual rounds of mass drug administration (MDA) being carried out every year since 2004 to break the transmission of lymphatic filariasis, India has not achieved elimination status in many areas of country. This study was conducted to determine the operational issues in the implementation of MDA for elimination of lymphatic filariasis in selected districts of Jharkhand. Two districts of Jharkhand state were selected for present cross-sectional study. Multi-staged cluster sampling was adopted to select study participants. Data were collected with use of prescribed questionnaire of National Vector Borne Disease Control Programme (NVBDCP) from the study participants. Data related to socio-demographic details, coverage and compliance of MDA and operational issues were collected. Findings of independent assessment show that percentage of MDA coverage and compliance for Hazaribag district was 96.02% and 88.90%, respectively. On the other hand, percentage of MDA coverage and compliance was found to be only 67.06% and 48.44% in Chatra district. Overall drug consumption was significantly associated with age group (p-value = 0.045), educational status (p-value = <0.0001) and socio-economic status (p-value <0.0001) of eligible population. Most common reason for not swallowing the drugs was found to be absence of family members at the time of MDA rounds followed by no visit of house by drug distributors. Coverage and compliance of MDA was better in Hazaribag district as compared to Chatra district. In order to increase compliance, socio-demographic factors must also be addressed apart from other operational issues.

Implementation and acceptance of government-sponsored malaria control interventions in Meghalaya, India

BackgroundIndia has made considerable progress in malaria reduction over the past two decades, with government-sponsored indoor residual spraying (IRS) and insecticide-treated bed net (ITN) or long-lasting insecticidal nets (LLIN) distribution being the main vector-related prevention efforts. Few investigations have used non-participant observational methods to assess malaria control measures while they were being implemented, nor documented people’s perceptions and acceptance of IRS or LLINs in India, and none have done so in the northeast region. This study evaluated household (HH)-level operation of IRS and distribution of LLINs by India’s National Vector Borne Disease Control Programme (NVBDCP) in 50 villages of Meghalaya state, and documented their acceptance and use.MethodsStudy field teams accompanied the government health system teams during August-October, 2019 and 2020 to observe deployment of LLINs, and record HH-level data on LLIN numbers and use. In addition, NVBDCP spray teams were followed during 2019–2021 to observe IRS preparation and administration. HH members were interviewed to better understand reasons for acceptance or refusal of spraying.ResultsA total of 8386 LLINs were distributed to 2727 HHs in 24 villages from five Primary Health Centres, representing 99.5% of planned coverage. Interviews with 80 HH residents indicated that they appreciated the LLIN dissemination programme, and generally made regular and appropriate use of LLINs, except during overnight travel or when working in agricultural fields. However, HH-level IRS application, which was observed at 632 HHs, did not always follow standard insecticide preparation and safety protocols. Of 1,079 occupied HHs visited by the spray team, 632 (58.6%) refused to allow any spraying. Only 198 (18.4%) HHs agreed to be sprayed, comprising 152 (14.1%) that were only partly sprayed, and 46 (4.3%) that were fully sprayed. Reasons for refusal included: inadequate time to rearrange HH items, young children were present, annoying smell, staining of walls, and threat to bee-keeping or Eri silk moth cultivation.ConclusionsThese findings are among the first in India that independently evaluate people's perceptions and acceptance of ongoing government-sponsored IRS and LLIN programmes for malaria prevention. They represent important insights for achieving India's goal of malaria elimination by 2030.

Pattern of clinical presentation, lab findings and mortality risk among patients of dengue fever admitted in pediatric intensive care unit in a tertiary care centre in South-east Rajasthan

Background: India is one of the 7 identified countries in south-east Asia region regularly reporting dengue fever outbreaks. Dengue can present with varying degrees of severity of illness in Indian children, present study is aimed at studying the clinical presentation lab findings and mortality risk among patients of dengue fever admitted in PICU in a tertiary care centre in South-east Rajasthan. Methods: It is a retrospective observational study. All dengue seropositive patients admitted in PICU from August 2021 to October 2021 were included in the study. Patients were classified based on National Vector Borne Disease Control Program (NVBDCP). Clinical presentation laboratory findings and mortality risk among patient were studied. esults: Out of 61 patients with dengue, 28(46%) were males and 33(54%) were females. Fever was present in 100% cases followed by GI symptoms vomiting(54.1%), pain abdomen(52.5%) and bleeding manifestations(26.2%) were common presenting complaints. On examination common findings were conjunctival congestion (57%) , hepatomegaly (44%) and flushing (26%). Among complications hypotension/shock (51%) was the commonest followed by hemorrhage (31%), pleural effusion and hepatitis each 21%. Most common bleeding manifestation was melena (19%). Most common affected age group was between10-15 years (42.6%).

Radiological features of dengue fever in cases and control

Background: Dengue (pronounced DENgee) fever is a painful, debilitating mosquito-borne disease caused by any one of four closely related dengue viruses. Aim of the study was to study radiological features of dengue fever in cases and control.Methods: Randomized, double blind, placebo controlled, parallel group study conducted among 100 seropositive dengue patients,18-60 years of age (fulfilling inclusion and exclusion criteria) at Lala Lajpat Rai hospital, Kanpur for December 2019 October 2021. Selected patients were subjected to history, examination, necessary investigations and then were managed according to national vector borne disease control programme (NVBDCP) guidelines. A total of 100 serology proven dengue patients were included and followed up. Two groups (fifty in each) were allocated by simple first and then systematic random sampling. Case group was given doxycycline and control group was given placebo.Results: USG findings commonly seen in both the cases and control group were hepatomegaly, splenomegaly, ascites right pleural effusion, thickened GB wall and edema. In both the groups, pleural effusion was the most common complication.Conclusions: Ultrasound examinations detected plasma leakage in multiple body compartments around time of defervescence. Presence of plasma leakage in form of ascites and pleural effusion was more in control group as compared to case group seems doxycycline decrease the plasma leakage. Pleural effusion is most common finding of plasma leakage.

A Study of Malaria in Chhattisgarh State of India

Background: In 2019, Chhattisgarh contributed 2.29% of the population of India and 18% of Malaria cases in the country. Bastar Division contributed 76% of cases in the state. Objectives: To study the distribution of Malaria in Chhattisgarh and measures being adopted by the state government to tackle it. Methods: Analysis of the annual reports of the Malaria Division of the National Vector Borne Disease Control Programme (NVBDCP). Also, an analysis of NVBDCP annual reports from Chhattisgarh’s Department of Health website. In addition, a web search was made of reports pertaining to the recently held “Malaria-Mukt Bastar Abhiyan” campaigns held in Chhattisgarh. Results: The impact of the Phase 1 and Phase 2 campaigns were as follows. In the year prior to November 2019, there were 5272 cases of Malaria in the Bastar region. During the next year until November 2020, there were only 2696 cases. In other words, there was a reduction of about half in the number of Malaria cases. Conclusion: Therefore, some beneficial effects of these campaigns emerged in that the reservoirs of the malarial parasite, which is, the humans were effectively treated thereby reducing the number of those persons who could be sources of infection to the female Anopheline mosquito.

A Study of Malaria in Jharkhand State

Background: The aim of India is to reach zero Malaria cases by 2027 and then wait for three years before WHO can grant Malaria-free status certification. It is already the beginning of 2022 and India is about to reach the halfway mark of the Malaria Elimination framework period of 2016 to 2027. Objectives: To see how far Jharkhand has reached about Malaria elimination targets. Methods: By reviewing documents published by the National Vector Borne Disease Control Programme (NVBDCP). Results: The Latehar District of Jharkhand had a very high Annual Parasite Incidence (API) of 10.86 during 2018. Conclusions: If interventions like the treatment of positive patients and asymptomatic carriers occur, the API will be expected to decrease drastically.

The Outbreaks of Acute Encephalitis Syndrome in Uttar Pradesh, India (1978-2020) and Its Effective Management: A Remarkable Public Health Success Story.

IntroductionAcute encephalitis syndrome (AES) is a major public health enigma in India and the world. Uttar Pradesh (UP) is witnessing recurrent and extensive seasonal AES outbreaks since 1978. Government of India and UP state government have devised various mitigation measures to reduce AES burden and AES associated mortality, morbidity and disability in Uttar Pradesh. The aim of this study was to describe the public health measures taken in order to control seasonal outbreaks of AES in UP between 1978 and 2020.MethodsWe used literature review as a method of analysis, including the Indian government policy documents. This review utilized search engines such as PubMed, Google Scholar, Research Gate, Cochrane, Medline to retrieve articles and information using strategic keywords related to Acute Encephalitis Syndrome. Data was also collected from progress reports of government schemes and websites of Indian Council of Medical Research (ICMR), National Vector Borne Disease Control Programme (NVBDCP) and Integrated Disease Surveillance Programmes (IDSP).ResultsThe incidence of AES cases in UP have declined from 18.2 per million population during 2005-2009 to 15 per million population during 2015-2019 [CI 12.6–20.6, P-value < 0.001] and case fatality rate (CFR) reduced from 33% during 1980-1984 to 12.6% during 2015-2019 [CI 17.4–30.98, P-value < 0.001]. AES incidence was 9 (2019) and 7 (2020) cases per million populations respectively and CFR was 5.8% (2019) and 5% (2020). This decline was likely due to active surveillance programs identifying aetiological agents and risk factors of AES cases. The identified etiologies of AES include Japanese encephalitis virus (5–20%), Enterovirus (0.1–33%), Orientia tsutsugamushi (45–60%) and other viral (0.2–4.2%), bacterial (0–5%) and Rickettsial (0.5–2%) causes. The aggressive immunization programs against Japanese encephalitis with vaccination coverage of 72.3% in UP helped in declining of JE cases in the region. The presumptive treatment of febrile cases with empirical Doxycycline and Azithromycin (EDA) caused decline in Scrub Typhus-AES cases. Decrease in incidence of vector borne diseases (Malaria, Dengue, Japanese Encephalitis and Kala Azar) i.e., 39.6/100,000 population in 2010 to 18/100,000 population in 2017 is highlighting the impact of vector control interventions. Strengthening healthcare infrastructure in BRD medical college and establishment of Encephalitis Treatment Centre (ETC) at peripheral health centres and emergency ambulance services (Dial 108) reduced the referral time and helped in early treatment and management of AES cases. The AES admissions increased at ETC centres to 60% and overall case fatality rate of AES declined to 3%. Under clean India mission and Jal Jeevan mission, proportion of population with clean drinking water increased from 74.3% in 1992 to 98.7% in 2020. The proportion of household having toilet facilities increased from 22.9% in 1992 to 67.4% in 2020. Provisions for better nutritional status under state and national nutrition mission helped in reducing the burden of stunting (52%) and wasting (53.4%) among under five children in 1992 to 38.8% (stunting) and 36.8% (wasting) in year 2018. These factors have all likely contributed to steady AES decline observed in UP.ConclusionThere is a recent steady decline in AES incidence and CFR since implementation of intensive AES surveillance system and JE immunization campaigns which is highlighting the success of interventions made by central and state government to control seasonal AES outbreaks in UP. Currently, AES incidence is 9 cases per million population (in year 2019) and mortality is 5.8%.

Unreported mixed Plasmodium species infection may increase vivax malaria in India: a challenge for malaria elimination.

In India, there are several malaria-endemic regions where non-falciparum species coexist with Plasmodium falciparum. Traditionally, microscopy and rapid diagnostic tests are used for the diagnosis of malaria. Nevertheless, microscopy often misses the secondary malaria parasite in mixed-infection cases due to various constraints. Misdiagnosis/misinterpretation of Plasmodium species leads to improper treatment, as the treatment for P. falciparum and Plasmodium vivax species is different, as per the national vector-borne disease control program in India. Blood samples were collected from malaria-endemic regions (Jharkhand, Madhya Pradesh, Chhattisgarh, Maharashtra, Odisha, Assam, Meghalaya, Mizoram and Telangana) of India covering almost the entire country. Molecular diagnosis of Plasmodium species was carried out among microscopically confirmed P. falciparum samples collected during a therapeutic efficacy study in different years. The polymerase chain reaction analysis revealed a high prevalence (18%) of mixed malaria parasite infections among microscopically confirmed P. falciparum samples from malaria patients that are either missed or left out by microscopy. Deployment of molecular tools in areas of mixed species infection may prove vital for accurate diagnosis and treatment of malaria. Further, it will help in achieving the goal of malaria elimination in India.

A study on dengue incidences in arid and semi arid regions of Rajasthan

In India, the incidence of dengue fever (DF) and dengue hemorrhagic fever (DHF) have risen dramatically in the last two decades. In Rajasthan dengue cases are tremendously increasing year after year. In our study on the basis of climatic conditions some arid (Jaisalmer, Barmer, Bikaner) and semi-arid (Jodhpur, Ganganagar, Hanumangarh) region districts of Region districts of rajasthan were selected. Retrospective data of the past 5 years from 2015 to 2019 were collected. Data collection was done with the help of various Chief Medical and Health Office of the concern district and also with the help of National vector borne disease control programme (NVBDCP). In this study, we obtained total 5142 dengue cases from selected arid and semi-arid regions of Rajasthan. Maximum dengue cases were found in Jaisalmer and Jodhpur in arid and semi-arid region, respectively. Minimum dengue incidence was analysed in Bikaner and Hanumangarh in arid and semi-arid regions, respectively.

Monitoring of Insecticide Resistance in Anopheles culicifacies in Twelve Districts of Madhya Pradesh, Central India (2017-2019).

Background Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are malaria vector control measures used in India, but the development of insecticide resistance poses major impediments for effective vector control strategies. As per the guidelines of the National Vector Borne Disease Control Programme (NVBDCP), the study was conducted in 12 districts of Madhya Pradesh to generate data on insecticide resistance in malaria vectors. Methods The susceptibility tests were conducted on adult An. culicifacies as per the WHO standard technique with wild-caught mosquitoes. The blood-fed female mosquitoes were exposed in 3 to 4 replicates on each occasion to the impregnated papers with specified discriminating dosages of the insecticides (DDT: 4%, malathion: 5%, deltamethrin: 0.05%, and alphacypermethrin: 0.05%), for one hour, and mortality was recorded after 24-hour holding. Results An. culicifacies was found resistant to DDT 4% in all the 12 districts and malathion in 11 districts. The resistance to alphacypermethrin was also observed in two districts, and possible resistance was found to alphacypermethrin in seven districts and to deltamethrin in eight districts, while the vector was found susceptible to both deltamethrin and alphacypermethrin in only 3 districts. Conclusion An. culicifacies is resistant to DDT and malathion and has emerging resistance to pyrethroids, alphacypermethrin, and deltamethrin. Therefore, regular monitoring of insecticide susceptibility in malaria vectors is needed for implementing effective vector management strategies. However, studies to verify the impact of IRS with good coverage on the transmission of disease are required before deciding on the change of insecticide in conjunction with epidemiological data.

Cost of National Vector Borne Disease Control Programme in North India.

Background & objectives:Despite significant resources being spent on National Vector Borne Disease Control Programme (NVBDCP), there are meagre published data on health system cost upon its implementation. Hence, the present study estimated the annual and unit cost of different services delivered under NVBDCP in North India.Methodology:Economic cost of implementing NVBDCP was estimated based on data collected from three North Indian States, i.e. Punjab, Haryana and Himachal Pradesh. Multistage stratified random sampling was used for selecting health facilities across each level [i.e. subcentres (SCs), Primary Health Centres (PHCs), community health centres (CHCs) and district malaria office (DMO)] from the selected States. Data on annual consumption of both capital and recurrent resources were assessed from each of the selected facilities following bottom-up costing approach. Capital items (equipment, vehicles and furniture) were annualized over average life span using a discount rate of 3 per cent. The mean annual cost of implementation of NVBDCP was estimated for each level along with unit cost.Results:The mean annual cost of implementing NVBDCP at the level of SC, PHC and CHC and DMO was ₹ 230,420 (199,523-264,901), 686,962 (482,637-886,313), 1.2 million (0.9-1.5 million) and 9.1 million (4.6-13.5 million), respectively. Per capita cost for the provision of complete package of services under NVBDCP was ₹ 45 (37-54), 48 (29-73), 10 (6-14) and 47 (31-62) at the level of SC, PHC, CHC and DMO level, respectively. The per capita cost was higher in Himachal Pradesh (HP) at SC [₹ 69 (52-85)] and CHC [₹ 20.8 (20.7-20.8)] level and in Punjab at PHC level [₹ 89 (49-132)] as compared to other States.Interpretation & conclusions:The evidence on cost of NVBDCP can be used to undertake future economic evaluations which could serve as a basis for allocating resources efficiently, policy development as well as future planning for scale up of services.

Urine Spot Protein Creatinine Ratio as a Predictor of Disease Severity and Adverse Outcome in Children with Dengue: A Cross-sectional Study

Introduction: Dengue is a viral infection with different presentations, hence predicting the disease severity at admission is essential to triage patients needing meticulous monitoring. In severe dengue there is increase of urinary protein clearance due to the increase in systemic vascular permeability. Simple urine protein excretion screening test could guide the triage and monitor the patients with suspected dengue infection. Aim: To evaluate the urine spot Protein Creatinine Ratio (PCR) as a tool in predicting the disease severity and adverse outcome in children with dengue. Materials and Methods: The present cross-sectional study was conducted in Institute of Child Health, Egmore, Tamil Nadu, India, from October 2021 to December 2021. All children aged 1 month to 12 years presenting with symptoms of fever, thrombocytopenia (less than 1, 50, 000 /µL) with or without dengue non structural protein component (NS1)/ Immunoglobulin M Enzyme Linked Immunosorbent Assay (ELISA) positivity were recruited for the study. Study parameters included were demographic factors, severity of dengue classification based on National Vector Borne Disease Control Programme (NVBDCP) guidelines, urine spot PCR. The UPCR (urine protein creatinine ratio) was compared between dengue and non dengue cases and within the different categories of dengue cases. Chi-square was used for comparing proportions. Results: Among 150 children enrolled in present study, 134 (89.3%) were dengue positive, 16 (10.7%) were non dengue. Most predominant age group involved was 6-9 years followed by 3 to 6 years. Among 134 children with dengue, 98 (73.1%) had high UPCR and among 16 non dengue children, 2 (12.5%) had high UPCR which was statistically significant (p&lt;0.0001). Mean spot UPCR was 0.32±0.12 in mild dengue, 0.77±0.40 in moderate dengue and 1.68±1.67 in severe dengue which was statistically significant (p&lt;0.0001). Children with severe dengue had higher PCR values in comparison to mild and moderate dengue. Conclusion: There was a statistically significant association of urine spot PCR with severity of dengue and this simple test can be used for triaging and monitoring children with suspected dengue.

Emergence of Dengue as a Febrile Illness in Rewa and Nearby Districts of Madhya Pradesh During the Year, 2021: A Cross-sectional Study

Introduction: Dengue is a mosquito borne viral disease, found in tropical and subtropical countries. Dengue virus (DENV) infected mosquitoes of Aedes species are crucial for the transmission of disease. It has emerged as a threat to the public health systems. Dengue is endemic in many parts of India but still the status of dengue cases in Rewa Madhya Pradesh is not reported convincingly. Aim: To investigate the presence of dengue in Rewa district of Madhya Pradesh. Materials and Methods: This cross-sectional study was conducted in the Department of Microbiology at Shyam Shah Medical college Rewa under National Vector Borne Disease Control Programme (NVBDCP), Rewa, Madhya Pradesh, India, including 1113 Outpatient/Inpatient Department samples received during March 2021 to October 2021. Blood samples were collected from patients having febrile illness and after serum separation, serum were subjected to NS1 Enzyme Linked Immunosorbent Assay (ELISA) test. Descriptive statistics and Chi-square tests were applied for data analysis. Results: A total of 1113 sample were received and tested for dengue NS1 out of that 108 sample were found NS1 positive by ELISA. The cases of dengue started from the month of July 2021. But in the month of October dengue positivity was highest in number. Dengue cases reported were 297 (6.73%) in the rainy season (July-August), but the dengue positivity increased (713, 9.3%) in the post rainy season (September-October). Overall prevalence of dengue was higher in the 21-30 years (34.3%) age group followed by 11-20 years (24.1%), 31-40 years (18.5%), 41-50 years (18.5%), 51-60 years (7.4%) and &gt;60 years (3.70%) age groups with respect to total positive cases. The prevalence of dengue was higher in male (12.94%) in comparison to females (5.54%). Conclusion: This study warrants the dengue virus infection as one of the important causes of fever during rainy and post rainy season in this region. Early diagnosis and reporting of cases are important for the better management of disease.

Knowledge, Attitude and Practice Regarding Dengue in 1 Year MBBS Students of Shree M. P. Shah Govt. Medical College, Jamnagar, Gujarat

Introduction: Dengue is a mosquito-borne viral disease that has rapidly spread in all regions of WHO in recent years. During 2019, the National Vector Borne Disease Control Programme (NVBDCP) reported more than 100,000 in country and more than 14,000 laboratory confirmed cases of dengue in Gujarat. In hostels of Shree M. P. Shah Medical College, Jamnagar cases of dengue are reported in every season but during the rainy season number of cases gets increased. Objective: To assess the knowledge, attitude and practice regarding Dengue and its prevention and control measures among 1st year M.B.B.S students. Method: A cross sectional study was conducted among 192 1st year MBBS students of Shree M P Shah Government Medical College, Jamnagar in September 2019. A pre-designed, pre-tested, semi structured, self-administered questionnaire was used to collect information. Microsoft excel was used to analyze the data. Results: Among study participants 76% knew that dengue is spread by Aedes mosquito, 81.25% said that adult female mosquito bite responsible for dengue, 27.07% knew that clean storage water was the breeding place of dengue mosquito. Social media and newspaper were main source of information. 71.3% study participants were using mosquito coils/mats/ repellent/ liquid against mosquito. Only 25% were regularly checking for breeding site at hostel/house. Conclusion: Majority of 1st year medical graduates had a basic knowledge regarding dengue. But there is still gap in prevention knowledge and practices of personal protective measures and eliminating source of mosquitoes.