Malaria in Tribal Areas PHRN Book 15

Is Malaria burden different in tribal areas? Some studies- pg 88

What Are The Factors For Higher Disease Burden In Tribal Areas? 1.Environment Round the year presence of vectors More breeding sources Vector human contact is higher Low effectiveness of indoor residual spray on tribal houses 2. Malnutrition 3. Poor access to health services 4. Development projects and deforestation

Critical Issues In Malaria In Tribal Areas: Existing Gaps And Possible Strategies 1. Falciparum malaria and severe and complicated malaria Village level: Lack of adequate access to health workers, diagnostic aids and essential drugs. Lack of access to 24x7 services, basic investigations and safe blood at peripheral levels (PHC, CHC) Access to basic investigations on an emergency basis continues to be of concern even at the District Hospital and Medical College Hospital levels. Access to tertiary care in the context of Falciparum malaria viz. Hemodialysis, Ventilation is rare in the Indian health system. Availability of public transport in rural areas, and provision of ambulance services from PHCs/CHCs is a sorely felt need

2. Drug resistance and emerging issues in treatment of malaria PF treatment with ACT- 50 high endemic districts of Andhra Pradesh, Chhattisgarh, Jharkhand, Madhya Pradesh and Orissa, 67 districts of NE states and 252 PHCs in 45 districts spread over 11 states But as malaria has a local and focal epidemiology, resistance to Chloroquine is also local and focal Issues in ACT treatment- Book reading pg 97 3. Malaria in pregnancy low birth weight, maternal anemia stillbirth, spontaneous abortion and maternal death Treatment- quinine Prevention- Bednets Screening Immediate referral

4. Issue in diagnosis of malaria- Rapid Diagnostic Kits vs Microscopy Advantages of Microscopy Disadvantages of Microscopy 100% specific Require trained human resource Cost effective as able to diagnose more than just malaria along with low recurring costs Result may not be immediately available to the patient Highly sensitive Can detect all 4 varieties of malaria They are heat stable and long lasting

In what circumstances should RDKs be used? Where/when microscopic diagnosis is not available In remote communities or highly mobile populations For prevention and management of severe malaria In special situations like health emergencies where malaria is a risk Suspected malaria epidemics For diagnosis in travelers, military forces, and organized workforces ‘After-hours’ diagnosis in hospital laboratories or clinics.

5. Issues in Malaria Reporting

Planning for malaria in tribal areas Reducing pool of infected/infective people through early diagnosis and complete treatment, use of primaquine in high transmission areas, presumptive treatment, use of RDTs Reducing Anopheles mosquito larva population through anti-larval measures like better drainage and engineering, using oil to kill larvae in identified breeding stagnant water sites, use of larvicidal fish. Reducing Adult Anopheles mosquito population through indoor residual spray Promoting use of Insecticide treated bednets and mosquito repellants Reducing malaria related mortality through facility level treatment of complicated and uncomplicated cases Malaria Surveillance through Active and Passive case detection, examination of blood smears, calculating indices of ABER, API, SPR, SfR and Pf%.

Behavioral Change Communication (BCC) to reduce transmission Planning for malaria in pregnancy Implementing new diagnosis protocol in Community level early diagnosis: Implementing new drug protocol High coverage through bednets Village Level Malaria Plans Use of GIS mapping along with other parameters to identify highly endemic areas and accordingly plan malaria control activities The NVBDCP guidelines for commodities needed for the programme should be kept in mind.

Role of ASHA in malaria Role in building awareness about malaria Role in treatment Role in prevention Challenges: Irregular and inadequate supply of anti-malarial drugs to the ASHA in some places Microscopy results were not reported in time in some blocks. This resulted in less and less slides being collected in such areas. Referral transport was not available and many patients from extremely remote areas could never reach the facility. Lack of regularity in payment of incentive to ASHA for slide making etc. Developing village malaria plans and getting volunteers to actually implementing the plans on a sustained basis required high levels of regular field based support to ASHA