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Press Release





From Times of India

8 December 1999 - original


HEADLINE:

Acute Shortage of Drugs, Insecticides

BYLINE: By Sachchidanand Jha

DATELINE: 8 December 1999

Deadly Strain Spreads to North, Central Bihar


PATNA: There is an acute shortage of anti-malaria drugs and effective insecticides in the state even as falciparum malaria (FM) has spread to north and central Bihar including Patna, Saran, Supaul, Aurangabad, Jehanabad, Muzaffarpur, Vaishali and Samastipur districts.

The Patna Medical College Hospital's head of the medicine department Gopal Prasad Sinha admitted that on an average 15 malaria patients including FM cases had been reporting to the hospital everyday for the last few weeks from different parts of the state including Patna and south Bihar.

Sinha, however, claimed that the patients responded to the treatment of quinine drip, E-mall and falcigo [Webmaster's Note:identity of "E-mall" and "Falcigo" is not known. ] if rushed to hospital in time. A professor of medicine at the Ranchi Medical College Hospital (RMCH), K N Jha, also expressed similar views. Jha said the RMCH too was receiving about 15 FM cases everyday. Both of the doctors claimed that only 5 percent of the hospitalised patients had succumbed to the disease.

A senior physician of the Kurji Holy Family Hospital here, Lal Bahadur Singh, said there were FM and cerebral malaria patients in the hospital on December 6. They had come from Muzaffarpur, Aurangabad, Supaul, Jehanabad and Patna. In Patna, he added, the patients had come from Danapur, Maner, Digha, Jakkanpur and some other localities. Mangalam Child Health and Research Centre director Arun Kumar Thakur said his centre had been receiving four to five FM cases everyday for the last few days.

When contacted, the director-in-chief of the state health services, V S Singh, admitted that there was a shortage of anti-malaria drugs and effective insecticides to control the disease. He said 18 districts of the state were reeling under malaria.

Singh informed that he had directed the civil surgeons of all the malaria- affected districts that in the areas where the disease had broken out in a virulent form, four quinine tablets be administered to even those not suffering from it as a preventive measure. With regard to the shortage of anti-malaria drugs and effective insecticides, Singh said the Centre had promised to supply both in good quantity to the state. He had already discussed the issue with the joint director of the malaria eradication programme. A state government official had already been rushed to Karnal, Haryana, to bring the drugs, he added.

With regard to DDT spraying, Singh said mosquitoes causing malaria had become DDT resistant. He instead pleaded for the spraying of malathion. When asked about the malaria death figures, Singh said so far only 71 deaths had been confirmed while 56 others were yet to be confirmed.

It may be recalled that the CAG, in its last report, said death due to malaria had increased five times between 1992 and 1996. It also observed that radical treatment had not been provided to 48,000 positive cases in the state during 1992-97. In five high risk districts of south Bihar, nearly 30,000 cases were not given radical treatment. In these five districts, 51 percent posts of laboratory technicians were vacant at the time of audit scrutiny.

The CAG report said one round of DDT spraying instead of the requisite two resulted in wasteful expenditure of Rs 1.66 crore. Susceptibility tests were not carried out as the then director had not obtain impregnated papers from the government of India since 1991. The state government did not send the names of three towns with high malaria incidence for coverage under the Urban Malaria Scheme as asked by the Centre. The state government also failed to place indent for the required quantity of DDT during 1992-98 while the use of machinery and equipment received from the Centre was delayed up to four years, the report added.

Webmaster's Notes: This article strongly suggests serious operational failures in the Indian Malaria Control Programme. These failures appear to be throughout the programme, from case surveillance to drug treatment to vector control.
  • Failure to provide radical treatment to malaria patients ensures the future spread of malaria in the district because these persons have the parasites [gametocyte stage] available for anopheline mosquitoes to pick up with a blood meal. This point is EXTREMELY IMPORTANT. Malaria cannot be controlled effectively without reducing contact between mosquitoes and parasitemic persons. This involves not only vector control but also drug treatment of patients. In fact, proper malaria control strategy involves drug treatment of not only people with malaria symptoms, but of all persons who harbor the malaria parasites. This requires a strategy called Active Case Detection.
  • The vector species is not mentioned in this article, yet knowing the vector is crucial to success of a malaria control programme. Anopheles stephensi is often amenable to source reduction, as it breeds in urban areas. Anopheles culicifacies is a species of rural areas.
  • DDT resistance in Anopheles stephensi has been present in India since 1955 (Chang and Ungureanu 1965) and resistance in Anopheles culicifacies has been present since 1959. (Pal 1965)The resistance is present in certain areas. These areas are subject to change, because insecticide pressure changes and resistance is partially recessive. Of note in this article is the incomplete treatment [omission of a spray cycle]. Resistance has sometimes been used as an excuse for failure of operationally incomplete treatments. It is impossible to tell in this case whether the control failure is due to operational failure or resistance [or both], without access to the resistance data. In this spirit, the following is suggested:

    A nationwide survey of insecticide resistance in the two major vectors of India, An. stephensi and An. culicifacies, to DDT, malathion, permethrin, and cypermethrin [or other pyrethroid currently in use] would be extremely helpful in guiding that country's Malaria Control Programme. It would be especially helpful to programme coordination if the resources of the World Wide Web could be used in transferring this information across India, which is a large country. This is an example of the nationwide coordination that is necessary for effective malaria control and has recently been enabled by the world wide web. It is very unfortunate that these resources have not been utilized to their potential so far.

SOURCES:
  • Pal, R. 1965. Insecticide Resistance in Anopheles culifacies. WHO/MAL/482.65. Mimeographed report. World Health Organization. Geneva, Switzerland.
  • Chang, L.T., and E. M. Ungureanu. 1965. Insecticide resistance in Anopheles stephensi and its operational importance. WHO/MAL/482.65. Mimeographed report. World Health Organization, Switzerland.

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