From Times of India
8 December 1999 - original
Acute Shortage of Drugs,
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
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
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.
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.
- 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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