By Dr. Jorge Caravotta
MUNGER, India 24 September 2009 - Munger is a district in Bihar surrounded by beautiful foot hills and rice paddies. Under the blue skies you may feel like you are in paradise, but this immense greenery hides breeding grounds of mosquitoes that carry malaria.
Although Bihar is considered a low transmission state for malaria and not considered to be at risk of massive outbreaks, Munger district came under attack this summer. There was an outbreak of cerebral malaria in two blocks of Munger which resulted in more than 3,600 cases and 22 deaths.
Epidemic in the making for some time now
The district had all the ingredients for an outbreak. DDT spraying had not been undertaken in these areas for the last two years and poor sanitation conditions prevailed. The number of mosquito breeding places was high, community awareness was low and insecticide-treated mosquito nets (ITNs) were unavailable. The health facilities were overwhelmed with fever cases.
The Primary Health Center (PHC) Haveli Kharagpur coped with five hundred consultations per day in July, two hundred of which were fever cases out of which 150 tested positive for malaria. The State government provided the rapid diagnostic kits to the PHC to deal with this alarming number of cases, enabling diagnosis in just 10 minutes. In the Dharahra block, an average of 100 cases per day was reported. A UNICEF-led surveillance team enabled further detection of cases at Dharahra.
“Malaria is a threat, especially for the poor and disadvantaged in many parts of India,” said Dr Henri van den Hombergh, UNICEF India’s Chief of Health. “We need to be well prepared to act when the disease strikes like it did in Munger where the population is now protected.”
It was a great challenge for the District administration to control the deadly outbreak of falciparum malaria. Large queues of patients could be seen at the health centers waiting to receive Chloroquine drug treatment. However, the strain proved resistant to the drug as is the case in many other districts of India.
UNICEF, Government work in tandem to reach the affected
Once it was clear that Chloroquine was not adequate to treat patients for this outbreak, the National Vector Borne Disease Control Programme, in consultation with the National Institute of Malaria Research, mobilized a more powerful drug called ACT immediately to the district.
Protecting the population from the bite of these deadly mosquitoes was another major challenge for the Government of Bihar.
A strong partnership between UNICEF and the government at state and district level led to the formulation of a joint strategy. UNICEF was requested to supply of 30,000 long-lasting insecticide treated mosquito nets (LLINs) for the two affected blocks of Munger. These were to be distributed to 62 villages in Kharagpur and 32 villages in Dharahra.
LLINsare recommended worldwide for malaria prevention, but this was the first time they were used in Bihar. Unfortunately, the distribution was delayed for 10 days due to security concerns.
With a commitment to reach out to these affected people, especially women and children who were most vulnerable, a plan for door to door distribution using the polio vaccination teams was developed.
A strong partnership between UNICEF and the government at state and district level led to the formulation of a joint strategy. UNICEF was requested to supply of 30,000 ITNs for the two affected blocks of Munger.
The Integrated Child Development Services (ICDS) was closely involved by enlisting the full support of the ICDS officials. Anganwadi workers as well as Auxiliary Nurse Midwives of the affected panchayats were provided with an orientation on the proper use of bednets and communication messages for malaria prevention.
In addition, distribution of communication materials for spreading awareness in the affected communities was undertaken.
The distribution of all the 30,000 LLINs was completed in 20 days time using the polio vaccination teams. More than 50% of the households, who received ITNs, belonged to socially excluded groups such as the Musahars and Santhali Adiwasi tribal groups.
A Santhali tribal woman, who was 3 months pregnant, was the first to receive a net. She thanked the Civil Surgeon for the net saying she was seeing the disease spreading in her village and was concerned of how to protect herself as well as her unborn baby from malaria.
There is a need to rapidly scale up the preventive strategies for malaria control, Dr van den Hombergh says. Lessons learned while combating this outbreak will help in improving government health programming for malaria control in Bihar.