IEC / BCC


JSSK

Kutsil

NAS

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)

STATE VECTOR BORNE DISEASE CONTROL PROGRAMME

INTRODUCTION:

. The control programme for Malaria began in Mizoram in the year 2005 whereas Dengue Control Programme was initiated during 2012-2013. Although much has been accomplished already during the last ten years, there is so much work that lie ahead if we are to eradicate Malaria altogether. Among the six vector borne diseases Malaria still remains a major public health problem in the State. Dengue is also on the rise although the cases are few and no fatality had been reported. Beside indigenous Malaria and Dengue, Japanese Encephalitis posses a potential threat to the State. As Culex Mosquitoes are prevalent in the state, there is also every possibility of Acute Encephalitis Syndrome / Japanese Encephalitis (JE) occurrence in the State as suspected cases have been reported. Other vector borne diseases such as Chikungunya, Kala-azar and Lymphatic filariasis have not been found in the State as of now.

Although the indigenous malaria disease incidence and death rate were on decline during the last 3 or 4 years, the year of 2014 – 2015 saw a steep rise in positive cases and a slight increase in mortality. This was partly attributed to scanty intermittent rainfall with warm and humid climate reported throughout the State and increased surveillance. Positive cases increased throughout the State from low endemic to high endemic Districts. There were also reports of focal outbreaks from few high endemic Districts. However, the situation was put under control and deaths were prevented as far as possible with the combined efforts of the District and the State with continued support and guidance from the Directorate of NVBDCP, New Delhi.

In this regard, the SVBDCP, Mizoram is very grateful to the Central Government for assisting the State financially and materially in the control of vector borne diseases especially Malaria and It would continue to work its best in combating the dreadful diseases and reduce the burden on health and economic development of the thousands affected by these vector borne diseases.

The Salient points or current status on Malaria and Dengue in Mizoram are as follows:

YEAR MALARIA
ABER SPR Pf% API Death
2010 33.74 4.70 92.42 15.85 31
2011 17.41 4.93 94.49 8.58 30
2012 14.29 5.87 95.49 8.38 25
2013 20.88 5.11 88.02 10.67 21
2014 29.65 6.98 91.25 20.71 31
YEAR DENGUE
Suspected Case Positive Death
2012 90 6 NIL
2013 96 7 NIL
2014 246 19 NIL

STRATEGIC PLAN FOR MALARIA CONTROL IN INDIA (2012-2017)

MISSION :

To reduce the morbidity and mortality due to malaria and improving the quality of life, thereby contributing to health and alleviation of poverty in the country.

GOALS :

  • Screening all fever cases suspected for malaria (60% through quality microscopy and 40% by Rapid Diagnostic Test).
  • Treating all P. falciparum cases with full course of effective ACT and primaquine and all P. vivax cases with 3 days chloroquine and 14 days primaquine.
  • Equipping all Health Institutions ( PHC level and above), especially in high-risk areas, with microscopy facility and RDT for emergency use and injectable artemisinin derivatives.
  • Strengthening all District and Sub-District Hospitals in malaria endemic areas as per IPHS with facilities for management of severe malaria cases.

OBJECTIVE :

To achieve by the end of 2017, an API of < 1 per 1000 Population at National Level.

OUTCOME INDICATORS :

  • At least 80% of those suffering from malaria get correct, affordable, appropriate and complete treatment within 24 hours of reporting to the health system by the year 2017.
  • At least 80% of those at high risk of malaria get protected by effective preventive measures such as ITN/LLIN or IRS by 2017.
  • At least 10% of the population in high-risk areas is surveyed annually (Annual Blood Examination Rate >10%).

IMPACT INDICATORS :

  • To bring down annual incidence of malaria to less than 1 per 1000 population at National level by 2017.
  • At least 50% reduction in mortality due to malaria by the year 2017, taking 2010 level as baseline.

ACHIEVEMENTS OF MIZORAM STATE ON MALARIA CONTROL PROGRAMME

YEAR MALARIA
ABER API MORTALITY
2009 17.52 9.59 119
2010 33.74 15.85 31
2011 17.41 8.58 30
2012 14.29 8.38 25
2013 20.88 10.67 21
2014 29.65 20.71 31

MIZORAM STATE GOALS AND TARGETS FOR THE 12TH FIVE YEAR PLAN :

Year STATE GOALS FOR THE 12TH FIVE YEAR PLAN
ABER API MORTALITY
2012-2013 >16.5% < 5 < 22
2013-2014 >18% < 4 < 16
2014-2015 >19.5% < 3 < 11
2015-2016 >21% < 2 < 8
2016-2017 >22.5% < 1 < 5

Considering the high incidence of Malaria in Mizoram, especially with Malaria Pf rate of over 95.09 %, the SVBDCP, Mizoram, is of the opinion that blanket coverage of DDT spray, distribution of LLINs, Impregnation of bed nets, Entomological surveillance and environmental management in the whole state is pertinent. Example can be cited for the same on how 4 years back DDT spray was not undertaken in few areas where API was less than 2. Consequently, it was found out that Malaria incidence increased to a great extent in the following years in those unsprayed areas. Apart from DDT spray and LLIN, it is felt that much of the Malaria cases and the few fatalities which were witnessed during 2014 could have been prevented with impregnation of local bed nets as it is most acceptable to the community. However, due to non supply of K-Othrine (Deltamethrin 2.5%) for impregnation of bed nets, it was witnessed that the API still remains very high in spite of improved IRS coverage in many endemic regions. Apart from these, vector control through Entomological surveillance and Sanitation drive are of the utmost importance for which the implementation have not been done. Hence, provision for impregnation of bed nets, setting up of Entomology cell and environmental management are crucial to the State and are regarded to be the major factors in preventing deaths due to Malaria. Provision for impregnation of bed nets is essential as majority of the population prefers to use their own bed nets which have their tailoring of choice over distributed LLINs.

After careful analysis of the State situation and performance, the yearly API target set during the 12th Five year plan was found not feasible and farfetched. All the while keeping the State Goals in mind, yearly revised targets set are as below:

Year ABER API MORTALITY
2015-2016
  • >30.00%
<15.00 25
2016-2017
  • >32.00%
<12.00 20

OBJECTIVES AND TARGETS OF DENGUE CONTROL PROGRAMME:

OBJECTIVES : Following are the specific objectives of the Mid Term Plan

  • To reduce the incidence of Dengue and Chikungunya and to bring down the disease burden.
  • To reduce the case fatality rate due to Dengue.

TARGETS :

  • Dengue cases fatality rate to below 1%.
  • Functional Sentinel Surveillance Hospital in all endemic districts/towns/cities.
  • Functional Rapid Diagnostic Response team in all endemic districts/towns/cities.

By the latter part of 2012, Dengue and Chikungunya Control Programme was implemented in the State. Civil Hospital, Aizawl was identified as Sentinel Surveillance Hospital for Dengue. Random Sampling was done from the OPD patients and 6 cases were found to be positive for Dengue infection in the year 2012, 7 cases in the year 2013 and 19 cases in 2014.

Due to delayed release of funds in 2012 (as well as unreleased of funds) for Dengue and Malaria in the second instalment, the State faced problems in procurement of Dengue NS1 antigen test kit. The IgM MAC ELISA test kit (96 test) received from NIV Pune was used up within a short period of time and the State could not proceed further in diagnosing Dengue Disease during 2012-2013. Then in 2013 – 2014, the same amount of test kit (i.e 96 test kits) was received and the State had to procure additional test kits from the SSH budget, 246 suspected cases were tested and out of which 19 were found to be positive for Dengue.

It was also felt necessary to increase the number of Sentinel Surveillance sites to have better coverage of the population at risk. Keeping in mind the high percentage of patient attendance in Private Hospitals of the State, setting up additional Sentinel Surveillance sites at three other hospitals, namely, Presbyterian Hospital, Durtlang in northern Mizoram, Civil Hospital, Lunglei and Christian Hospital, Serkawn in the southern part of Mizoram was proposed.

The proposed additional Sentinel Surveillance Site for Dengue was approved and will be setup at Civil Hospital, Lunglei. ELISA reader and washer will be procured and installed as soon as the funds are released.

STATUS OF MIZORAM FOR DENGUE IS AS FOLLOWS:

Year Suspected Cases Positive Cases Deaths
2012 90 6 Nil
2013 96 7 Nil
2014 246 19 Nil

Note – 5 cases were detected in the year 2010 from Private Hospital before programme was implemented in the State.

EXECUTIVE SUMMARY

The disease situation in Mizoram State is as below:

Year Malaria Cases Malaria Deaths Dengue Cases Dengue Deaths Chikungunya Cases AES/
JE Cases
AES/
JE Deaths
Kala-azar Cases Kala-azar Deaths Micro-filaria Rate %
2012 9883 25 6 Nil Nil Nil Nil Nil Nil Nil
2013 11408 21 7 Nil Nil Nil Nil Nil Nil Nil
2014 23105 31 19 Nil Nil Nil Nil Nil Nil Nil


In the State, Malaria is still a major public health problem till date. 32 cases of Dengue have been identified from 2012-2014. Two cases of registered death due to suspected AES/JE were also seen in the state but due to lack of diagnostic facilities, the cases were not confirmed and the actual prevalence of the disease cannot be estimated as yet.

Malaria is endemic (API>2) in 5 districts (out of 9) namely :

  • 1.Mamit District
  • 2.Kolasib District
  • 3.Lunglei District
  • 4.Lawngtlai District and
  • 5.Saiha District