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WHO declares El Salvador Malaria Free – 1st country in Central America to be certified Malaria Free

WHO declares El Salvador Malaria Free – 1st country in Central America to be certified Malaria Free

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  • GS 3 || Science & Technology || Health and medicine

What are mosquito-borne diseases?

  • When a mosquito feeds on blood, it also swallows any viruses or parasites living in the blood.
  • These viruses and parasites can be transferred to the next person the mosquito bites through its saliva.
  • Any disease that is spread in this way from mosquito to human (or animal) is known as a ‘mosquito-borne disease’.
  • While the mosquito may not be affected, these mosquito-borne diseases can cause immense suffering for humans.

Mosquito-borne diseases

  • Mosquito borne diseases are widespread in over 150 countries around the world.
  • In India, around 40 million people contract mosquito borne diseases annually.
  • Common vector borne diseases in India spread by Mosquitoes are:
    • Malaria
    • Dengue
    • Chikungunya
    • Filaria
    • Japanese Encephalitis
  • Vector-borne diseases account for more than 17% of all infectious diseases, causing more than 700 000 deaths annually.
  • Dengue fever, together with associated dengue hemorrhagic fever (DHF), is the world’s fastest growing vector borne disease.
  • Malaria causes more than 400,000 deaths every year globally, most of them are children under 5 years of age.
  • India is endemic for six major vector-borne diseases (VBD) namely malaria, dengue, Chikungunya, filariasis, Japanese encephalitis and visceral leishmaniasis.
  • Six states — Odisha (40%), Chhattisgarh (20%), Jharkhand (20%), Meghalaya, Arunachal Pradesh, and Mizoram (5-7%) — bear the brunt of malaria in India.
  • These states, along with the tribal areas of Maharashtra and Madhya Pradesh, account for 90% of India’s malaria burden.

Main Vectors ( Mosquitos) and diseases:

Vectors Diseases
Aedes mosquito ●        Chikungunya

●        Dengue fever

●        Lymphatic filariasis

●        Rift Valley fever

●        Yellow fever

●        Zika

Anopheles mosquito ●        Malaria

●        Lymphatic filariasis

Culex mosquito ●        Japanese encephalitis

●        Lymphatic filariasis

●        West Nile fever

Initiative to tackle Mosquito borne diseases:

  • New paper-based test kit for rapid Malaria Detection: A group of researchers from IIT Guwahati has developed a simple detection method that uses an instrument when in the lab or a piece of chromatographic paper when in the field.
  • MERA India’ to eliminate malaria by 2030: By The Indian Council of Medical Research – – a conglomeration of partners working on malaria control – in order to prioritise, plan and scale up research to eliminate the disease from India by 2030.
    • It aims to harness and reinforce research in coordinated and combinatorial ways in order to achieve a tangible impact on malaria elimination.
  • GM Mosquitos: GM mosquitoes are mass-produced in a laboratory to carry two types of genes: A fluorescent marker gene that glows under a special red light.
    • This allows researchers to identify GM mosquitoes from wild mosquitoes.
    • A self-limiting gene that prevents female mosquito offspring from surviving to adulthood
    • This technique uses biotechnology to control the population of harmful mosquito species.
  • National Vector Borne Diseases Control Program (NVBDCP): of India has developed a comprehensive framework to achieve the overarching vision of “Malaria free India by 2030. The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of vector-borne diseases and is subsumed under the National Health Mission.
  • National Strategic Plan (NSP) for Elimination of Malaria (2017-2022): India has set its goal to eliminate Malaria by 2027 three years ahead of 2024 which is the global deadline for the elimination of Malaria.
    • It is designed based on the National Framework for Malaria Elimination (NFME) 2016 formulated with the support of the WHO’s Global Technical Strategy for Malaria (2016-2030).
  • Kala Azar control programme: Kala-azar is the main problem in Bihar, Jharkhand, West Bengal and some parts of Uttar Pradesh.
    • It is a centrally sponsored programme in endemic states in 1990-91.
    • A tripartite MoU has been signed between India, Bangladesh and Nepal for achieving Kala Azar from the South East Asia Region.
    • All programmes are being implemented by the NVBDCP.
  • National Filaria Control Programme: Bancroftian filariasis is restricted to 6 states – UP, Bihar, Andhra Pradesh, Orissa, Tamil Nadu, Kerala, and Gujarat.
    • The National Filaria Control Programme was launched in 1955.
    • It has the objective of controlling Lymphatic Filariasis in un-surveyed areas and urban areas through anti-parasitic and anti-larval measures.
    • The National Health Policy 2017 envisages the elimination of Lymphatic Filariasis.
    • Year 2020 was the target year for Global elimination of the disease.
  • Japanese Encephalitis Control Programme: Japanese encephalitis (JE) is reported from 26 states and UTs since 1978, only 15 states are reporting JE regularly.
    • A task force is constituted by the Government of India for the control of Japanese Encephalitis.
    • The Directorate of NVBDCP monitors the situation of Japanese Encephalitis in the country. Objective of the programme is the early diagnosis of the disease and sincere case management.
  • Dengue Control: Japanese encephalitis (JE) is a zoonotic disease transmitted by Culex mosquitoes.
    • This disease has been reported from 26 states and UTs since 1978, only 15 states are reporting JE regularly. The states have been taking measures at regular intervals to control dengue in urban areas.

Global efforts for Mosquito borne diseases:

  • Global Vector Control Response (GVCR) 2017–2030: It provides strategic guidance to countries and development partners for urgent strengthening of vector control as a fundamental approach to preventing disease and responding to outbreaks.
  • World Mosquito Program: The World Mosquito Program (WMP) is a not-for-profit initiative that works to protect the global community from mosquito-borne diseases such as dengue, Zika and chikungunya.
    • Previously known as the Eliminate Dengue Program, the World Mosquito Program uses naturally occurring bacteria called Wolbachia to reduce the ability of mosquitoes to transmit these disease-causing viruses.

Challenges:

  • Limited Capacity of health infrastructure and services: Mosquito borne disease prevention programmes at national and subnational levels have limited public health entomology capacity and poor infrastructure.This insufficient capacity for vector control programmes results in gaps in access and coverage.
  • Poor coordination and lack of swift actions in case of an outbreak: The poor links between organisations, and other structural requirements most often affects the efficacy of national initiatives.
  • Lack of R&D: A lack of basic and applied research has limited the evidence base to support effective vector control in India and in many countries.
  • Environmental factors: Factors such as Climate Change, rapid urbanisation or local alterations in land use etc. can extend the distribution of vectors to more regions.
  • Financial factors: The Mosquito borne diseases mostly occur in tropical developing and underdeveloped countries. These countries do not possess enough financial resources to tackle these diseases in a sustained manner.
  • Ethical challenges: There are several ethical challenges and concerns relating to Mosquitos control methods and their implementation and research into new interventions must follow standard ethical guidelines to ensure that results of studies can be obtained without adverse effects on humans and the environment. Eg: GM Mosquitos

Case Study: Odisha’s success in Malaria prevention

  • Odisha used to be highly endemic for malaria and bears almost a quarter of the country’s disease burden.
  • But recent innovative methods involving non-health workers in malaria control have resulted in a near-80 percent decline in the cases.

How did Odisha achieve this?

  • Community participation: In under-served villages where Accredited Social Health Activists (ASHAs) were unable to reach, alternative providers like teachers, forest animators were trained to do mass screening by running blood tests and providing medication to villagers.
  • Comprehensive Case Management Programme: Launched by the ICMR as an intervention in high incidence areas. Odisha used this programme very wisely.
    • Four districts — Bolangir, Dhenkanal, Angul and Kandhmahal — were divided into a control block and an intervention block under the CMP.
    • In the intervention block, activities were intensified while in the control block things went on as usual.
  • Proactive measures: In hill-top areas, people were screened and even if they had no symptoms of malaria, but their blood samples showed presence of parasites, they were treated with anti-malarial drugs

Outcome:

  • In four years, the difference was apparent. While there were close to 4, 44, 850 cases of malaria in 2016 in the State, this dropped to around 55,360 till October 2018, and deaths were reduced from 77 in 2016 to just four in 2018.

Way forward:

  • Intensive health services: In high-burden regions, there is a need for Government’s ASHA or community health workers, who are equipped with rapid diagnostic kits, to quickly test and facilitate treatment.
  • Countering drug resistance: The above is important to ensure that medicines are given only to those who need it. Resistance to a drug develops when people are treated randomly or when those taking the drug do not complete its full course.
  • Reporting and well documentation: data about people being treated in private hospitals may not be getting captured. If the Government mandated that the private sector report its malaria cases to them (as is with TB), that would be “powerful”.
  • Proactive surveillance system: There is a need to keep looking as to where the first cases emerge from and report them immediately. All clinics and hospitals, both government and private, should be able to inform the authorities immediately, when there are suspected cases of dengue or chikungunya.
  • Rapid response emergency vector control: With a focus on eradicating breeding places, prompt action should be taken to spray and fog suspected breeding grounds.
  • Awareness programmes during rising cases: When dengue and chikungunya cases start appearing, people need to be aware of what they should do at the first signs, such as seeking treatment from proper hospitals with facilities for blood tests.
  • Training and capacity development: Health personnel should be given continuous training in the management and monitoring of dengue patients.

Model Mains Question:

  1. Vector borne, in particular Mosquito borne diseases, are a considerable drag on the health services as well as the development process of a country. In this backdrop, critically examine the challenges involved in successful eradication of Mosquito borne diseases.