DISSERTATION PAPER ON:DISSERTATION PAPER ON: ““ Malaria Epidemiology Malaria Epidemiology o on n Jalpaiguri

District Applying Remote Sensing & Geographic Information System ”.

SUBMITTER BY:

NAME: SANTANU DUTTA

ROLL NO-16

SESION:2005 -06

SUPERVISED BY:

DR.SUSHMA ROHATGI

CENTRE FOR REMOTE SENSING APPLICATION,N.B.U CONTENTS: CHAPTER NO NAME PAGE NO.

LIST OF MAPS 1.(i)LIST OF TABLES 1.(ii)

ACKNOWLEDGEMENT 2PREFACE 3-4CHAPTER I INTRODUCTION 5-11 CHAPTER II REMOTE SENSING & GIS- A

VISIONARY TOOL IN MALARIA EPIDEMIOLOGY 12-19

CHAPTER III THE DISEASE: MALARIA & IT’S HISTORY 20-37

CHAPTER IV GEO ENVIRONMENTAL STATUS OF JALPAIGURI 38-45 DISTRICT.

CHAPTER V DISTRIBUTIONAL ASPECT OF MALARIA 46-49

CHAPTER VI SPATIAL DISTRIBUTION & TREND OF MALARIA IN JALPAIGURI DISTRICT 50-66

CHAPTER VII NATIONAL MALARIA CONTROL PROGRAMME 67-71

CHAPTER VIII MALARIA CONTROLM ACTION PLAN IN 72-88 JALPAIGURI DISTRICT.

CONCLUSION

REFERRANCE

APPENDIX

LIST OF MAPS: -

1. LOCATION MAP. 2. BLOCK MAP OF JALPAIGURI DISTRICT.

3. HEALTH STATUS OF JALPAIGURI DISTRICT.

4. LAND USE MAP OF JALPAIGURI DISTRICT.

5. SETTLEMENT MAP OF JALPAIGURI DISTRICT.

6. MALARIA POSITIVE RATE IN THREE YEARS IN JALPAIGURI DISTRICT.

7. IRRIGATION & HYDROLOGY MAP OF JALPAIGURI DISTRICT.

8. REGIONWISE A.P.I MAP OF JALPAIGURI DISTRICT.

9. POPULATION MAP OF JALPAIGURI DISTRICT.

10.YEARWISE ANNUAL PARASITIC INCIDENCE MAP OF JALPAIGURI DISTRICT.

11.SPECIESWISE MALARIA POSITIVE RATE IN JALPAIGURI DISTRICT.

LIST OF TABLES:

1. REMOTE SENSING APPLICATIONS FOR MALARIA SURVEILLANCE

2. DEGREE OF ENDEMICITY & SPLEEN RATE

3. TREND OF MALARIA CASE & DEATHS IN INDIA.

4. BLOCKWISE & YEARWISE MALARIA POSITIVE CASES IN DIFFERENT BLOCKS OF JALPAIGURI DISTRICT.

5. REGIOWISE ANNUAL PARASITIC INCIDENCE.

6. IDENTIFICATION OF HIGH RISK AREAS.

7. AGE & SEXWISE DEATH REPORT OF MALARIA IN JALPAIGURI.

8. EXAMPLE OF CORRELATION TABLE.

ACKNOWLEDGEMENT:

The format of the project has been designed to cover such important areas operating to malaria as its scientific aspects, history, global position, position in India, & position in West Bengal with special reference to JALPAIGURI.malaria control & eradication programmes. On the basis of the study, the researcher has recorded their findings & ultimately attempted

to suggest remedial measures & make maps of malaria epidemiology to control the malaria in Jalpaiguri, West Bengal.

I was inspired to go through a book by SAROJINI PACHOLI, “MEDICAL GEOGRAPHY OF MALARIA IN MADHYA PRADESH”. It occurred to me that new vistas of enquiry might be found with respect to the health pf people even in the field of my own subject of specialization-ZOOLOGY. My curiosity found further, when I saw huge amount of deaths due to malaria in Jalpaiguri district in last few months. Then as a student of M.PHIL in REMOTE SENSING & GIS, I talked to my head of the department & Joint director & Academic coordinator DR.SUSHMA ROHATGI. This further encouraged me to request her to take the responsibility of supervising my project work, which she very kindly agreed to. Without her constant encouragement & guidance at all levels this work would not have seen the light of the day. I have no words to appropriately express my sense of gratitude to DR.SUSHMA ROHATGI.

In connection with my data collection campaign I had the good support of meeting Deputy Director Of Health Sastha Bhavan & Malaria Inspector Of Sastha Bhavan.

I am very obliged to Dr.Bishwajit Roy, ACMOH of Jalpaiguri Hospital, without his help, it was impossible to complete the work.

I am also grateful to CMOH of Jalpaiguri hospital. His inspiration gave a life to work in this field.

So, at last again I offer my sincere thanks to one & all.

PREFACEMalaria is endemic in India. It has made people suffer for centuries and has claimed millions of life. The discovery of malaria parasite, nearly a century ago in Algiers by Lavarian; relationship of malaria parasite, Anopheline mosquito and man was found out in the last year of nineteenth century by Ronald Ross in India. Ever since the unending battle between man & is on. In 1939 after the insectisidal properties of DDT was discovered by Paul Muller, a new strategy began between the two. Venezuella was the first country to launch an eradication programme against malaria in 1945.In 1955, the Eighth World Health Assembly recommended the eradication of

malaria as an international objective, following the reported development of resistance by the vector to the insecticides in many countries. The credit of co-ordinating the global campaign against malaria goes to the World Health Organization.

In India the fight against malaria was started in 1953 with the National Malaria Control Programme & before the vectors could develop resistance, the shift to the National Malaria Eradication was undertaken in 1958. Out of the 390 units, 250 units were declared free from this disease by 1966. Due to this phenomenal success it was thought that the country has nearly eradicated the disease. But as the efforts in this field slackened down the whole fortification turned turtle, of course due to various disease. The reappearance of malaria in many areas is bewildering the experts. The same is the case of West Bengal; the area of research of the present work is Jalpaiguri district. Jalpaiguri, the name is derived for Jalpai olive trees, which once abounded the town of Jalpaiguri. It is situated between 26º16’ & 27º0’ in the northern hemisphere. The easternmost extremity of the district is marked by 88º25'.The chief town & the administrative headquarters of the district & also of the Jalpaiguri division, is Jalpaiguri, situated on the west or the right bank of the Tista river in 26º32' north & 88º43' east. It contains total 2905.64 square miles area & a total 4108,048 souls population. Jalpaiguri has undergone several administrative changes in its boundary & area in the past. The present status of the Jalpaiguri is the result of reorganization of boundary commissioner of Bengal in 1876.It contains total 13 blocks, of which the main focus of the research work is Alipurduar 1, Alipurduar 2 & Kalchini & few tea gardens in Alipurduar, which are malaria prone area. The vicious circle of disease- low income, bushy area, poor health services, more disease & more poverty not only poses a problem of health & sanitation but also the welfare of the society at large. In order to avoid such a situation it seems pertinent to attempt an interdisciplinary study, which may help in safe guarding the health of the people. Jalpaiguri is one of those districts of West Bengal where occurrence &

recurrence of malaria has been reported on a large scale. This calls for serious diagnostic study. Since physical factors do contribute to the incidence of malaria & there may be various patterns of the prevalence of disease.

Chapter wise Description:

CHAPTER 1 deals with INTRODUCTION

CHAPTER 2 deals with – REMOTE SENSING & GIS-A VISIONARY TOOL IN MALARIA EPIDEMIOLOGY.

CHAPTER 3 deals with – THE DISEASE: MALARIA & IT’S HISTORY.

CHAPTER 4 deals with – GEOENVIRONMENTAL STATUS OF JALPAIGURI DISTRICT.

CHAPTER 5 deals with – DISTRIBUTIONAL ASPECT OF MALARIA.

CHAPTER 6 deals with – SPATIAL DISTRIBUTION & TREND OF MALARIA IN JALPAIGURI,WEST BENGAL.

CHAPTER 7 deals with – NATIONAL MALARIA CONTROL PROGRAMME. CHAPTER 8 deals with – MALARIA CONTROL ACTION PLAN IN JALPAIGURI DISTRICT.

CHAPTER 1-INTRODUCTION (i)Problem:

Malaria history is not a new phenomenon of India. Some of the earliest references to this fever occur in the Atharva Veda believed to have been composed about 1500 B.C. Vndyke Carter & others verified the discovery of malarial parasite by Laveran in 1881 quickly in India, but it is not till later

that minds of research workers began to be directed towards the association of the insects with disease. In India the fight against malaria was started in 1953 with the National Malaria Eradication Programme & before the vectors could develop resistance, the shift to the National Malaria Eradication was undertaken in 1958, Again that was converted into National Vector Borne Disease Control Programme. Jalpaiguri district of West Bengal is basically a malaria prone zone. The geographical status of this district ids mainly a causative phenomenon of this disease. The GIS database used for relationship of health condition with land use and other spatial and non-spatial data of the district, which show positive relationship with poor health condition and tea garden belts than other part ofdistrict.

The primary causes of the poor health are – (a) Poor drinking facility due to the contamination of ground and surface water and waste management of tea garden belts because do not have concert platform of tube well and deep tube well. (b)Land use pattern, geomorphology, hydrology condition and drainage networks all are directly or indirectly related with marshy land which are more favorable condition for malaria disease. The secondary cause of the poor health condition –

(a)Literacy Literacy is one of the prime factors of human interference hazard and creating awareness. Health and literacy both are complementary step for better future. But unfortunately literacy rate is very poor in the tea garden area compare to the district. In recent census literacy rate is 63.62% in whole district where as 37.48% in tea garden area. Illiterate people do not know how to combat with the hazard.

(b)Lack of awareness Being a backward district Jalpaiguri is confronted with a very major social problem which is a great concern for the programmed of eradication water-borne diseases like malaria, The entire problem is alarming in this region due to lack of awareness about their health. The rural families, majority of whom are living under the poverty line, they are aware about their sanitation

(c) Poverty Poverty of the Tea Garden belt area:More than 70% of the total populations in Tea garden area are working as daily-labourer. The percentage of Below Poverty Line (BPL) families have decreased from 62.01(1997) to 59.53 (2002) in all over the district. But the percentage of BPL families in Tea Garden area is 67.07%. Tea garden labourer gets minimum wage in relation to labourers of other spheres. The feudalistic character of tea garden management still treats them as their bonded labors. For this reason huge amount of deaths are reported from this district during last four months. In order to avoid such a situation it seems pertinent to attempt an interdisciplinary study, which may help in safe guarding the health of the people.

(ii) Review of literature:

(Malaria incidence & vector density in relation to climetogical factors in Western Doon Valley, Uttaranchal). A study on malaria incidence & vector density in relation to climetogical factors in Western Doon Valley in Uttaranchal, conducted by R.K.Mahesh & R.K.Jahuri during January 1999 to December 2002 revealed considerably high infection of P.vivax. The study was done on the basis of 2402 Anopheline mosquito specimens’ comprosing 10 different species of which A.stephensi recorded most no & then A.nigerrimus. During 1999 to December 2002 total 374 A.stephensi were collected & then 341 A.nigerrimus were collected.During these 6 years less amount of A.vagus were collected, which was only 46. But in case of yearwise analysis A.fluviatilis were mostly collected in the year 1999, A.subpictus were mostly collected in the year 2000. In the year 2001 & 2002,mostly dominent species were respectively A.nigerrimus & A.stephensi. According to the epidemiological data analysis it is clearly evident that July, August & September is the most peak period of malaria positive cases. Due to huge rainfall, July, August & September is the peak period of different Anophelines.

Basically according to the report of Singh(1984), A.culcifacies recorded most number in the month of September due to high incidence of Plasmodium vector during June to October.

On the other hand according to the report of Hati, Chatterjee & Biswas (1992), A.stephensi recorded most in the beginning of the monsoon & decreased after September & in the Winter & Summer few specimens were recorded in Calcutta. So it is clear that raise in density of species the number of malaria cases also increase.

So conclusively it can be interpreted that malaria incidence is totally depend on temperature & rainfall. This climatologically variation influence the breeding status of mosquito population. Plasmodium vivax recorded most from Jan-May & Plasmodium falciperum recorded most from April to June. So temperature is the key factor of the mosquito transmission.

(iii)Objectives:

The main objective of this work is Malaria endemicity zone mapping.of JALPAIGURI DISTRICT. This work will help to manipulate the area & interprets the affected area in in future.

(iv)Study area:

Jalpaiguri a district of the combined Rajshahi Kuch Bihar commissionership or division, is situated between 2616’ & 27in the northern hemisphere. He easternmost extremity of the district is marked by 8825’. The chief town & the administrative headquarters of the district & also of the Jalpaiguri division, is Jalpaiguri, situated on the west or the right bank of the Tista river in 2632’ north & 88east. It contains total 2905.64 square miles area & total 4108,048 souls populations.

This district contains 13 blocks, namely, Sadar, Rajganj, Maynaguri, Dhupguri, Mal, Metali, Nagrakata, Falakata, Madarihat, Klachini, APD I, APDII & Kumargram. There are total 150 tea gardens in Jalpaiguri district. Topography of this district and its environs is characterized by uneven elevation of this region varies form 62m to 350m. The altitude falls from 350m to above mean sea level at the foot of the Himalayas to 150m above mean sea level over a distance of 25km and then falls to about 60m above mean sea level over a distance 110 km further south. The climate of the area is characterized by a sub-topical & humid, the maximum, minimum

temperature 370 C and 60C respectively. The average annual rainfall of this district is 3736mm.The storm rainfall is of hydro-meteorological significance causing inundation and flood of the area.

(v)Data source:

Data’s are collected from various sources namely:

(a) The Deputy Chief Medical Officer Of Health, Jalpaiguri. (b) The Chief Medical Officer Of Health, Jalpaiguri.(c) Sastha Bhavan, Kolkata.(d) Website Of National Vector Borne Disease Control Programme.

(vi)Methodology:

Jalpaiguri is one of those districts where malaria has claimed millions of lives during the course of history & the study of the disease in its geographical perspective appeared tempting enough. In fact, following methodologies have been adopted for the study of malaria epidemiology in Jalpaiguri.

(1) Remote Sensing (2) Geographic Information System. (3) Cartograms

LOCATION MAP

1)REMOTE SENSING:

Remote sensing is the science & art of obtaining information about an object, area or phenomenon through the analysis of data acquired by a device that is not in contact with the object, area or phenomenon under investigation.

This is a broad definition, but we generally use this term for observing our earth’s surface from space using satellites or from the air using aircraft, which have been modified suitably. The elements of the data acquisition process are energy sources.

(A)Propagation of energy through the atmosphere. (B)Energy interactions with earth surface features. ©Retransmission of energy through the atmosphere. (D)Airborne/space borne sensors.

(E)Resulting in the generation of sensor data in pictorial or digital form. (F)In short, sensors record variations in the way earth surface features reflect & emit electromagnetic energy. (G)The data analysis process involves examining the data using various viewing & interpretation devices to analyze pictorial data & a computer to analyze digital sensor data. (H)Reference data about the resources being studied (such as soil maps, crop statistics,) are used when & where available to assist in the data analysis. (I)With the aid of reference data, the type, extent, location & condition of the various resources are extracted, which the sensor data were collected. (J)Then this information’s are compiled in the form of hardcopy maps & tables or as computer files that can be merged with other layers of information in a Geographic Information System (GIS).

Few Remote Sensing software’s have been used to construct the land use land cover maps. EASI PACE is one of the most important Remote Sensing software’s. Digital images can be processed with this software. Digital Image Processing involves the manipulation & interpretation of the digital images with the aid of a computer.

Total procedure has few steps: Image rectification & restoration. Image enhancement. Image classification. Data merging & GIS interpretation. Hyperspectral image analysis.

Biophysical analysis. Image transmission & compression.

(2) Geographic Information System (GIS)

A system for input, storage, manipulation & output of geographic information. A class of software. A practical instance of a GIS combines software with hardware data, a user, etc, to solve a problem, support a decision, help in planning.

A geographic Information System is a computer-based tool for mapping & analyzing geographic phenomenon that exist, & events that occur, on earth. GIS technology integrates common database operations such as query & statistical analysis with the unique visualization & geographic analysis benefits offered by maps.

A GIS has four main functional subsystems, these are:

A data input subsystem. A data storage & retrieval subsystem. A data manipulation & analysis subsystem. A data output & display subsystem.

So, a common accepted definition of a GIS is “a system of hardware, software, data, people, organizations & institutional arrangements for collecting, storing, analyzing, & disseminating information about areas of the earth.”

(3) CARTOGRAMES:

Charts & Diagrams are effective devices for vivid presentation of statistical datas. The main objective of diagrammatic representation is emphasis the relative position of different subdivisions & not simply to record details. The charts & diagrams are used here:

(a)LINE DIAGRAM:

Line diagram is most effective method to representing statistical data, specially used where data are shown in according with the time of occurrence.

(B)BAR DIAGRAM:

Bar diagram consists of group of equisaped rectangular bars, one for each category of given statistical data. Bars starting from a common base line must be of equal width & their lengths represent the value of statistical data.

(4) SOFTWARES:

There are several software’s, which have been used here: 1. ARC VIEW. 2. SPANS. 3. MAP INFO.

CHAPTER 2 -

RS & GIS – A visionary tool in Malaria Epidemiology

Malaria is a major public health problem in India. Nearly 2-3 million cases occur every year with about 1000 deaths in India. Control of malaria requires case detection; treatments of affected individuals, & for curtailment of malaria transmission, control of malaria vectors are undertaken. Vector control requires knowledge of the ecology of breeding & resting habitats & behavior of various specious of mosquitoes. Periodical surveys are essential for arriving of any conclusion for developing vector control strategy.

Routine entomological surveys over vast geographic areas are impractical, time consuming & expensive & therefore are confined to limited areas.

(I) REMOTE SENSING: Remote sensing is a tool for the surveillance of habitats, densities of vector species & even prediction of the incidence of the diseases, has opened up new vistas in the epidemology of the malaria & other vector borne disease. Several characteristics of remote sensing data help to study environmental process. Imagery acquired from aircraft or satellite platforms provides a synoptic view of earth’s surface. Sensors can be calibrated to record in spectral region beyond those to which the human eye is sensitive. Data are commonly available in digital format for computer analysis & integration with other digital databases. They provide a historical record of conditions for a particular area or region.

The digital image generated by multispectral scanner system is actually a two dimensional array of discrete picture elements or pixels. The sensors for each array are calibrated to record reflected or emitted energy in a specific spectral region. Individual pixels in this array may be from a few meters to several kilometers. The DN value of each pixel, which corresponds to photographic gray level, represents the average reflectance over the ground area being measured. The interpretation of enhanced multispectral imagery or aerial photography that has been photographically processed, involves the visual identification of objects & the determination of their meaning or significance based on colour, tone, texture, shape, shadow, pattern, location & association.

(I.i) Detection of habitats of mosquito vectors: In India, a feasibility study using multidate IRS 1A & 1B satellite data was undertaken in collaboration with the Indian Space Research Organization in & around Delhi by selecting six states including West Bengal with different ecological features.

It was found that false colour composite images can help in the development of base maps of the study area & macro stratification of mosquitogenic conditions is possible. The limitation of satellite resolution (36.5m) was felt,

as the smaller habitats of anopheles mosquitoes were not detectable. Correlation of changes in the area of land use features; water bodies &vegetation with mosquito density was found significant in some places. Based on IRS LISS II data, mosquito larval production can be estimated.

(I.ii) Monitoring of environmental parameters affecting populations of mosquito vectors:

The role of environmental factors; temperature, rainfall & relative humidity in the epidemology of vector- borne diseases is well known. Meteorological data obtained from different places are not uniform & therefore limit their use for modeling of diseases, The advanced high resolution radiometer (AVHRR) sensor, on polar orbiting meteorological satellites of National Oceanic & Atmospheric Administration (NOAA) & Meteostat satellite provide data about rainfall (based on cold cloud duration), vegetation state (NDVI), land surface temperature & soil & vegetation moisture contents. The Normalized Difference Vegetation Index (NDVI) is a reliable indicator of rainfall. The NDVI values are obtained in the range of –1.0 to 1.0. The values of 0 to 0.2 indicate bare soils (with scanty vegetation), 0.2 to 0.7 different categories of green vegetation & negative value indicates the presence of water. The NDVI data are usually composited fortnightly or monthly. High NDVI values generally corresponded with high rainfall. The ability to foresee flooding of mosquito habitats by remote sensing was found to have importance bearing on developing strategies for mosquito control & disease prevention.

(I.iii) Future Perspective : The foregoing account indicates that RS technology has provided a tool for mapping the breeding habitats of anopheline mosquitoes, prediction of densities of vector species & even development of risk maps of malaria. The purpose of RS is not to detect the mosquitoes, but the indirect parameters of their ecology & behavior, which help in thriving of vector species. Remote sensing is likely to become a rapid epidemiological tool for surveillance of vector borne diseases & malaria in particular. sA number of studies have established the potential of remote sensing for detection of malaria. Studies on the use of remote data to identify mosquito-

breeding sites have also been carried out. The findings of the studies cited on the following table illustrate hoe geospatial technologies can provide scientists with a new perspective with which to study the factors influencing the patterns of malaria at a variety of landscapes levels.

Remote sensing data used

Parameter derived from remote sensing data

Disease Reference

Colour infrared aerial photography

Land & water cover

Mosquito Welch et.al

TM simulator/ Landsat TM

Water & vegetation cover

Mosquito larvae Wood et.al

Landsat TM Land cover Malaria/ Mosquito Beck et.al

SPOT HRV Vegetation amount

Malaria/Mosquito Roberts et.al

AVHRR NDVI,(8km) Temperature,(MIR)

Vegetation amount

Malaria/Mosquito Hay et.al

AVHRR NDVI (1.1 km)

Vegetation amount

Malaria/ Mosquito Thomson et.al

IRS 1A & 1B Vegetation/ Ecotype

Malaria/ Mosquito Sharma et.al

IRS 1D Eco-epidemiological classes

Malaria/Mosquito Srivastava et.al

Remote Sensing Applications For Malaria Surveillance

(II) GEOGRAPHIC INFORMATION SYSTEM

Many misconceptions exist as to the meaning of the term GIS, particularly in disciplines where the use of such technology has not been firmly established. The phrase “Geographic Information System” was first used in the 1960s to refer to a computerized system for asking questions of maps showing current & potential land use. A GIScan be defined as a ‘set of tools for collecting, storing, retrieving, transforming, displaying spatial data from the real world for a particular set of purposes’. A typical GIS comprises an organized collection of computer hardware, software, geographic data, & personnel data, designed to efficiently capture, store, analyze, & display all forms of geographically referenced information. Each piece of information is related in the system through specific geographic coordinates to a geographical entity (e.g. health center, school, dam, drainage, village or state). The information can be displayed in the forms of maps, charts, graphs, and tables. GIS adds the dimension of geographic analysis to information technology by providing an interface between data & maps. GIS has several advantages over conventional methods used in health planning, management & research.

(II.i) DATA MANAGEMENT:

GIS provides the user the ability to store, integrate, query, display & analyze data from the molecular level to that of satellite resolution through their shared spatial components obtained from diverse sources.

Surveillance of diseases requires continuous & systemic collection & analysis of data. GIS can eliminate the duplication of effort involved in the data collection across an organization, & hence substantially reduce the cost involved. It can also serve as a common platform for convergence of multi-disease surveillance activities.

Global Positioning System (GPS) can be used to obtain the location of point features on a map such as wells or septic tanks, precisely. GIS can process aerial & satellite imageries to allow information such as temperature, soil types & land use to be easily integrated & spatial correlations between potential risk factors & the occurrence of disease to be determined. Latest & accurate maps are essential for epidemiological surveillance. GPS, high-resolution satellite imageries & aerial photographs can be used to obtain accurate & up to date maps of a region. Multitemporal satellite imageries can be used to monitor land use & land cover changes over time.

(II.ii) VISUALISATION:

GIS offers powerful tools to present spatial information to the level of individual occurrence, conduct predictive modeling. It determines geographical distribution & variation of disease, & their prevalence & incidence. In studying the surveillance of malaria in India, in studying the surveillance of malaria in India, it is important to find out which type of malaria is occurring. Such studies have important implications for the disease eradication strategy to be employed. GIS can help to generate thematic- maps, ranged colour maps or proportional symbol maps to denote the intensity of a disease. In comparison with tables & charts, maps developed using GIS are more effective means for communicating messages clearly even to those who are not familiar with the technology. GIS allows policy makers to easily understand & visualize the problems in relation to the resources & effectively target resources to those communities in need. GIS permits dynamic link between databases & maps so that data updates are automatically reflected on the maps.

(II.iii) OVERLAY ANALYSIS:

GIS can overlay different pieces of information. This helps in decision-making & medical research through multicriteria modeling. It helps to understanding the association between prevalence of certain diseases & specific geographic features.

(II.iv) BUFFER ANALYSIS:

GIS can create buffer zones around selected features. A radius of 10 km around a hospital to depict its catchments area or 1 km around an effluent discharge site or 50 met on both sides of sewerage to indicate the spread of hazardous material. The user can specify the buffer size & then combine this information with disease incidence data to determine the number of cases fall within the buffer.

(II.v) NETWORK ANALYSIS:

GIS provides the ability to quickly access the geodemographic dynamics of an organizations existing service area in contrast to the likely demand for services at a new location. It can identify catchments areas of health centers & also locate suitable site for a new health facility. GIS provides accurate & timely information about where health services are located, & instructions & maps on how to get there.

(II.vi) STATISTICAL ANALYSIS:

GIS can carry out specific calculations, such as proportion of population falling within a certain radius of a health center. It also calculates distances & areas for example distance of a community to a health center, & area covered by a particular health programme.

(II.vii) QUERY:

GIS allows interactive queries to extract information contained within the map, table or graph. It can answer queries of location, condition, trends, spatial patterns & modeling. (II.viii) EXTRAPOLATION:

GIS provides a range of extrapolation techniques, for example, vector distribution in inaccessible & non-sampled areas can be mapped using GIS.

(II.ix) WEB GIS:

One of the recent advancements in GIS technology is web based GIS, health data is stored in central server, which can be accessed from various terminals connected to the server through internet or intranet. Dynamic web published on the web allow continuous monitoring for effective health interventions.

(II.x) Potential applications of GIS in public health: GIS is gradually being accepted & used by public health administrators & professionals, including policy makers, statisticians, epidemiologists, regional & district medical officers. Some of its potential applications in public health are listed below:

Determine the geographical distribution & variation of diseases. Analyze spatial & temporal trends of diseases. Identify gaps in immunizations. Map populations at risk & stratify risk factors. Document community health care needs & assess resource

allocations. Forest epidemics. Plan & target interventions. Monitor diseases & interventions over time. Manage patient care environments, materials, supplies & human

resources. Monitor the utilization of health centers. Route health workers, equipments & supplies to service locations.

Publish health information maps on the internet. Locate the nearest health facility.

CHAPTER 3 –

THE DISEASE: MALARIA & ITS HISTORY

(A)DEFINATION:(A.I) DEFINATION OF MALARIA:

Malaria (marsh fever, periodic fever) is a parasitic disease that involves infection of the red blood cells (RBCs). Malaria is caused by the protozoan parasites belonging zoologically to the class sporozoa. These parasites are peculiar to man, who constitutes their intermediately host & in whose red blood corpuscles they live & multiply & may give rise to a periodic fever associated with anemia, enlargement of spleen, & the deposit of black pigment in that organ & elsewhere.PARK (1972) defines malaria as a communicable disease caused by sporozoan parasites of the genus Plasmodium SP & transmitted to man by certain species of infected female Anopheline mosquitoes. Periodic chills & fever, enlargement of spleen & secondary anemia with a tendency to relapse characterize the disease clinically.

LIFE CYCLE OF MOSQUITO:

All mosquitoes must have water in which to complete their life cycle. This water can range in quality from melted snow water to sewage effluent and it

can be in any container imaginable. The type of water in which the mosquito larvae is found can be an aid to the identification of which species it may be. Also, the adult mosquitoes show a very distinct preference for the types of sources in which to lay their eggs. They lay their eggs in such places such as tree holes that periodically hold water, tide water pools in salt marshes, sewage effluent ponds, irrigated pastures, rain water ponds, etc. Each species therefore has unique environmental requirements for the maintenance of its lifecycle.

The feeding habits of mosquitoes are quite unique in that it is only the adult females that bite man and other animals. The male mosquitoes feed only on plant juices. Some female mosquitoes prefer to feed on only one type of animal or they can feed on a variety of animals. Female mosquitoes feed on man, domesticated animals, such as cattle, horses, goats, etc; all types of birds including chickens; all types of wild animals including deer, rabbits; and they also feed on snakes, lizards, frogs, and toads.

Most female mosquitoes have to feed on an animal and get a sufficient blood meal before she can develop eggs. If they do not get this blood meal, then they will die without laying viable eggs. However, some species of mosquitoes have developed the means to lay viable eggs without getting a blood meal.

The flight habits of mosquitoes depend again on the species with which we are dealing. Most domestic species remain fairly close to their point of origin while some species known for their migration habits are often an annoyance far from their breeding place. The flight range for females is usually longer than that of males. Many times wind is a factor in the dispersal or migration of mosquitoes. Most mosquitoes stay within a mile or two of their source. However, some have been recorded as far as 75 miles from their breeding source.

The length of life of the adult mosquito usually depends on several factors: temperature, humidity, sex of the mosquito and time of year. Most males live a very short time, about a week; and females live about a month depending on the above factors.

The mosquito goes through four separate and distinct stages of its life cycle and they are as follows: Egg, Larva, pupa, and adult. Each of these stages can be easily recognized by their special appearance. There are four

common groups of mosquitoes living in the Bay Area. They are Aedes, Anopheles, Culex, and Culiseta.

Egg : Eggs are laid one at a time and they float on the surface of the water. In the case of Culex and Culiseta species, the eggs are stuck together in rafts of a hundred or more eggs. Anopheles and Aedes species do not make egg rafts but lay their eggs separately. Culex, Culiseta, and Anopheles lay their eggs on water while Aedes lay their eggs on damp soil that will be flooded by water. Most eggs hatch into larvae within 48 hours.

Larva : The larva (larvae - plural) live in the water and come to the surface to breathe. They shed their skin four times growing larger after each molting. Most larvae have siphon tubes for breathing and hang from the water surface. Anopheles larvae do not have a siphon and they lay parallel to the water surface. The larva feed on micro-organisms and organic matter in the water. On the fourth molt the larva changes into a pupa.

Pupa: The pupal stage is a resting, non-feeding stage. This is the time the mosquito turns into an adult. It takes about two days before the adult is fully developed. When development is complete, the pupal skin splits and the mosquito emerges as an adult.

Adult: The newly emerged adult rests on the surface of the water for a short time to allow itself to dry and all its parts to harden. Also, the wings have to spread out and dry properly before it can fly.

The egg, larvae and pupae stages depend on temperature and species characteristics as to how long it takes for development. For instance, Culex tarsalis might go through its life cycle in 14 days at 70 F and take only 10 days at 80 F. Also, some species have naturally adapted to go through their entire life cycle in as little as four days or as long as one month.

LIFE CYCLE OF MOSQUITO:

EGG: PART ONE OF LARVAE: PART TWO OFMOSQUITO LIFE CYCLE. MOSQUITO LIFE CYCLE.

PUPAE: PART THREE OF MOSQUITO LIFE CYCLE.

PART FOUR OF MOSQUITO LIFE CYCLE.

(I.i) TYPES OF MALARIA:

The following four distinct types of human malaria are recognized, based on the period of recurrence of fever. They are also caused by four different species of Plasmodium SP.

(I.i.a) Benign tertian or vivax: It is caused by Plasmodium vivax. Fever recurs after every 48 hours. Death rate is low. Temperature may rise up to 106º to 107º but also comes down soon.

(I.i.b) Malignant tertian: It is due to Plasmodium falciperum. Fever recurred every second or third day that is after 36 to 48 hours. Death rate is very high because the infected red blood corpuscles tend to clump into masses, thus blocking up small blood vessels of internal organs, such as brain, spleen, lungs, etc. It is known as aestivo-autumnal or the tropical epidemic malaria of man.

(I.i.c) Quartan: It is caused by Plasmodium malariae. The fever recurs every fourth day that is after 72 hours. It may last 40 years or more in untreated persons. Death rate is low. Chronic infection may result in lethal kidney conditions.

(I.i.d) Ovale or mild tertian: It is caused by Plasmodium ovale. The fever recurres every third day or after 48 hours. It is not greatly harmful & is mainly confined to tropical Africa

(A.II) INCUBATION PERIOD:

The period intervening between the entry of the malarial parasite & the onset of fever is called incubation period.According to PARK “Incubation period is the length of time between the bite of an infected mosquito & the first attack of fever. The period is usually not less than 10 days”.

The incubation period varies according to the species of the parasite. “It varies from a minimum of 6 to a minimum of 25 days for falciperum & from 8 to 27 days for vivax infection. In the latter, however a ‘ protected incubation period’ or ‘ prolonged primary latency’ which may last 9 or 10 months, frequently occurs in some parts of the world.” The average incubation period of the falciperum infection is about 11 days; of vivax infections 14 days; of ovale infections about 15 days, & of P. malariae infections about 4 weeks, though generally longer, the minimum incubation period described having been 18 days. With some strains of P. vivax, the incubation period may be delayed for several weeks or months; this may also occur with other species in persons who have been taking suppressive antimalarial drugs.Malaria is caused by the protozoan parasites of the genus Plasmodium (of the phylum Apicomplexa), and the transmission vector for human malarial parasite is the female Anopheles mosquito. The P. falciparum variety of the parasite accounts for 80% of cases and 90% of deaths. Children under the age of five and pregnant women are the most vulnerable to the severe forms of malaria.

(A.III) SYMPTOMS OF MALARIA

Typically, malaria produces fever, headache, vomiting and other flu-like symptoms. The parasite infects and destroys red blood cells resulting in easy fatigue-ability due to anemia, fits/convulsions and loss of consciousness. Parasites are carried by blood to the brain (cerebral malaria) and to other vital organs.   Malaria in pregnancy poses a substantial risk to the mother, the fetus and the newborn infant. Pregnant women are less capable of coping with and clearing malaria infections, adversely affecting the unborn fetus.

(A.IV) SYMPTOMS OF SEVERE AND COMPLICATED MALARIA 

The priority requirement is the early recognition of signs and symptoms of severe malaria that should lead to prompt emergency care of patient.  The signs and symptoms that can be used are non-specific and may be due to any severe febrile disease, which may be severe malaria, other severe febrile disease or concomitant malaria and severe bacterial infection.The symptoms are a history of high fever, plus at least one of the following:-

Prostration (inability to sit), altered consciousness lethargy or coma Breathing difficulties Severe anaemia Generalized convulsions/fits Inability to drink/vomiting Dark and/or limited production of urine Patients with prostration and/or breathing difficulties should, if at all

possible, be treated with parenteral antimalarials and antibiotics.   Oral treatment should be substituted as soon as reliably possible.  Frequent monitoring of laboratory parameters is essential – blood sugar, blood urine, fluid balance, associated infection, etc.  Drugs that increase gastro intestinal bleeding should be avoided.

 (A.V) SIGNS OF SEVERE AND COMPLICATED MALARIA

Cerebral malaria, defined as unarousable coma not attributable to any other cause in a patient with falciparum malaria.

Generalized convulsions. Normocytic anaemia. Renal failure. Hypoglycaemia. Fluid, electrolyte and acid-base disturbances. Pulmonary oedema. Circulatory collapse and shock (“algid malaria”). Spontaneous bleeding (disseminated intravascular coagulation). Hyperpyrexia. Hyperparasitaemia. Malarial haemoglobinuria.

(A.VI) RISK FOR SEVERE COMPLICATIONSIn areas of low transmission – all age groups are vulnerable but adults develop more severe and multiple complications.  The transmission pattern in most parts of India is usually low, but intense transmission is seen in

north-eastern states and large areas of Orissa, Chattisgarh, Jharkhand and Madhya Pradesh. In areas of high transmission – children below 5 years, visitors, migratory labour. Association of pregnancy-pregnant women are less capable of coping with and clearing malaria infections, adversely affecting the unborn fetus.

(A.VII) MEASUREMENT OF MALARIA:

In any community evaluation of malaria can be done by estimating the;

(A.VII.i) Prevalence,

According to WHO prevalence is defined as the “ Number of cases of disease or infection existing at any given time in relation to the unit of population in which they occur (a static measurement)”The prevalence of malaria in a locality at a given point of time may be estimated by examining a sample of the population for enlargement of spleen or parasites in their blood. The results are expressed by different indices or rates, namely:

(A.VII.i.a) Spleen rate (A.VII.i.b) Parasite rate (A.VII.i.c) Infant parasite rate (A.VII.i.d) Proportional case rate (A.VII.i.a) Spleen rate It is the percentage of children between 2 to 10 years of age showing enlargement of spleen. Adults are not taken into account for spleen surveys because; causes other than malaria frequently operate in causing splenic enlargement in them. First time DEMPSTER T.E. used this procedure for measurement of malaria prevalence in India in 1948. (A.VII.i.b) Parasite rate: It is the percentage of children between the age 2 & 10 years showing malaria parasites in their blood films.

(A.VII.i.c) Infant parasite rate: It is the percentage of infants below the age of one year showing malaria parasites in their blood films. It is regarded as the most sensitive index of transmission of malaria in a locality. If the infant parasite rate is zero for three consecutive years in a locality then it is regarded as absence of malaria transmission, provided the survey is done every year during a fixed period & a sufficient number of blood films of infants have been examined. . (A.VII.i.d) Proportional case rate: It is the number of cases diagnosed as clinical malaria for every 100 patients attending the hospitals and dispensaries.

(A.VII.ii) The incidence of disease: In a community with the rapid decline of malaria, consequent upon eradication operations, the classic tools of malaria evaluation described under prevalence, were found no longer sensitive to measure the traces of malaria left in the community. The term measurement therefore changed from prevalence to incidence. The method used for this purpose has been given the name of surveillance or case detection. The incidence of malaria can be described in two procedures:

(A.VII.ii.a) Annual Parasite Incidence The number of malaria cases occurring in the whole population under surveillance is detected by passive case detection. This is expressed as Annual Parasite Incidence, which can be calculated as follows: Confirmed cases during one year A.P.I = 1000 Population under surveillance The significance of the Annual Parasite Incidence (A.P.I) as a measure of malaria incidence depends upon adequate coverage of the population concerned in respect of blood examination.

(A.VII.ii.b) Annual Blood Examination Rate

The adequacy of the coverage is indicated by the Annual Blood Examination Rate (A.B.E.R), which is calculated by the following formula:

Number of slides examined A.B.E.R = * 100 Population The WHO Expert Committee on Malaria (1964) recommended that the monthly number of slides should amount to at least 1 per cent of the population. Measurement of Malaria in a community helps in finding the endemicity of the disease & the factor of endemicity is very vital in the study of the spatial distribution of the disease.

(A.VIII) MALARIA ENDEMICITY:

Malaria is endemic in many parts of the world including India. An endemic disease is visibly present, in greater or lesser frequency, all the time in the population. Woodruff points out “ Malaria is regarded as endemic in an area when there is measurable incidence & natural transmission over the year”. Endemicity is commonly described in terms of the rate of enlarge spleens & the incidence of parasites (parasite rates) found in the community. It is classified so as to have a clear picture of the occurrence of disease in any area.

(A.VIII.i) CLASSIFICATION OF ENDEMICITY: Before the Second World War it was customary to classify endemic malaria on the basis of the spleen rate. The WHO Malaria Conference for Equatorial Africa, held at Kampala (Uganda) in 1950, gave a new classification & some new terms with respect to endemicity. These were published by WHO (1951). According to this, the degree of endemicity is classified as follows:

DEGREE OF ENDEMICITY SPLEEN RATE (in children of 2-9 yrs age)

1.Hypo endemic area Less than 10 per cent2.Meso endemic area Between 11 to 50 per cent3.Hyper endemic area Constantly over 50 per cent4.Holo endemic area Constantly over 75 per cent

The adult spleen rate also varies in different areas. In holo endemic area adult spleen rate is low but tolerance is high, while in hyper endemic area high spleen rate in adults is a common feature.

(A.IX) DURATION OF MALARIA

The knowledge about the duration of malaria is the foundation of the concept of Malaria eradication.Falciperum infections are generally the most short lived (this is the only type of human malaria without a secondary exo-erythrocytic cycle). Its duration generally does not exceed 10 months in most strains. In some strains longer duration have been recorded, especially of African origin. Vivax infections last longer, sometimes attacks are seen after 3-4 days. P.malariae infections may well last through life. Ovale infections sometimes last longer than it was previously assumed. Relapses (subsequent attacks of paroxysms) are seen about 4 ½ years in many cases. At times malaria is fatal.

(B) HISTORICAL PERSPECTIVE

In India before the Malarial Control Programme was taken that it was estimated that 75million people suffered from Malaria & about 8 lakh died directly due to it in normal years. This number was sometimes doubled during epidemic years. This had an adverse affect of the socioeconomic life of the country. Realizing the immense problem of suffering of people & the economic loss of the Government of India launched a National Malaria Control Programme in 1953, as a joint venture mainly between the central & state government with the assistance from such Internationals Organizations as WORLD HEALTH ORGANISATION (WHO) & USAID .It was the biggest programme launched against single disease anywhere in the world. Prior to the implementation of this programme there were pilot projects in the malaria’s areas giving protection to the people.

(B.I) HISTORY OF MALARIA IN INDIA Long before the British colonized India, malaria was a serious problem for the country, imposing enormous economic costs and a great deal of human misery. Malaria epidemics occurred throughout India with varying intensity. In 1852, one malaria epidemic wiped out the entire village of Ula and then spread across the Bhagirathi River to Hooghly and continued to devastate populations for many years in Burdwan. The development of the Indian railways under the British administration contributed to the spread of malaria. While the construction of railway embankments provided a number of breeding sites for the malaria vectors, the laborers probably introduced different strains of the parasite to the areas in which they worked. The city of Bombay suffered greatly from malaria epidemics. The construction of railroads or bridges was often associated with increases in malaria, probably due to imported Labour from malarious areas. There were significant outbreaks of malaria during the construction of the Colaba causeway between 1821 and 1841 and during the construction of Alexander Dock and Hughes Dry Dock. Malaria epidemics in the Punjab and Bengal both show a startlingly high morbidity and mortality. In the early 1920s, Bengal suffered a severe malaria epidemic which resulted in over 730 000 deaths in 1921 alone. Thereafter, the number of deaths from malaria slowly decreased to within 300 to 400 000 per annum. During the Second World War however malaria deaths rose again, particularly in 1943, when Bengal recorded over 680 000 deaths and in 1944 when there were an appalling 763 220 deaths from the disease. Although quinine was available at the time, its supply was probably inadequate and patients did not seek treatment on time. On the

other, some of the great successes in controlling the disease were also achieved in India. Formal malaria control programmes were started under British colonial rule and continued after Indian Independence in 1946. Early malaria control efforts involved removal of breeding sites and later used chemicals such as the larvicide’s Paris green and kerosene. One of the first formal operations to control the disease was at at Mian Mir, near the city of Lahore (now in Pakistan). Mian Mir had an intricate system of irrigation canals which provided excellent breeding grounds for the vectors. The malariologists Drs. J.W.W. Stephens and S.R. Christophers, who had worked with Sir Ronald Ross in Freetown, Sierra Leone earlier, arrived at Mian Mir in 1901 with ambitious plans to remove all the breeding sites, evacuate the infected people and administer quinine as both a curative and preventative measure. Their programme developed into a massive effort, with between four and five hundred soldiers set to work full time at filling in the irrigation canals. The programme of constantly filling in ditches and removing puddles and any other potential breeding site continued until 1909. During 1909 there was a serious malaria epidemic, as there was in 1908 throughout the Punjab, and the courageous, but ultimately useless control programme was abandoned.Larviciding operations were also conducted at Bombay, Jhansi, Poona, Meerut, Secunderabad and all other military posts. In 1917, the Bengal Nagpur Railway and the East India Railways formed a separate malaria control organisation, specifically to control the disease in and around stations. National Railways managed to dramatically reduce the incidence of malaria among its staff though a comprehensive larviciding programme. Similar larviciding and breeding pool removal programmes were undertaken during the 1920s in the tea plantations of Assam and in Mysore by the Rockefeller Foundation. In 1927 the Central Malaria Bureau was expanded and renamed as the Malaria Survey of India. The first reported aerial spraying of Paris Green was in 1937. In 1938, pyrethrum was first used in malaria control in Delhi. The Rockefeller Foundation began using pyrethrum sprays experimentally in India to great success. Dr. D. K. Viswanathan then expanded the use of pyrethrum to Assam in 1942. However, all these interventions were unable to sustain the control of the disease. Vast breeding, colossal numbers of malaria vectors, limited effectiveness of pyrethrum sprays in houses and cattle sheds against the An. culicifacies vector, but not against An. fluviatilis and An. minimus were some of the causes for this setback.

(B.II)FACTORS RESPONSIBLE FOR OCCURRENCE OF MALARIA.

(B.II.i) Climatic factors:The climatic conditions have a profound effect on the life cycle and longevity of vector mosquito and also on the development of the malaria parasite. The important climatic factors are:

Temperature and Relative Humidity (RH) – the optimum for development of malaria parasite is between 25 0 C To 30 0 C, and average RH at least 60%. these temperature and RH conditions increase the longevity of mosquitoes & thus aid malaria transmission. Rainfall- Increased rainfall specially rainy days result in mosquitogenic conditions. Pre-monsoon rains, which maintain temperatures between 25-30 C and relative humidity around 80% for longer duration, lead to increase vector density and longevity to initiate malaria transmission, if parasite load exists in the community. Natural calamities- The natural calamities/ disasters like flood, drought and earthquake, usually cause increase in mosquitogenic conditions resulting in outbreak of malaria epidemic.

(B.II.ii) Vulnerability:

Some of the important points of vulnerability of an area are as follows:

In urban slums, an increase in mosquitogenic conditions (especially mosquito breeding) due to increased houses, water storage, and poor drainage;

Change in bionomics and behaviour of vector/s with special reference to change in resting and feeding habits, and response to insecticides;

Deforestation; Increase in breeding and density of vector; and Increase in the degree of man- mosquito contact.

(B.II.iii) Parasite factors:

Increasing trend of fever cases and SPR (Slide positivity rate), Increasing in proportion of gametocytes in the community Increase in Pf proportion; Resistance in parasite to drug/s Increase in malaria mortality; and Increase in consumption of anti- malariaials

(B.II.iv) Operational factors:

Inadequate basic health services may contribute heavily to outbreak of malaria epidemic in the area, particularly the following points:

Staff vacancy Poor surveillance machinery; Lack of adequate transport facilities Lack of approach road to far flung areas; Inadequacy in material and equipment; and Inadequate training and lack of motivation of work.

(B.III)VECTORS OF MALARIA IN WEST BENGAL

There are many vectors of malaria Anopheles culicifacies is the main vector of malaria in rural India and

Anopheles stephensi in urban India Anopheles minimus is an efficient vector in the West Bengal and

Anopheles fluviatilis in hill and foot hill areas of this district.

(B.III.i). Feeding habitsIt is a zoophilic species When high densities build up relatively large numbers feed on human beings

(B.III.ii) Resting habitsRests during daytime in human dwellings and cattlesheds

Breeds in rainwater pools and puddles, borrowpits, river bed pools, irrigation channels, seepages, rice fields, wells, pond margins, sluggish streams with sandy margins. Extensive breeding is generally encountered following monsoon rains. (B.III.v) Biting timeBiting time of each vector species is determined by its generic character, but can be readily influenced by environmental conditions. Most of the vectors, including Anopheles culicifacies, start biting soon after dusk. Therefore, biting starts much earlier in winter than in summer but the

peak time varies from species to species.

MOSQUITO HABITATS FOR BREEDING: FRESH & SALT WATER

CHAPTER-4 GEOENVIRONMENTAL STATUS OF JALPAIGURI DISTRICT

Malarial parasites are found widely spread from 45º S to 63º N latitudes. Their endemic home is in the tropical zone, but they occur in many temperate countries. Of the four human infecting species P.vivax is the most widespread and prevailing species of the temperate region; P.falciparum is confined to the warmer countries only, P.malariae occurs in the subtropical zone; while P.ovale the rarest of the four of the species. In between these malarial species most predominant species of the JALPAIGURI district is the Plasmodium vivax and Plasmodium falciperum.

JALPAIGURI DISTRICT PROFILE

1. LOCATION Between 26'.16'' and 27'.0'   North and   88'.4' and 89'.53'' East longitude

2. ESTABLISHED 1869

3. GEOGRAPHICAL AREA 6245 sq. km

4. AREA UNDER TEA GARDEN  1987 sq. km

5. AREA UNDER FOREST LAND  1790 sq. km

6. AVERAGE ANNUAL RAINFALL 3160 mm.

7. AVERAGE MAXIMUM TEMPERATURE : 30.9 degree Celsius

8: AVERAGE MINIMUM TEMPERATURE: 10.8 degree Celsius.

9. REALATIVE HUMIDITY:  82%

10. MAIN CROPS OTHER THAN TEA Rice & Jute 11. MAJOR RIVERS: Teesta, Torsa, Jaldhaka, Raidak, Sankosh

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LANDUSE MAP OF JALPAIGURI DISTRICT

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SETTLEMENT MAP OF JALPAIGURI DISTRICT

(4.A) Geomorphologic characters of Jalpaiguri.

Jalpaiguri district is bounded in the north by the hill ranges of the Himalayan and the south by the piedmont plains. Which Gradually Grade into the alluvial plains further south, which gradually exhibits a diversity sediment and soil colour. This feature has been fan deposit, in this tectonically affected composing the piedmont plain in the area are of apparently fluvial origin. As evidence by the huge size of the boulders they display later fluvial activity is seen in the terraces and later deposits beside a plethora of distributary channels. Rill & gully erosion over along period of time has produced an undulatory surface in these ancient deposits. The norths they consist mainly of pebble to quartzite over lain by finer water lain deposit. Later fluvial deposits ranging mainly from cobble to clay size material over lain the area. In alluvial plains leaves back swamps ox-bow lakes etc. Represent the usual landscape features comprising mainly the more recent flood plains but ancient flood plains surfaces may perhaps be coeval with the uplifted Barind landform.

(4.B)Geological And Structural Setup Of Area: The geological milieu in the district represents the sub Himalayas or the foothill zone consist almost entirely of the siwaliks and typical formation of quarternary boulder and conglomerate horizons. The lower portion occurs as a fluvial terrace deposit. The recent sediments mainly represent thick pile of fluvial unconsolidated sediments.The various faulting occur in this region. The time of faulting ranges from phocene to recent with some of the structures assumed to be seismically active. The tectonic activity has played the pivotal role in creating the elevations and depression has hard both a direct and indirect effect on the erosion and depositional aspect and drainage network in the region, which persist even today.

(4.C)Climatic condition of this area:The climate of this area characterized by a sub topical & humid, the maximum average temperature in summer 37c & minimum average temperature in winter 6c respectively the average annual rainfall of this district is 3736mm.The storm rainfall is of hydro meteorological significance causing inundation and flood of the are.

(4.D)Soil:

The soil of this district is red alluvial in nature and has alight texture and defined as sandy loam to loamy sand which highly permeable porosity. The geological point of view soils are mainly the product of weathering of fluvial clasticts acidic in nature having high percentage of organic carbon But eastern Dooars soil is gray sandy loam with lower percentage of organic carbon. Pedologically the deposits can be grouped into five unit based on soil formation, colour of topsoil & composition of soil, quarternary terrace deposits. The first one has no soil cover which is the present day flood plain the second unit consists of enormous well developed coarse to fine sand size grading southward away from the foot hills, to developed the Nitrogen content in soil of Dooars ranges between 0.3-2.3% organic carbon 0.3 to 2.9% available P2O5 to 185ppm & available K2O 10 to 60ppm.

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POPULATION

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BLOCK MAP OF JALPAIGURI DISTRICT

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HEALTH STATUS OF JALPAIGURI DISTRICT

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Persons

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OTHER WORKERS

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According to 2001 census total population of JALPAIGURI DISTRICT is 3,403,204. Total male population is 1,753,278 & female population is 1,649,926. Rural population is so high in this district. Population density per square km is 547.

Total 512,357 persons are under 0-6 years of age. Rural populations are more than urban population in 0-6 years of age. Population density per square km is only 82.

Literacy rate is not so high here. Only 1,839,036 persons are literate among 3,403,204 persons. More males are literate than females. Density of literacy per square km is 296.

There are 1.305,668 persons are main & marginal workers in Jalpaiguri district, of which most of them, are rural workers. No of rural workers are 1,110,146.Urban workers are 195,522.

Rural persons are mostly cultivators in this district, no of rural cultivators are 261,915,and most of them are males.

Total 230,363 persons are agricultural laborers in Jalpaiguri district. In between these peoples 226,944 persons are rural agricultural labourers. & 3149 persons are urban labourers. Mostly are males in between these agricultural labourers.

Household industries Workers are 23,219. In between these 18,460 persons are rural workers & 4,759 are urban labourers. Mostly are male workers.

Other workers are 786,987. Mostly are rural workers, no is 602,827 & urban workers are 184,160. Here also mostly are male.

JALPAIGURI IS MALARIA PRONE ZONE DUE TO FEW FACTORS

CLIMETIC CONDITION. ENVIONMENTAL CONDITION. POOR SOCIOECONOMIC CONDITION. POOR DRAINAGE SYSTEM. INADEQUATE HEALTH INFRASTRUCTURE.

CHAPTER 5-

DISTRIBUTIONAL ASPECT OF MALARIA

Where malaria is found depends mainly on climatic factors such as temperature, humidity, and rainfalls. Malaria is transmitted in tropical and subtropical areas, where: Anopheles mosquito can survive and multiply Malaria parasites can complete their growth cycle in the mosquitoes ("extrinsic incubation period"). Temperature is particularly critical. For example, at temperatures below 20°C (68°F), Plasmodium falciparum (which causes severe malaria) cannot complete its growth cycle in the Anopheles mosquito, and thus cannot be transmitted.

Geographic Distribution of MalariaEven within tropical and subtropical areas, transmission will not occur:At high altitudes During cooler seasons in some areas In deserts (excluding the oases) In some islands in the Pacific Ocean, which have no local Anopheles species capable of transmitting malaria In some countries where transmission has been interrupted through successful eradication.

(5.A) DISTRIBUTIONAL ASPECTS OF MALARIA IN INDIA.

Malaria is endemic in all of India except at elevations above 1800 meters and in some coastal areas. In most parts of the country, periodic epidemics of malaria occur every five to seven years. Although the total number of cases of malaria in India has stabilized somewhat over the past ten years, there has been an increase in the number of P. falciparum cases. 65% of malaria infections in India are caused by P. vivax and 35% are caused by P. falciparum. P. falciparum malaria has a shorter average incubation phase in the mosquito vector, thus speeding up transmission between people by limiting the time in the interim phase. P. falciparum also causes the most fatal type of malaria. The estimated economic loss due to malaria in India from 1990-1993 is $506.82 million to $630.82 million. India has spent up to 25% of its health budget on malaria control from 1977-1997, and starting in 1997, India planned to spend $40 million on malaria control, a 60% increase from the previous year. This expenditure is part of a five year program aimed to target 100 districts where 80% of all P. falciparum cases occur. 70-80% of the malaria control money in India is spent on insecticides.

India started using DDT to control malaria in 1946. In 1953, when 70 million cases and 0.8 million deaths occurred due to malaria (NMEP, 1996), the National Malaria Control Program was created. This program was renamed the National Malaria Eradication Program (NMEP) in 1958 due to the success of DDT and the commitment to malaria eradication in India at that time. The NMEP believed that it could eradicate malaria in seven to nine years, but malaria began to re-emerge in 1965. After 1965, malaria rates in India rose gradually and consistently with a peak of 6.47 million cases in 1976 (NMEP, 1996). This resurgence of malaria caused India to begin an attempt to control rather than eradicate malaria in 1977 with the Modified Plan of Operation (MPO) which also comprised the P. falciparum Containment Programme (PfPC). The PfPC aimed to contain the spread of falciparum malaria, which is the most commonly resistant and most deadly strain of malaria. During MPO, chloroquine distribution was extended through Fever Treatment Deport and Drug Distribution Centers in addition to the other ways that malaria drugs had already been distributed. MPO also only used residual insecticides in areas with an API (Annual Parasite Index) above two. This method still relied mainly on spraying pesticides and distributing anti-malarial drugs, although there was also an attempt to get

more local officials involved in anti-malarial activities and an increase in research.. By 1985, it seemed as though the NMEP would succeed in controlling malaria because there were only 2 million cases of malaria and the incidence rate had stabilized. India has, however, experienced more epidemics and deaths from malaria in the 1990’s along with the creation of new malaria paradigms .In 1994, there were large-scale epidemics of malaria throughout India, and since then malaria mortality has increased.   Although the total number of cases of malaria has remained relatively constant for the last five years, outbreaks have increased the number of malaria deaths. P. falciparum cases have also consistently increased from 9.73% of malaria cases in 1977 to 34.5% of cases in 1995 with a peak of 43.3% in 1991 (NMEP, 1996). In 1995, India implemented a Malaria Action Plan.

Resistance to pesticides was first noted in India in 1959. However, it was only as resistance increased in areal extent and amount, that it started to affect the success of the eradication program. In the 1960s, because the eradication program was doing so well, malaria research stopped. Also, as resistance to DDT increased, so did the use of alternative insecticides, which later caused the emergence of vectors resistant to those insecticides. As of 1996, individuals of An. culicifacies, one of the six most important vectors of malaria in India, had been found resistant to DDT in 18 states and 286 districts, to HCH (hexachlorobenzene) in 16 states and 233 districts, and to malathion in 8 states and 71 districts. An. stephensi, another important malaria vector in India, was found resistant to DDT in 7 states and 34 districts, to HCH in 6 states and 27 districts and to malathion in 3 states and 8 districts. The use of some of the same pesticides in agriculture could have increased the speed with which malaria-transmitting mosquitoes became resistant.

Not only does resistance limit the effectiveness of pesticides in malaria control, but pesticide prices are increasing and India only makes 30% of its DDT domestically. Therefore, pesticides are not an economically unsustainable malaria control technique for India (Sharma, 1996a). Pesticides are also toxic to humans and the environment. Currently, 70% of all insecticides in India are DDT and BHC (benzene hexachloride), and their use is increasing at a rate of 6% a year in India. Both of these pesticides are persistent, and accumulate in soil, water, and biological organisms, and thus were banned in the US. Due to the increasing use of DDT and BHC in India, food contamination is expected to increase (Pimentel, 1997).

However, the NMEP reports that there has been “no adverse reaction of DDT on human health” (NMEP, 1996).However, the NMEP reports that there has been “no adverse reaction of DDT on human health” (NMEP, 1996).

Trend of Malaria Cases and Deaths in India

CHAPTER 6

SPATIAL DISTRIBUTION & TREND OF MALARIA IN JALPAIGURI, WEST BENGAL

In the context of spatial distribution of malaria in JALPAIGURI, WEST BENGAL, it is desirable to deal it under different heads so that the problem is situated in its entirely. As such it seems logical to cover the following aspects of the incidence of malaria in the state WESTBENGAL.

A.INCIDENCE OF MALARIA IN DIFFERENT YEARS IN DIFFERENT BLOCKS.B.DISTRIBUTIONAL PATTERN.C.MORTALITY.

A.INCIDENCE OF MALARIA IN DIFFERENT YEARS IN DIFFERENT BLOCKS.

(A.I)Total malaria cases in different blocks of Jalpaiguri from 2004,2005 & 2006

In 2004, total malaria positive cases were 88404, in the 13 blocks under Jalpaiguri district. Whereas in 2005, total malaria positive cases were 56,714 in the 13 blocks, but in the year of 2006, from January to July total malaria positive cases were 25,734, according to the figures obtained from malaria epidemiological situation data. The whole span of 3 years can be divided into a number of periods, so as to analyze the increase or decrease of the positive incidence of malaria in detail.

13

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Region of very high incidence.shp2731

Region of high incidence.shp11131517

Region of moderately high incidence.shp6910

Region of moderate incidence.shp34

Region of low incidence.shp1

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REGIONWISE A.P.I MAP OF JALPAIGURI DISTRICT

SADAR

RAJGANJ

MAYNAGURI

DHUPGURI

MAL

METALINAGRAKATA

FALAKATA

MADARIHATKALCHINI

ALIPURDUAR IALIPURDUAR II

KUMARGRAM

Kumargram.shp177894

Alipurduar ii.shp169606

Alipurduar i.shp197160

Kalchini.shp262322

Madarihat.shp185499

Falakata.shp254027

Nagrakata.shp119556

Metali.shp105661

Mal.shp264711

Dhupguri.shp379430

Maynaguri.shp281554

Rajganj.shp287615

Sadar.shp280446

Scale(0-5).shp

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POPULATION MAP OF JALPAIGURI DISTRICT

SADAR

RAJGANJ

MAYNAGURI

DHUPGURI

MAL

METALINAGRAKATA

FALAKATA

MADARIHATKALCHINI

ALIPURDUAR IALIPURDUAR II

KUMARGRAM

Kumargram.shp177894

Alipurduar ii.shp169606

Alipurduar i.shp197160

Kalchini.shp262322

Madarihat.shp185499

Falakata.shp254027

Nagrakata.shp119556

Metali.shp105661

Mal.shp264711

Dhupguri.shp379430

Maynaguri.shp281554

Rajganj.shp287615

Sadar.shp280446

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POPULATION MAP OF JALPAIGURI DISTRICT

MALKALCHINI

SADAR

RAJGANJ

DHUPGURI

MAYNAGURI

NAGRAKATA

MADARIHAT

KUMARGRAM

FALAKATA

METELI

ALIPURDUAR IALIPURDUAR II

JAL.shpA.P.I IN 2004A.P.I IN 2005A.P.I IN 2006(JAN-JUL)

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YEARWISE ANNUAL PARASITIC INCIDENCE MAP OF JALPAIGURI DISTRICT

MALKALCHINI

SADAR

RAJGANJ

DHUPGURI

MAYNAGURI

NAGRAKATA

MADARIHAT

KUMARGRAM

FALAKATA

METELI

ALIPURDUAR IALIPURDUAR II

JAL.shpPlasmodium vivaxPlasmodium falciparum

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SPECIES WISE MALARIA POSITIVE RATE IN JALPAIGURI DISTRICT

MALKALCHINI

SADAR

RAJGANJ

DHUPGURI

MAYNAGURI

NAGRAKATA

MADARIHAT

KUMARGRAM

FALAKATA

METELI

ALIPURDUAR IALIPURDUAR II JALPAIGURI.shp

positive in 2004positive in 2005positive in 2006

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MALARIA POSITIVE RATE IN THREE YEARS IN JALPAIGURI DISTRICT

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Aquifer beyond150m depth.shpAquifer with highly assorted meterials.shpCanal.shpContours .shpDistrict boundary.shpIndex.shpInternational boundary.shpRiver.shp

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IRRIGATION & HYDROLOGY MAP OF JALPAIGURI DISTRICT

2004 2005 JAN-JUL 2006NAME OF BLOCKS

TOTAL POSITIVE CASES

TOTAL POSITIVE CASES

TOTAL POSITIVE CASES

SADAR 1202 1112 962RAJGANJ 9496 3554 3188MAYNAGURI 1130 408 157DHUPGURI 9712 5206 1866MAL 9752 8037 2293METALI 8751 4910 2274NAGRAKATA 15009 9365 2667FALAKATA 2846 1152 668MADARIHAT 6477 4233 1066KALCHINI 10861 9337 3914ALIPURDUAR I 1687 2227 1620ALIPIRDUAR II 7190 4303 2968KUMARGRAM 4291 2870 2091TOTAL 88404 56714 25734

(A.I.i)Malaria incidence in 2004: The total malaria positive cases were shown in JAN-DEC 2004, were 88404 in 13 blocks under Jalpaiguri district. Whereas only in the month of December 2004, the no. Of malaria positive cases were 5990. In between 13 blocks, maximum positive cases had been found in Nagrakata, 15009, & minimum numbers of positive cases were shown in Maynaguri, 1130. In Alipurduar I the malaria positive cases were 1687 & in Alipurduar II, it was 7190. So after assembling of I & II of that block, total malaria positive cases were 8877, in 2004.

(A.I.ii). Malaria incidence in 2005: The total malaria positive cases were 56714 in the year 2005 in 13 blocks of Jalpaiguri district, whereas in the month of December 2005, the malaria cases were 29529. So it is clear that 50% above cases has been detected in the month December 2005. In between these 13

blocks, maximum malaria positive cases were in Nagrakata, total 9365 were malaria positive cases, whereas minimum no of malaria positive cases were in Maynaguri, only 408. In Alipurduar I malaria positive cases were 2227 & in Alipurduar II, it were 4303. So after joining the both blocks, in Alipurduar total 6530 cases were shown. In tea garden area of Jalpaiguri total malaria positive cases were 16655 in 2005. There are 27 tea gardens under Mal block & malaria positive cases were 4655, whereas in Alipurduar total no of tea gardens are 6, 3 in each block, & total no of cases were 190.

(A.I.iii). Malaria incidence in Jan-Jul 2006. The total malaria positive cases were 25734 in 13 blocks except the tea gardens, municipal & corporation from January-July 2006 in Jalpaiguri.In the month of July 2006; malaria positive cases were 8807, which is almost 1/3rd of the total malaria affections. In this year, till the month of July, maximum malaria positive cases were found in Alipurduar, that is 4597. In between these, 1629 cases were found in Alipurduar I & 2968 cases were found in Alipurduar II. Fewer amounts of malaria positive cases have been shown in Maynaguri, which are 157. In the month of July 2006, the malaria positive cases in Alipurduar were 1620. In between these, 1053 cases were in Alipurduar I, & 567 cases were in Alipurduar II. Whereas in May, 2006, Alipurduar I had 497cases & Alipurduar II had 499 malaria cases. So total cases were 996. Within three months 624 persons have been affected in malaria in Alipurduar. In tea garden area, total malaria positive cases were 3758 in Jalpaiguri from January to July. Total 16 gardens are present in Nagrakata block & maximum no.s of malaria positive cases were shown there also, i.e. 1074. Minimum no.s of malaria positive cases were shown in single tea garden of Maynaguri, which are only 3 in number. In Alipurduar, total positive cases are 260, 204 in Alipurduar I, & 56 in Alipurduar II.

(A.II) Comparative study of total malaria cases in successive 3 years, that is 2004, 2005 & Jan-Jul 2006 on the basis of slide positivity rate (SPR) In 2004, slide positive rate of 13 blocks of Jalpaiguri except tea gardens were 17.4 of which maximum slide positive rate were shown in Nagrakata block, that was 28.1. In Alipurduar I & Alipurduar II, slide positive rates were 6.6 & 14.3. Almost less amount of slide positive were shown in Maynaguri. In 2005, slide positive rate of 13 blocks under Jalpaiguri district except tea gardens slightly decreased & that was10.7. In this year also, Nagrakata had 21.6 -slide positive rate, which was highest of all blocks. Minimum numbers of slide positive rate were shown in Maynaguri, that was 1.6. In Alipurduar I & Alipurduar II, the slide positive rate was 6.8 & 9.5. In 2006, from January to July, slide positive rate of 13 blocks under Jalpaiguri district except tea gardens are 8.3%. Of which most slide positive rate has been shown in Alipurduar, i.e. 16.5%. Alipurduar I has 5.4&% & Alipurduar II has 11.1% slide positive rate. But the slide positive rate of Nagrakata is decreasing & that is 10.1%. Lowest slide positive rate is in Maynaguri, which is 0.8%.

(A.III)Species wise Malaria Incidence in Jalpaiguri

The species wise malaria cases are registered from 2004, in the state. Plasmodium vivax cases were the predominant in the state in the year 2004. The parasite is responsible for the benign tertian fever in which the temperature of the patient may shoot up to 106 to 107 & comes down in the same way. The fever continues for the long time & makes the patient very weak. The fever appears every third day in vivax infections. The other parasite of importance is the Plasmodium falciparum, which causes malignant tertian fever. This type of fever is associated with dysentery & other complications, such as the blockage of capillaries & blood supply to different organs, so falciperum infections are often fatal. The deaths due to malaria in the district are mainly due to increase in the Plasmodium falciparum infections, Plasmodium vivax & Plasmodium falciparum infections can occur together, forming the mixed infections in which the fever develops daily. The mixed infection is comparatively rare in number.

In 2004, total Plasmodium falciparum infection were 31575, out of 88404 malaria positive cases. Rests of the cases were Plasmodium vivax. In that year, the numbers of Plasmodium falciparum were 35.71% of the total incidence & 64.29% was Plasmodium vivax cases. In the tea garden area, out of 31777 malaria positive incidences, 12440 cases were due to Plasmodium falciparum & 19337 were due to Plasmodium vivax. So it can be easily analyzed that Plasmodium vivax war the most predominant species in the year 2004, including 13 blocks & tea gardens.

In 2005, total malaria positive cases were 56714 in the 13 blocks under Jalpaiguri district. Out of 56714, Plasmodium vivax was the huge amount of infections; total 41918 cases were due to P.vivax & 14796 cases were due to P. falciparum. Out of these 13 blocks, most p.vivax-affected cases were in Kalchini, 8175 & minimum numbers of P.vivax cases were in Maynaguri, 293.Alipurduar had 3845 P.vivax affected cases. On the other hand P.falciparum had 14796 cases in 13 blocks of Jalpaiguri district except tea gardens. Ofwhich 2685 cases were in Alipurduar after assembling Alipurduar I & Alipurduar II. Minimum numbers of cases were in Maynaguri, which are 115. In tea garden area out of 16655 malaria positive cases, 12355 cases were due to Plasmodium.vivax & 4300 cases were due to Plasmodium.falciparum. In between these P.vivax cases, maximum numbers of cases were in 27 tea gardens of Mal, 3770 & minimum numbers of cases were shown in Maynaguri, the numbers of P.vivax were only 5. In Alipurduar I, P.vivax cases were 39 & in Alipurduar II, P.vivax cases were 53. On the other hand, in Mal, 885 cases were due to P.falciparum & in Maynaguri only 10 cases were shown. In Alipurduar I, P.falciparum cases were 80 & in Alipurduar II P.falciparum cases were 18. So it can be assumed that P.vivax was also dominant vector in the tea garden area, P.vivax cases were 74.18% & P.falciparum cases were 25.82% of total malaria incidence. In 2005,in 13 block areas, 73.91% cases were due to P.vivax & 23.09% cases ere due to P.falciparum. So it is clear that P.vivax cases had been increased in 2005, in respect to the 2004 malaria cases in that area & on the other hand P.falciparum cases had been decreased in 2005, in respect to 2004.

In January to July 2006, P.vivax cases were 16936 in the 13 blocks under Jalpaiguri district & P.falciparum cases were 8798. Out of these 13 blocks,

mostly P.vivax affected block is Kalchini, 3176 & minimum numbers of Of Plasmodium.vivax affection shows in Maynaguri, 127. In Alipurduar I, Plasmodium.vivax affection rate is 856 & Alipurduar II, which is 1206.So it can be, interpreted that; the numbers of Plasmodium.vivax affection in Alipurduar has been decreased though it is half yearly data. On the other hand, Plasmodium.falciparum already affects total 8798 persons in 13 blocks under Jalpaiguri district. In Alipurduar II total no of Plasmodium.falciparum affected patients are 1762, which is maximum according to the malaria epidemiological data from January to July. In Alipurduar I, total 764 persons are affected due to P.falciparum. Less amount of P.falciparum cases are shown in Maynaguri, only 30 people are affected. So it can be analyzed that Plasmodium.falciparum cases has been increased in Alipurduar in respect to the 2004 & 2005 according to the epidemiological malaria report. In 2006, from January to July, 65.81% cases are due Plasmodium.vivax & 34.19% cases are due to Plasmodium.falciparum. So it can be interpreted that malaria affection rate due to Plasmodium.falciparum is increasing in Jalpaiguri, though it is half yearly data.

In tea garden area, total 2530 persons are affected due to P.vivax. In between these 150 tea gardens under 13 blocks, maximum number of P.vivax affection records in Nagrakata, which are 837, including 16 tea gardens of that block. P.vivax affects only 1 person in Maynaguri by P.vivax. Where as in Alipurduar, 147 cases are found in 6 tea gardens. On the other hand P.falciparum from January to July 2006 affects 1228 persons in Jalpaiguri tea gardens. In respect of 2005 tea garden epidemiological report, in 2006, from January to July P.falciparum cases are increasing. So, it can be interpreted that Maynaguri is not a malaria prone zone. Nagrakata was a malaria prone zone in 2004,2005. But in this year 2006, the reemergence of malaria affection has been shown in Alipurduar. In this block, P.falciparum, especially in Alipurduar II, causes maximum number of malaria affections.

B) DISTRIBUTIONAL PATTERN

Malaria is a major public health problem in Jalpaiguri, West Bengal, looking to the significance of the problem it is necessary to measure it in the whole population for a longer period. Annual parasitic incidence (malaria positive cases per thousand population) have been calculated & plotted for the years 2004 to 2006, though in 2006, half yearly parasitic incidence should be plotted, so as to find out the distributional pattern of malaria in the state. It is evident from the data that no area is malaria free in Jalpaiguri. The name Duars means gateways to the mountain. In general shape the district is an irregular rectangle lying lengthwise west & east. The west of the testa presents a slightly undulating expanse of level paddy fields & scrub jungles. These areas enough to produce favorable low temperatures for occurrence of the vectors & the parasites. In the rugged terrain & thick-forested parts of the district, malaria is endemic. These are also huge amount of tea gardens in this district, which are another breeding place of malarial vectors.

The district receives heavy rainfall. The temperature & humidity conditions are ideal for mosquito breeding.There are vast areas for mosquito growth forests & tea gardens. These keep stagnant for a long time. So they act as ideal mosquito breeding places. Poor socio-economic condition of the people. The tribal constitute a large proportion of the total population. Because of poor economic condition, they are not able to take proper anti malaria precautions. The migratory population in Jalpaiguri district is also a factor in increasing the cases because for all the cases blood smears cannot be taken due to the inadequate health infrastructure. Poor drainage systems in municipal areas contribute in the breeding of mosquitoes. All these factors along with the inadequate health infrastructure present the malaria control.

Jalpaiguri may be divided into a number of regions in the context of the incidence of malaria in the year 2004, 2005 & jan-jul 2006. These regions are as follows: -

REGION API PER THOUSAND POPULATION

Region of very high incidence Above 20Region of high incidence 10-20Region of moderately high incidence 5-10Region of moderate incidence 2-5Region of low incidence Below –2

(B.I) REGION OF VERY HIGH INCIDENCE: - According to the 2004 API report, very high incidence were shown in rajganj, Dhupguri, Mal, Metalli, Nagrakata, Madarihat, Kalchini, Alipurduar ii, & Kumargram block of Jalpaiguri district. In that year it was a zone of severe Plasmodium vivax malaria & malaria occurred there in a hyper endemic form. In between those blocks, the API of 180.6 per thousand of Nagrakata was the highest incidence in the whole district, followed by 107.1 per thousand of Metali In the year 2005, very high API incidence blocks were Mal, Metali, Nagrakata, Madarihat, Kalchini, Alipurduar II & Kumargram in the whole district. The API of 111.9 per thousand of Nagrakata was the highest incidence in the whole district, followed by 62.6 per thousand of Metalli. In that year it was also a zone of severe Plasmodium vivax malaria. In the year 2006, from the month of Jan – Jul , very high API incidence blocks are, Metalli & Nagrakata in the whole Jalpaiguri district. The API of 31.3 per thousand of Nagrakata is still highest incidence in the whole district, followed by Metalli 26.6 per thousand of population.

(B.II) REGION OF HIGH INCIDNCE: -

The region with Annual Parasitic Incidence between 10-20 per thousand is termed as region of high incidence. According to the 2004, API report, High incidence block was Falakata, which had 14.3 per thousand of population. In the year 2005, high annual parasitic incidence blocks were Rajganj, Dhupguri, & Alipurduar I. In between these blocks maximum high incidence region was Dhupguri where API was 18.4, followed by Rajganj 12.8 per thousand of population. In the year 2006, from Jan-Jul regions of high incidence are Rajganj, Kalchini, Alipurduar II & Kumargram. In between these blocks, the API of 17.2 per thousands of Kalchini is the highest incidence in the whole district, followed by 15.4 per thousand of Alipurduar II.

(B.III) REGION OF MODERATELY HIGH INCIDENCE: -

This region consists of Annual Parasitic Incidence between 5-10 per thousand. According to the 2004, API report, moderately high incidence region was Alipurduar I, which had 8.8 annual parasitic incidences per thousand populations.In the year 2005, moderately high annual parasitic incidences were shown in Sadar, Falakata. In between these two blocks, the highest annual parasitic incidence was in Falakata, 6.3 followed by Sadar 5.0.In the year 2006, from Jan- Jul, the moderately high incidence regions are Dhupguri, Mal, and Madarihat & Alipurduar I block. The respective parasitic incidence of 6, 9.9, 5.9 & 9.3 are found in Dhupguri, Mal, Madarihat & Alipurduar I respectively.

(B.IV) REGION OF MODERATE INCIDENCE: -

The annual parasitic incidence of this region is 2 to 5 per thousand. There were 2 blocks under this region according to the 2004 data. The blocks under this region were Sadar, Maynaguri. Annual parasitic incidence of Sadar was 4.8 & Maynaguri was 4.8 per thousand populations. In the year 2005, Sadar, the only block, which was in this region. The API was 5.0 per thousand populations. During this year 2006, from Jan-Jul, only two blocks are under moderate incidence region, which are Sadar (4.2) & Falakata (3.5).

(B.V) REGION OF LOW INCIDENCE: -

This region is characterized by the occurrence of the lowest annual parasitic incidence in the state Jalpaiguri during 2004, 2005 & Jan-Jul 2006. Blocks having API below are grouped together in it. In 2004, there was no block under this region. But in 2005, only Maynaguri (1.5) was in low incidence region. In this year 2006, Maynaguri is also in this region, which has .6 per thousand population

IDENTIFICATION OF HIGH RISK AREAS

ID NO BLOCK NAME BS EXAM POSITIVE DECECTED PF DETECTED SPR%

1 SADARBLOCKS 11805 962 449 8.1TEA GARDENS 738 211 109 28.6

2 RAJGANJBLOCKS 24948 3188 1450 12.8TEA GARDENS 974 91 47 9.3

3 MAYNAGURIBLOCKS 20713 157 30 0.8TEA GARDENS 25 3 2 0

4 DHUPGURIBLOCKS 21145 1866 160 8.8TEA GARDENS 3389 399 85 11.8

5 MALBLOCKS 27216 2293 667 8.4TEA GARDENS 8663 354 133 4.1

6 METALIBLOCKS 15172 2274 724 15TEA GARDENS 4816 539 205 11.2

7 NAGRAKATABLOCKS 26480 2667 228 10.1TEA GARDENS 7640 1074 237 14.1

8 FALAKATABLOCKS 15717 668 240 4.3TEA GARDENS 1055 232 130 22

9 MADARIHATBLOCKS 33601 1066 244 3.2TEA GARDENS 613 24 11 3.9

10 KALCHINIBLOCKS 32941 3914 738 11.9TEA GARDENS 4057 438 90 10.8

11 APD IBLOCKS 29916 1620 764 5.4

TEA GARDENS 788 204 77 25.912 APD II

BLOCKS 26672 2968 1762 11.1TEA GARDENS 478 56 36 11.7

13 KUMARGRAMBLOCKS 24251 2091 1342 8.6TEA GARDENS 1920 133 66 6.9

DISTRICT.shpJALPAIGURI

Endemic mouja of JALPAIGURI.shpBAIRAGURIBARADALDALIBHATIBARIBIRPARACHAPRARPARDAKHIN HALDIBARIDAKHIN MAKHALGURDHAOLJHORABASTIFOSKARDANGAGHAGRAMADDHYA HALDIBARMARKHATAPANIALGURIPASCHIM CHANGMARPASCHIMKHALISAMAPATKAPARAPUTIBARISALSABARITURTURIUTTARMAJHERDABRI

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ENDEMIC MOUJAS OF JALPAIGURI

R.F 1:1000000R.F 1:1000000

(C ) MORTALITY:-

Malaria is characteristically a disease of the tropics & subtropics of the world, but is also prevalent in many temperate countries such as India, England, etc. It has been a serious scourge to human civilization since ancient times, & even today, it poses the biggest health problem confronting the human race.

Nearly this disease affects a quarter of the world population & the death rate is colossal, probably greater than any other single disease. Even the mild attacks of malaria can cause serious loss of working ability or man power by undermining both the mental & physical development of the sufferers, who are also predisposed to other diseases,

Mortality rate of malaria in Jalpaiguri is also very high. Jalpaiguri is also malaria prone zone.

In the year of 2004, total malaria positive cases were 88404, but deaths due to malaria were 88. In between 88 deaths, most of the deaths were reported from Metalli, no were 30. There were 21 deaths in Nagrakata. In Sadar, Kalchini & Kumargram blocks had no death.

In 2004, 43 deaths were reported from 153 tea gardens of Jalpaiguri. Of which, 16 deaths were reported from Metalli in the year 2004.

But in the year 2005, the disease caused fewer amounts of deaths & in that year the death rate was 36. In that year the main vector was Plasmodium falciperum. Maximum 9 deaths were shown in Metalli & Nagrakata.Sadar, Kumargram & Kalchini had no death.

In the year 2006, from Jan-Jul, suddenly death rate has been increased. Alipurduar is the main malaria prone block in this year. In between Jan-Jul, total 56 persons has been died, of which 14 from Alipurduar I & 17 from Alipurduar II.Sadar, Maynaguri, Dhupguri, Metalli, Nagrakata & Falakata

has no death in this year according to the block wise epidemiological malaria report from January- July 2006.

(C.I) AGE WISE & SEX WISE DEATH REPORT OF MALARIA IN JALPAIGURI

AGE GROUP JANUARY -

JULY 2006

MALE FEMALE TOTAL0-10 14 9 2311-20 2 8 1021-30 3 8 1131-40 0 1 141-50 3 4 751-60 NIL NIL NILABOVE 60 NIL NIL NILTOTAL 22 30 52

STATIATICAL ANALYSIS:

In statistics, a mediation model is one that seeks to identify and explicate the mechanism that underlies an observed relationship between an independent variable and a dependent variable via the inclusion of a third explanatory variable, known as a mediator variable. Rather than hypothesizing a direct causal relationship between the independent variable and the dependent variable, a mediational model hypothesizes that the independent variable causes the mediator variable, which in turn causes the dependent variable. The mediator variable, then, serves to clarify the nature of the relationship between the independent and dependent variables

Correlation is used to denote the degree of association between variables. If two variables x & y are so related that variations in the magnitude of one variable tend to be accompanied by variations in the magnitude of the other variables, they are said to be correlated. If y tends to increase as x increases, the variables are said to be positively correlated. If y tends to decrease as x increases, if the values of y are not affected by changes in the values of x, the variables are said to be uncorrelated. In this study, many situations arise when we may have to study two variables simultaneously, say x & y. For an example, the variables may be: No of malaria cases in different blocks & percentage of ST population. No of cases & growth rate of population in different blocks. No of malaria cases & total area acquired by different blocks.

The correlation is one of the most common & most useful statistics. A correlation is a single number that describes the degree of relationship between two variables.

CORRELATION EXAMPLE:

Let’s assume that, we want to look the relationship between two variables, no. of malaria cases from JAN-JULY,2006 of 13 blocks in Jalpaiguri district & percentage of ST population of these blocks. Here is the data of 13 blocks. BLOCK NAME MALARIA POSITIVE

CASES% OF ST POPULATION

SADAR 962 6.2RAJGANJ 3188 7MAYNAGURI 157 1.9DHUPGURI 1866 23.9MAL 2293 39.4MITIALI 2274 50NAGRAKATA 2667 50.9FALAKATA 668 19.4

MADARIHAT 1066 36.4KALCHINI 3914 46.3ALIPURDUAR I 1620 23.7ALIPURDUAR II 2968 19.3KUMARFRAM 2091 34

COMPUTE THE CORRELATIONAL VALUE:

Nxy- (x)(y) R= √ {N∑x²- (∑x) ²}{N∑y²- (∑y) ²}

N= Number of pairs of scores ∑xy= Sum of products of paired scores ∑x= Sum of x scores ∑y= Sum of y scores∑x²= Sum of squared x scores ∑y²= Sum of squared y scores

A correlation coefficient is a no. between –1 & 1 which measures the degree to which 2 variables are linearly related. If there is perfect linear ralionship with positive slope between the two variables, we have a correlation cofficient of 1, if there is positive correlation, whenever one variable has a high(low) value, so does the other.If there is a perfect linear relationship with negative slope of the two variables, we have a correlation coefficient of –1 & if there is negative correlation, whenever one variable has a high(low) value,the other has a low (high) value.A correlation coefficient, of 0 means that there is no linear ralationship between two variables.There are no. of different correlation coffiecient that might be apprepriate depending on the kinds of variables being studied.

Null hypothesis r=0 Alternative hypothesis= r<>0 Now if we plug those values into the formula, we get the correlation for our 13 blocks in JALPAIGURI district is .48, which is a fairly strong positive relationship. Because we know the following formula:

-1.0 to –0.7 strong negative association. -0.7 to –0.3 weak negative associations. -0.3 to +0.3 little or no association. +o.3 to 0.7 weak positive association. +0.7 to +1.0 strong positive association.

So, on the other hand in other two cases, the relation between the malaria cases & growth rate ,totals area also show a fair strong positive relationship, consequently that show,.54 & .23.

TESTING THE SIGNIFICANCE OF A CORRELATION: Once a correlation has been computed the probability should be determined. That is, significance test can be conducted. Most often it is interested to determine the probability that the correlation is a real one and not a chance occurrence. Here in all hypothesis testing, it should be first determine the significance level.Here, the common significance level alpha=.o5 has been used. That means I am conducting a test where the odds that the correlation is a xchance occurrence is no more than 5 out of 100. Before I look up the critical value in a table, I also have to compute the degree of freedom or df. The df is simply equal to N-2 or, here 13-2=11. Finally, I have to decide whether I am doing one tailed or two tailed test. Here , I have no strong prior theory whether this relationship would be positive or negative. Iwill opt the two tailed test. With these three pieces of information the significance level, degree of freedom & type of test, I look through the significance of the Correlation I found. According to the statistical book, including this value, the value is .3749; I can conclude that the odds are less than 5 out of 100 that this is a chance occurrence. Since my correlation of .48 is actually quite a big higher, I conclude that it is not a chance finding & that the correlation is “statistically significant”. I can reject null hypothesis & accept the alternative. Here regression diagram’s has been shown, where no of malaria case is the independent variable, & growth rate, % of ST population, population density, no of PHC, total area & % of literacy are the dependent variables.

CHAPTER 7

NATIONAL MALARIA CONTROL PROGRAMME: -

(7.A) Malaria Control History in India1946: India started using DDT1953: NMCP is started1958: NMCP becomes the NMEP1959: The first time vector resistance is first detected in India (in Gujarat)1965: Malaria begins to re-emerge1976: Peak of malaria cases in reemergence period1977: India starts MPO and PfPC

1985: Only 2 million annual cases of malaria in India1991: Peak of P. falciparum cases1994: Large scale epidemics, primarily in eastern India and Western Rajasthan1995: NMEP has started. 1996-2001: NMEP was running successfully. 2001: NMEP was changed the name & converted into NVBDCP.

Along with other development programmes, The National Government assigned high priority to health schemes after attainment of independence. This programmes had the following salient features:

(7.A.i) Objective: - It is clearly defined its objectives. The objective of the programme was to reduce the incidence of malaria from massive proportion to such low levels that the disease would cease to be public health problem.

(7.A.ii)Strategy: - The strategy employed was indoor residual with DDT (a dose of 100 mg.per.sqfoot surface area) twice a year. The areas where spleen rates were below 10 per cent were left & only highly malaria’s areas brought under this scheme.

(7.A.iii) Organization: - Under this programmes anti malaria units were established. Each unit was designed to cover approximately 1 million populations. The Malaria Institute Of India, Delhi was entrusted with theresponsibility of co-ordination between the central & state governments. The health departments of various state governments were directed to implement the programme earnestly.

(7.A.iv)Operation: - The NMCP operated for five years (1953-58) & covered the last three Years of the First Five Year Plan & the first two years of the Second Five Year Plan. (7.A.v) Finance: - The total cost incurred on this programme was 24 crores for the whole country. The USAID (United States Agency for International Development) shared the major part of the expenditure by providing DDT,

necessary equipments & also mat half the cost of a DDT factory, established at Delhi. The Central & State Government shared the remaining expenditure.

Under the Malaria Control Programme large scale application of insecticides for a number of years, however, brought out important factors to the fore, namely a) possibility of disappearance of parasites from the population in protected areas, b) possibility of development of resistance in malaria carrying mosquitoes to the insecticides in use. While, the former showed the possibility of eradication of disease, the latter called for the urgency to switch over from control to eradication measures at the earliest. The two programmes though have the same aim to fighting malaria differ in their approaches to the disease. A control programme has been defined as “ an organized effort to institute & extend anti-malaria measures that are suitable under the prevailing epidemiological conditions & that use the available resources in order to achieve the greatest possible reduction of mortality & morbidity”. Malaria eradication is defined as “ the elimination of malaria parasites from the human population, so that there is no resumption of transmission even the presence of vectors.”

(7.B) MALARIA ERADICATION: - In 1955 the eighth World Health Assembly stated that worldwide malaria eradication, except in south of the Sahara, was technically feasible. However, a sense of urgency in achieving this aim was recognized because insecticide resistance in Anopheles had been reported in 1950. In 1968 the 22nd World Health Assembly realized it had been overoptimistic & declared that global malaria eradication was not at present possible, although it remained the ultimate goal, & that for the time being malaria control should be the aim. This basically remains the situation today. The Global Malaria Control Strategy was initiated in 1992 at the ministerial Conference on Malaria in Amsterdam & in 1995 the UN General Assembly endorsed a special initiative for Malaria control in Africa. The latest development was the announcement in 1998 by the WHO of a global “roll back malaria” programme, which will concentrate, at least initially, on Africa, & integrate with the African Initiative on Malaria

(7.B.i) NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME PROGRAMME: - Encouraged by the results of Malaria Control Programme the Government of India switched over to the National Malaria Eradication Programme In 1958. A malaria eradication programme consisted of four phases- (7.B.i.a) Preparatory Phase

Preparatory Phase: - This phase is of about two years duration & is concerned with the collection pf basic information’s. The assessment of money, man & matters necessary for the entire administrative plans are made & details of each activity is noted in the manuals. Such activities are geographical descriptions of the area, blood collections & examinations & spraying of insecticides.

(7.B.i.b) Attack PhaseDuring this phase the entire unit s were covered with DDT spray. The standard dose of DDT applied is 100 mg per sq. foot surface area; twice in a year during the malaria transmission period in endemic areas; while in hypo endemic areas the insecticidal spraying operations are practiced only once in a year. The sprayable surface included human dwellings as well as cattlesheds. In case the vectors are resistant to DDT then BHC is used, & if the vectors are resistant to both of these insecticides, then Malathion is used.

The conventional period is about four years for this phase but it may vary with the epidemiological conditions. The goal of attack phase is to reduce the number of anopheline mosquitoes in contact with man. This is done to that point where the disease is no longer transmitted. All this activities start when the Annual Parasite Incidence (API) reaches below 0.5 per thousand. The attack phase is terminated when the annual parasite incidence drops down to 0.1 per thousand populations per year.

(7.B.i.c) Consolidation PhaseDuring this phase the attack measures are stopped by withdrawing the spray operations, but surveillance activities are vigorously performed. The main activities of consolidation phase are: - (7.B.i.c.1) Surveillance of both types

(a) Active Surveillance Under Active surveillance door-to-door enquiries are done every 15 days. So that none of the malaria cases remain undetected.

Passive Surveillance is done by static agencies as primary health centers; hospitals, medical practitioners & dispensaries that detect fever cases & give the anti-malarial treatment.

Treatment of both presumptive & radical

The Presumptive treatment reduces the hazards of mosquito infection & renewed transmission. The standard radical treatment of 5 days is administered with chloroquine, primaquin or quinine. Infants are not treated with primaquin.

Epidemiological investigation of foci The epidemiological investigations are necessary for finding out source of infections & to institute appropriate remedial action to prevent further infections when focal outbreaks that is occurrence of more than one indigenous case during one surveillance cycle in an area is seen.

Institution of remedial measures to eliminate foci of malaria (7.B.i.d) Maintenance Phase The maintenance phase begins when malaria eradication has been achieved. WHO (1971) indicates that the objective of maintenance phase is to prevent the re-establishment of malaria endemicity in a country or area from which malaria has been eradicated. There is no fixed limit of the maintenance phase; it will last as long as the malaria present in that region. If any positive

case is achieved then focal insecticidal spray is carried out by the General Health Service Department who takes over the responsibility now & provides basic health services too.

CHAPTER 8 MALARIA CONTROL ACTION PLAN IN JALPAIGURI DISTRICT

(8.A) ROLE & RESPONSIBILITIES AT DIFFERENT LEVELS IN JALPAIGURI (As Per The Guideline Given In The National Vector Borne Disease Control Programme)

(8.A.i) The duties & work schedule of MULTIPORPOSE WORKER (MPW-MALE) for EARLY CASE DETECTION & PROMPT TREATMENT (EDPT) should be as follow: -

(a) He should have a village wise population register of his subcentre for which MF- of MPO-NMEP should be adopted & up dated every January. (b) He will have a fortnightly domiciliary house-to-house visit schedule developed by Medical Officer in charge of PHC in consultation with the District Malaria Officer. © He will collect blood smears from fever cases or cases with history of fever during domiciliary visits to households & keep the records in MP-2. (D) He will advise seriously ill cases to visit PHC for immediately intensive treatment. (E) He will contact all FTDs/ DDCs/Voluntary link workers of his area during his visit to the village & collect blood smears & MF-2 for transmission to laboratory. (F) He will take all precautions to use properly sterilized needles & clean slides while collecting blood smears.

(8.A.ii) The duties & work schedule of FTD/DDC holder: - In high-risk areas, selecting for implementing short term Malaria Action Programme, the case detection will be strengthened in the following manner:

(a)He will be completely voluntary in nature & a resident of the village. (b)He should be literate even if not formally educated. ©Medical Officer In Charge of PHC/District Malaria Officer should select him preferably in consultation with the community leaders. (d) A signboard should be affixed at the residence of the FTD holder. (e)He will be given training for one or two days at the PHC Headquarters in the collection of blood smears & administration of presumptive treatment. (f) Each FTD will have a stock of 200 tablets of Chloroquine.

(g)He will advice seriously sick cases to PHC for proper treatment. (h) He will be supervised by the MPW (Male). (8.A.iii) The duties & work schedules of voluntary link workers (VLW):

As recommended by the Expert Committee, it has been decided that in “High risk” areas there should be a voluntary worker in the area who can co-

ordinate activities of FTDs & ensure supplies of drugs & slides to them in time.

(a)Link worker will be voluntary worker selected from the local community. (b)The person will work as FTD for 1000 population or part there of in his headquarters village. ©His duties in respect of Blood Smears Collection from cases will be similar to other FTD holders. (d)He will, twice a week, contact neighboring FTD holders, collect the blood smears taken by them & take a copy of MF-2 pertaining to the blood smears. (e)The person will carry the blood smears collected in his area to the nearest malaria laboratory-PHC or malaria clinic which is responsible for examining the blood smears collected in the area & hand over blood smears & MF-2 to the laboratory technician, malaria microscopist.

(8.A.iv) Duties of the malaria microscopist/ laboratory technician: -

(a) At malaria clinic, the malaria microscopist will collect blood smears from all fever cases reporting at the clinic, examine them immediately & administer antimalarials. He will, if necessary, recall the patient on subsequent days or completing full radical treatment. (b)He will collect blood smears from fever cases reporting to him or referred to him by the medical officers & maintain their records in MF-2. © He will receive all blood smears along with MF-2 sent by the peripheral staff of the PHC. (d) He will stain the blood smears with J.S.B. stain. (e) He will maintain the stock for replenishment to MPWs (male & female), FTDs, and DDCs & Voluntary link workers.

(8.A.v) Duties of health supervisor of PHC

(a) He will supervise all activities of MPW (Male) (b) He will ensure that DDCs/FTDs/Voluntary link workers are contacted regularly by MPW (Male). If the post of MPW is vacant, he will contact the FTDs/DDCs/Voluntary link workers. ©He will administer radical treatment to all positive cases in his area.(d)He will refer seriously ill cases to the referral center.

(8.A.vi) Supervisory laboratory technician

It is decided that for a group of 10 PHCs or part there of, there will be a Laboratory Supervisor. This can be adjusted within the 10% leave receive of Laboratory Technicians. (a)He will visit every PHC at least once a month. (B)His tour schedule will be chalked out so that each laboratory is visited once a month for two days. ©He will inspect & conduct on the spot corrections in regard to laboratory records, returns, materials & equipment. (D)He will see that good quality J.S.B. stain is prepared & sent to PHC laboratory. (e)He will check whether the stain is filtered every day before use.

(8.A.vii) Duties of PHC medical officer: To fulfill the duties under the primary Health Care System, he should carry out the following activities

(a)He will select headquarters of DDCs, FTDs, & Voluntary link workers. (B)He will make a fortnightly calendar for house-to-visit of MPW (male) in consultation with District magistrate. ©He will refer all fever cases to malaria laboratory for blood smear collection & examination before giving final prescription/medicines. (e)He wills also ensure/supervise that all positive cases get radical treatment within 48hours of examination. (f) He will also ensure that sufficient stocks of antimalarials including quinine tablets & injectable quinine are available in PHC & periphery. (g)While supervising, the person have to look the condition of microscope & other equipment, stains, glass slides, etc. (h)He will do data analysis for action & prediction of outbreak & also assist in epidemiological investigation. (i)He will provide referral services to fever cases of malaria. (j)He will refer severe & complicated cases to District Hospital, if these treatment facilities are not available at PHC/CHC. (k)He will ensure that records of clinically diagnosed cases are maintained.

(8.B) MALARIA ACTION PLAN IN JALPAIGURI

Jalpaiguri is a malaria prone zone. The Annual Parasite Index, the slide positivity rate & the percentage of P.falciperum cases is high in this district. Deaths due to P.falciperum have also been recorded. The problem of malaria has also acquired new dimensions, viz. resistance of vectors to insecticides & drug resistance in strains of P.falciperum. All this, coupled with the inadequate health infrastructure in the district, present a grim situation. In view of the seriousness & the urgency of the situation, the State Government has appointed a “District Level Committee” for the control of malaria. This Action Plan has been prepared to reduce the morbidity & mortality due to malaria.

(8.B.i) Early case detection & prompt treatment: -

This is the single most important step to decrease malaria morbidity & mortality. In order to achieve this, it is proposed to establish the following:

(a)NEW MALARIA CLINICS. (b)FEVER TREATMENT DEPOTS. © DRUG DISTRIBUTION CENTRE.

The existing health infrastructure (malaria) will also be fully utilized.

(8.B.i.a) NEW MALARIA CLINICS: - It is proposed that New Malaria Clinics will be set up where the blood will be examined by a trained lab technician & treatment for malaria will be given. These will be set up in forest areas, tea garden, municipalities, & rural areas. (8.B.i.b) FEVER TREATMENT DEPOTS: -

They will be established in forest areas, municipalities & rural areas. The health worker in F.T.Ds will do the following.

The health worker will collect the blood smears of the area & send it to the nearest clinic for laboratory diagnosis. He will also give presumptive & radical treatment. The forest authorities will be responsible for the proper working of the centers in their areas. (8.B.i.c) DRUG DISTRIBUTION CENTRE: - Wherever it is not possible to open F.T.Ds, Drug distribution Centers will be opened.

(8.B.ii) Environmental modification & source reduction: -

Stagnant waters are ideal Mosquito Breeding Place. The following activities will be undertaken for the phase:

SPECIFIC WORK PLAN TO BE DONE BY

1.) Cleaning of canals of the district --------- Irrigation & Waterways dept.

2.) Filling up of water collection areas --------- Municipal Authorities. 3.) Development of Existing Drainage ---------- Municipal Authorities System (Improvement of the existing in Jalpaiguri Town)

4.) Flushing of dirty rivers ---------- Irrigation & Waterways dept.

(8.B.iii) Information, education & communication

(8.B.iii.a) General Objective – To create awareness among the members of the community about the causes, prevention, treatment & management of malaria cases leading to the reduction on the mortality & morbidity (mortality- nil & morbidity 0.5 cases per 1000 population per annum).

(8.B.iii.b) Specific Objective –

To create awareness on the reduction in the frequency of the contact between man & mosquito. To create awareness among the masses regarding methods which brings about reduction in the parasite load in the community. To create awareness on the methods which can bring about reduction in the mosquitogenic conditions leading to the lowering of the mosquito density in the area.

(8.B.iii.c) Strategy –

Mix Media Mass Media: Through electronic media like Video quickies & video on wheels etc. Print Media: Posters, Folders charts, flip booklets etc. Other Media: Through exhibition, Folk dance, drama etc.

(8.B.iii.d) Responsibilities –

At peripheral level

---- Poster & essay competition. ---- Hoarding & banners at melas. ---- Clay models depicting malaria vector life cycle, treatment etc. ---- Observation of MALARIA WEEK from 1st may to 7th may.

(8.B.iii.e) OBSERVATION OF ‘MALARIA WEEK’

Malaria Week:

1st May to 7th May every year has been earmarked as the observation of ‘Malaria Week’

Throughout the country. These days have been chosen, because it is the pre-monsoon period & the transmission of malaria starts around this period in most parts of the country.

The main activities:

a) Peripheral Level: -

District head quarter hospitals: Establishment of case detection cum treatment camp. Fever treatment, examination of blood. Display of posters & banners.

b) At PHC Level: - Special camps. Organization of meetings with village leaders & impressing about the prevention of malaria. Organizing group discussions.

c) In schools: -

Poster competition: Organisation of exhibition. Essay competition.

d) In Block/Taluk Level: -

Organisation of camps of opinion leaders. Meeting with Mahila Samities & Youth Clubs. Youth Clubs may organize street plays & puppet shows.

(8.B.iv) Malaria research & training center

One malaria research & training center is proposed to be established in Jalpaiguri in order to meet the needs of the area in the field of malaria control.

The basic prerequisites of a training center are the location of the center in an ideal environment with infrastructure facilities like adequate space, ideal class room fitted with modern teaching aids, well equipped laboratory, insectary, animal house for experimental malaria, a computer for information, storage & retrieval system, library with full spectrum of books, periodicals & scientific journals on malaria & other vector borne diseases, adequate transport facility for field visit, & above all a highly efficient team of trained teachers.

The operational research should be an integral part of the training centers to get first hand information on different aspects of malaria & other vector borne diseases, to evaluate skills through experimentation & also to record any change in the approach that may be warranted from time to tie. The research activities confer unique opportunities to augment the technical skills of trainers who in turn transmit the same trainees. The technical problems faced by the field staff could be taken up by the training centers to evolve solution through field studies. The operational research should include feasibility studies on alternative methods, chemotherapeutic trials, evaluation techniques, IEC activities for community participation, cost effective analysis, human behaviouristic patterns, etc.

(8.B.v) Management information system in malaria control (8.B.v.a) Purpose: -

Management Information System implies that the relevant information is collected, processed & transmitted to the concerned to enable a better decision making for timely change in the strategy wherever warranted.

Flow of information:

PHC is the operational management below district. The information at PHC relates to utilization of resources &

measurement of performance.

The information flows from operating level to top management level (State & National) & guidelines flow from top to bottom.

The information at PHC should be up to date, reliable, & complete to get back rational guidelines.

Some important data at district level is computerized & communicated to state & Center through satellite. The peripheral worker & PHC should analyses the data instead of mechanically filling up the forms. The analysis at micro level helps in timely containment of the problem.

(8.C) CONTROL OF EPIDEMIC IN JALPAIGURI

(8.C.i) DELINEATION OF AFFECTED AREA- RAPID SURVEY

To delineate the area affected by the epidemic, it is necessary to carry out rapid malaria survey, the methods adopted can be: -

Having ascertained that there is an epidemic situation in some of the villages of PHC, the PHC Medical Officer/ District Malaria Officer will make arrangements for delineation of the epidemic area & to find out the extent & severity of the epidemic.

They will immediately inform the Mobile Malaria Epidemic Control Team at District Level, the Zonal Officer & State Programmer Officer to help in the delineation of the area & implementation of containment measures on war footing.

(8.C.ii) RAPID FEVER SURVEY

During rapid fever survey, every village in the suspected epidemic zone is covered & only fever cases or cases with history of fever are taken up & their blood slides are exclaimed.

(8.C.iii) MASS SURVEY

As an alternative, mass survey of the entire population shall be carried out in every village irrespective of age & sex or fever status. Especially children must be included in the survey. It is necessary to expand the area of survey centrifugally from the epicenter of the epidemic till areas with normal positivity rates are reached. Thus the size of the area involved in the epidemic zone is delineated.

To carry out the surveys, it is always advantageous to establish field laboratories by pooling Laboratory Technicians from adjoining PHCs, Districts, Zonal office or State Headquarters laboratories & pool the peripheral staff from the PHC area to collect blood smears so as to cover the entire population as quickly as possible. This operation should be over in 7 to 10 days.

-- Blood smears collected should be examined within 24 hours.

-- All age groups should be covered, especially high-risk population i.e. children, pregnant woman & migrants.

-- All persons whole blood smears are collected should be given presumptive treatment with Chloroquin or mass radical treatment with a single dose of Chloroquine & Primaquine.

-- All positive cases should be given radical treatment at the recommended doses.

(8.C.iv) ESTIMATION OF POPULATION INVOLVED

The next step in the exercise is to calculate the population involved in the epidemic areas. Taking the village-wise population from MF-1 can do this or the census population of the villages identified, whichever is readily available at the PHC.

(8.D) ANTI-VECTOR MEASURES

(8.D.i) SPACE SPRAY:

Every house in all villages of the area affected by the epidemic should be covered. Indoors space spray should be carried out for 7 to 10 days or till the residual insecticidal spray in all houses of the locality are completed.

The equipment required for space spray would be a hand operated micro discharge fogging machine/ hand operated automisers.

Insecticides for indoor space spray will pyrethrum.

(8.D.ii) RESIDUAL INSECTICIDAL SPRAY:

The indoors-residual insecticidal spraying operation should be started simultaneously with indoor space spray. The insecticide of choice will be the insecticide to which the local vector is susceptible to control. Apply the recommended dose of insecticide chosen.Cover all houses & mixed dwellings including sleeping rooms. The cattle shades need not to be sprayed.

(8.D.iii) URBAN MALARIA:

The space spray with pyrethrum should be done in 15 households in & around a positive household. Intensify anti larval operations in addition to indoor space spray, & carry out Rapid fever survey. Give presumptive treatment to fever cases & radical treatment to all positive cases.

(8.D.iv) OTHER MEASURES:

Apart from space spray & residual insecticedal spray, some times it can be necessary to resort to other anti-vector measures. Such measures should be implemented on the basis of results of entomological findings.

(8.E) DURATION OF EPIDEMIC CONTROL MEASURES The entire exercise should be completed in a period of 7 to 10 days & in any case not exceeding a fortnight (i.e. within one extrinsic incubation period) so that secondary cases are prevented. Follow Up Actions

To see the impact of remedial measures, it is necessary to take the following follow-up actions: Carry out mass survey or rapid fever survey in the area where remedial measures have been implemented. The same procedure has mentioned for the first survey is to be adopted & field laboratory is established. Two consecutive follow up surveys are to be carried out; the first survey 21 days after remedial measures are completed & second survey 21 days after the first follow up survey. During these surveys no mass radical treatment is to be given. Strengthen the case detection operations & ensure fortnightly visits to all villages. Activate all FTDs & Voluntary link workers. Investigate cause of epidemic by an epidemiological investigation to find out whether the epidemic was due to Influx of migratory population, which was not, covered by routine control measure such as screening at the entry points & regular fortnightly surveillance in the project areas. Whether it was due to breakdown of regular malaria control operations. In some instances unusual natural calamities such as floods, heavy rainfall, drought with opening up of relief camps & other temporaries.

(8.F) FUTURE STRATEGY OF ERADICATION OF MALARIA:-

The methods currently adopted to control malaria are based on mosquito control by insecticides & chaemotherapy. The resurgence of malaria in the face of these measures warrants a search for new tools for controlling malaria. Hence, the World Health Organisation selected malaria as one of the six tropical diseases in their “Special Programme” & is promoting inrensive research in several areas in find such tools. This involves a search for more effective control of mosquitoes by chemicals(newer insecticides), biological(predator or larvivorous fish, plants) & genetic methods(release of sterile males & introduction of strains with cytoplasmic incompatibility).

(8.F.I) NEWER INSECTICIDES:

The chemical control of Anophelines remains the method of choice & most probably will continue to be for years to come. Though D.D.T has many advantage as being a long acting residual insecticide, with no toxic effect on mammals & a relatively low cost of production, the vector resistance has forced scientists to look few newer insecticides, namely:

Artemether-Lumefantrin (Therapy) Atovaquon-Proguanil (Therapy and prophylaxis) Quinin (Therapy) Chloroquin (Therapy and prophylaxis; use restricted due to resistence) Doxycyclin (an antibiotic: mainly for prophylaxis) Mefloquin (Therapy and prophylaxis) Primaquin (Therapy of certain malaria types) Proguanil (Prophylaxis)

(8.F.II) GENETIC CONTROL :-

The genetic control methods involves inducing reproductive failure in a given vector population. The genetic control is achieved by inducing sterility in males by: Irradication Use of chaemosterillents Use of incompatible strains.

(8.F.III) BIOLOGICAL CONTROL:-

Amongst all the malaria controlling measures, biological control is the cheapest, easiest & the best way of controlling mosquito nuisance.This is done by releasing living organisms which attack the acquatic stages of mosquitoes either by killing them or by swallowing them, into the water. The natural enemies of mosquitoes are parasites(fungi), predators(fish) & pathogenic agents(bactaria & virus germs), fishes are Gambusia affinis, Techokho etc.

(8.F.IV) SUPPLY OF MEDICATED BED NETS & CITRONELLA PLANTATION IN SELECTED GRAM PANCHAYET AREAS THROUGH SELF-HELP GROUPS:-

According to the reports of bed net surveys conducted in different corners of the district almost 60% families are using bed nets. Nevertheless, this does not fully serve the purpose for malaria control in terms of per family number as well as lack of provision for special medication, especiall in this hyperendemic zones of the country. This has been observed that, the rural people of this district can’t avail the benefit of proper use of medicated bed nets for malaria control because of lack of money & awareness. In small scale domestic plantation of “ Citronella(lemon grass)” reduces the dominance of mosquito & other insects in the environment. Some of the southeast asian & African countries have already introduced this strategy & have achieved significant reduction in malaria incidence. Therefore, promotion of Citronella plantation needs to be promoted in the rural areas of this District Point should be noted that, this is cheap & eco-friendly unlike & other mosquito control measure including DDT spray. The cost of these plantation & its sustenance is bare minimum, not even 2 rupees. After 3 months of plantation, a stem of plant can be used as mosquito repellent oinment. The use of that oinment on body parts/clothes reduces the chance of mosquito bite by 98%.

EPIDEMIOLOGICAL PARAMETERS

Annual Blood Smear Examination Rate (A.B.E.R):

Calculation Formula:

Number of blood smears examined in a year A.B.E.R = * 100 Total Population

Epidemiological Significance Annual Blood Smear Examination Rate (ABER), - Reflects efficiency & adequacy for case detection. A minimum ABER of 10% was fixed under NMEP. It is based on estimated fever rate in India. The blood smear collection should not be less than 1% per month during the transmission period.

ABER should be equal to fever rate in the locality. The fever rate in the community differs from season to season of the year. Ensures that all localities covered regularly under surveillance.The population is covered according to prescribed time schedule. If some villages not covered by surveillance during the transmission season, there is a great danger of focal outbreaks.In case of discrepancy, high fever rate, low collection of slides, MO/PHC and DMO should become concerned with the situation & take further steps. The blood slide collection & fever rate ate statistically correlated, but if the blood smear collection is very high & laboratory results show low positivity rates, the supervisory officer should be alert & investigate the efficiency of the laboratory & verify the microscopic diagnosis.

Slide Positivity Rate (SPR)

Calculation Formula:

Total no of blood smears found positive for malaria parasite SPR= *100 Total no of blood smears examined

Epidemiological Significance

SPR is less dependent on ABER Whenever the case detection mechanism is inadequate, these dependable parameters for determining the progress of containment measure. It is more reliable than API even for those years when ABER fluctuates from year to year. SPR assumes greater significance, if the ABER is low & gives better indication load in the community.

Plasmodium falciparum Percentage (PF%)

Calculation Formula:

Total no. Of blood smears positive for P.falciparum * 100Total no. Of blood smears positive for malaria parasite.

Epidemiological Significance

P.f % given the relative proportion of P.falciparum infection & trends in relation to total case load. Any rise in P.falciparum cases during any month indicates the high level transmission. High P.falciparum percentage also indicates when the malaria control activities breakdown, leading to high morbidity & high mortality.

CONCLUSION

FINDINGS- TRENDS & ABNORMALITIES

Malaria fever is a serious disease of human being & is created by protozoan endoparasite known, as Plasmodium sp. Female Anopheles mosquito is themaij vector of the disease. So they are regarded as definitive host. 24species of Anopheles as vectors of malaria fever in different parts. Of which Anopheles stefensi,Anopheles Philippensis, Anopheles minimus,Anopheles fluviatilis are the main causal agent of malaria.

The study has revealed that the incidence of malaria is a dominant disease of this region, JALPAIGURI district. It breaks out on a larger scale during the periods of high temperature & high humidity. Whereas there is a noticeable decline in the incidence of malaria during the low temperature & low humidity.

If we look through the other diseases in this district, it can be explained that from 1995-2001, there were few cases of diarrhoea & other water borne disease. From 1995 to 2001, the death due to diarrhoea affected patients were 263, 212,306,159 & 286 in the jalpaiguri district.But after that the rate of diarrhoea was decreased.On the other handduring that period from 1999 to 2001, the number of deaths due to water borne diseases were 128, 325,125,258 & 195 in this district. At that same time from 1999 to 2001, total 2375,3225,1734,4302 & 5449 people were affected due to malaria & deaths were 157,408,92,113 & 258 respectively.From that time the malaria endemicity was increasing consistently in this district.Suddenly another disease has been seen in this region, which is Dengue.Basically, in this disease ,Aedes sp is the main vector. But, the frequency rate of this disease is very slow & it is not epidemic in this region. It has also been found that the amount of vegetative cover also plays its role in the incidence of malaria. Those parts of JALPAIGURI, which are thickly forested, are perpetual homes of malaria while regions with sparse natural vegetation record comparatively lesser malaria cases, unless, of course, some other element is introduced there. Simultaneously eastern & western dooars are almost malaria affected.Eastern dooars – Torsha river to Sankosh River, Hasimara to Alipurduar to Kumargram. Western dooars- Jaldhaka River to Teesta River. Mal-Metali-Samsing-Bagrakota-Wasabari. Central dooars- Torsha River to Jaldhaka River. Madarihat-Banarhat- Nagrakata- Birpara. Basically tea gardens are the main occupational field of the population. Total 153 tea gardens are in JALPAIGURI district. According to the last 3 years epidemiological report NAGRAKATA is mostly malaria prone block, where 17 tea gardens are present. Tea gardens are the ideal mosquito breeding places. Another problem is socio-economic status of the people. The tribal constitute lion’s share of total population. Due to the poor economic condition, it is tough to take proper anti malarial precautions. The immigration is also responsible for the intermingling of the people carrying malaria parasite & those comparatively free from the disease. This is why the incidence of malaria is comparatively high in those areas where tribal people are almost dominant. Poor drainage condition in municipal areas contributes in the breeding of mosquitoes.

However, they are regions of very high incidence, high incidence, moderately high incidence & low incidence. According, to this study it has been shown that NAGRAKATA is in very high incidence zone consistently last 3 years. In this year, from January to July, 2006.Nagrakata ranks 1st according to the BCR report. Out of those regions, first three regions have several forested & mostly tea gardens are located in those regions & lastly they are the homes of several aboriginal tribes which form the permanent reservoir of infection & keep the high endemicity rate.

Incidence of malaria in JALPAIGURI illustrates some interesting features.

According to the 2004 report, total malaria positive cases were 88404 in the blocks except tea gardens, municipalities & corporations.31777 positive cases were in tea gardens & 711 cases were only in municipalities & corporations. In 2005, only 56714 malaria positive cases were shown in 13 blocks except tea gardens, municipalities & corporations. But in tea gardens huge amount of positive cases have been decreased, only 16655 cases were only shown. In municipalities & corporations, only 248 cases were shown. In fact it is clear to us that more or less 39% malaria positive cases have been decreased in 2005, in respect to 2004 data.

In 2006, if we look through the epidemiological data, the malaria situation is very high during January to July. 25734 malaria positive cases have been shown in these 6 months in 13 blocks of Jalpaiguri district. It is so alarming that in between these 6 months, from Jan-May total malaria positive cases were 10777.But in June & July it has been seen that total 14957 cases occurred.

But in respect to last year from Jan-Jul epidemiological data, more or less 5000 malaria positive cases are lesson in this year. On the other hand if we look through the last year Jan-Dec data, total cases were 56714 & from Jan-Jul it was 30636. So from August to December 2005, 26078 malaria positive cases were identified. So the increase in this year, Jan-Jul 2006 clearly shows the influence of following factors:- The resistance developed in the vector mosquitoes towards chloroquine, which was considered as the most effective insecticides.

Short supply of insecticides.

The species wise malaria positive cases were 41918 P.v & 14796 P.f in 13 blocks except tea gardens, municipalities & corporations in Jan-Dec 2005. In 2005, P.v cases were 12355 & P.f cases were 4300, in tea gardens. In this year, from Jan-Jul total 16936 P.v species & 8798 P.f species have been identified in 13 blocks. In tea gardens, 2530 P.v & 1228 P.f have been identified. So it is clear that the parasite Plasmodium vivax is predominant in the state & the Plasmodium falciparum cases come next but the mixed infections are very few.

The abnormal increases in the P.v cases are due to the drug resistance of Plasmodium vivax in the state. In few tea gardens less no of P.v cases have been shown than P.f cases. But more or less both of the parasites are so effective in this district. But P.f is the mostly mortal parasite of human than P.v in JALPAIGURI. The spatial distribution of malaria in JALPAIGURI shows that except MAYNAGURI, none of the blocks are malaria fre in the district. The climatic, physiographic conditions & living habitats of the people, favour the parasite & vectors of malaria, as a result of which the incidence of malaria is high in the state. But it is noticeable that the incidence of malaria is different from block to block & in the same block from year to year. In 2004, most no. Of malaria positive cases were shown in KALCHINI, but in 2005, In NAGRAKATA most of the cases were shown & in this year KALCHINI records mostly in malaria positive cases. But according to the death report, total 30 deaths, were occurred in METELI in 2004, including 88 deaths. But in last year in between 36 deaths, only 9 deaths were from METELI & in this year according to JAN-JUL data, there were no death cases in METELI. But, in respect to last 2 years data, in this year from Jan-Jul 2006, mostly death

cases have been found in ALIPURDUAR, 22 cases of which 6 from APD I & 16 from APD II, then KALCHINI, 12 cases have been shown there. In last 2 years there were no deaths in KALCHINI. So, it can be analyzed that ALIPURDUAR & KALCHINI is in verge of malaria prone blocks.The maximum API has been continuously observed in METELI & NAGRAKATA through out the study period. Tribal population, illiteracy, living habits & lack of transport facilities most probably are also responsible

for the alarming situation. But SADAR & MAYNAGURI are more or less, malaria free zone.

The blocks having Annual Parasitic Incidence above 15 thousand have some similarities.

Majority of them have higher percentage of total population. Majority of them have high percentage of forest cover. Due to less development means of transport & communication, the accessibility is very poor. As a consequence workers of National Vector Borne Disease Control Programme are not able to reach the remote areas of the district & hence persistent high incidence of malaria in the district is recorded.

The mortality due to malaria occurred in ALIPURDUAR I,II & KALLCHINI in JALPAIGURI, where P.f cases dominate. The zone is also characterized by high malaria incidence.

On analyzing sex wise data of mortality it is found that no. of female deaths are more than males in Jan-Jul, 2006. But in 2005, the ratio was more or less same. Although male patients are more susceptible to mortality due to malaria. This may be due to general weakness of females. The maximum deaths are observed in the age group of 0-10 years, total 23.Then 21-30 & 11-20 have mostly equal numbers of deaths. Un the age group of 51-60 & above 60 has no deaths at all.

ADMINISTRATIVE & ORGANISATIONAL PROBLEMS: -

A number of difficulties are encountered in the organizational patterns of current health service because of poor facilities & low capacities. In the last year all the contractual MT (Lab) s have been terminated. For that reason, the ABER had increased. In 2003, Annual Blood Examination Rate

was 24% & after termination of the contractual MT (Lab), the ABER fell down far below the desired level. For instance in the month of August2005, in which the service of the contractual laboratory technicians was not available due to delay in their re-

engagement after completion of the previous contract. There was huge backlog of unexamined slides. But in August 2005, 24 permanent laboratory technicians examined only 60475 slides, which was not also very unsatisfactory. Inspite of that, the number of backlog slides in August 2005, was 31681. So. If ABER falls down, the blood slide collection will also fall automatically. Because, it will be difficult to motivate the community to give blood samples, if no examination report is obtained. Moreover, not the collection rate but the examination rate has a significance in surveillance. It is just loss of logistics if the collected slides are dumped unexamined. For that reason, after termination of contractual MT (Lab) s, the entire anti-malaria programme was jeopardized & morbidity & mortality due to malaria increased. According to the Technical Advisory Committee (TAC) meeting held on 16th March, 2004, approved the use of combinations therapy to replace SP-mono therapy, that should be administered only in those cases where P.f malaria cases in drug resistance pockets, or are not responding clinically to chloroquine & the use has to be decided on a case to cases basis by the clinians. According to the guidelines of use of Sulpha- Pyrimethamine Artestinate Combination Therapy (SP-ACT), the indiscriminate use & pilferage of the drugs should be controlled. Use of this combination in areas placed under second line drugs would improve the efficacy of treatment. The use of these drugs should be carefully monitored. Many posts are lying vacant in the district’s malaria department with the increase of population year by year & thereby increase in the number of house dwellings the present strategy of NVBDCP needs more surveillance staff to cover each & every house on fortnightly basis for detection of fever cases. Similarly, more staff is needed for carrying the equipments & for spray operations.

SOCIOLOGICAL PROBLEMS: -

Though caused by a parasite & a vector, man’s role as a host as well as controlling factor of malaria cannot be ignored. He too creates problems for the spread of malaria in a number of ways.

The people do not co-operate in such operations as DDT spraying, collection of blood slides & mosquito studies. There are many reasons behind this attitude viz, the caste system, religious beliefs & disliking for the insecticides & the preferred timings of early mornings & evenings do not

suit the inhabitants. The sifting of house furniture’s & other articles from one room to another & that too twice a year is inconvenient for them. Sometimes people do not trust the strangers in the spray teams. The needle prick for preparation of blood slides is a painful affair for some; especially children & so people do not allow the surveillance worker to perform his duty. Such problems in both rural & urban areas. Generally, the people do not like the bitter taste of the anti-malaria drugs; they do not take the treatment properly & appear very casual about it. Lack of sanitation also creates problems. The majority of rural & urban settlements are unplanned. For that reason, water accumulation in houses, & nearby pools into which domestic drains empty, the village wells, paddy fields etc. are all favorable breeding places created by man. The man- made malaria in the urban area where slums are a common factor, has flourished in the district. Superstition prevails in the uneducated masses & people do not take the anti-malaria drugs. Instead they belief their tribal gods, ozhas & quacks for the cure of the disease. Forests mostly cover this study area, which is the den of the mosquito breeding. Tea garden workers are also carrier of this disease. From them this disease spreads rapidly. The habit of mud plastering in rural & urban areas just after rains & at other occasions, minimizes the effect of residual sprays as DDT.

SUGGESTIONS: -

The present study reflects that the disease is a multiple phenomena & that various factors co-mingle in time & space for its incidence. The future strategy of eradication of malaria is to be decided very thoughtfully in order to get rid off this scourge from the state. It is the natural environment that has created suitable conditions for this disease. We are unable to change the environment but the man-made malaria can be eliminated by constant vigil on all fronts & more integrated control & eradication measures should be implemented in the campaign against malaria. The following suggestions deserve serious considerations: - Fight against mosquito vectors should go on. Replacing chemical control by alternative methods means replacing a simple, simple procedure by multiple procedures, each demands expert knowledge.

The National Vector Borne Disease Control Programme should be tackled on war footing because it is not just another activity of ministry of health; it is a major national problem of civilians, which in turn requires an exceptional approach.

The administrative & organizational problems should be solved as early as possible.Jalpaiguri is a vast district & the establishment of the health services to cover the entire district requires a large number of efficient organizations with trained personnel. The vacant posts should be filled up on all the levels of the set up. More numbers of surveillance staff, technicians, biologists, entomologists etc. should be sufficient enough so that the control operations do not suffer at any level. Since all the parameters of malaria incidence depend in responsibility of Laboratory Technicians at PHC, it is essential to have a qualitative check on his performance. Every workers of the FTD/DDC holder, VLW, Laboratory technician, PHC medical officer would have to be serious & devotee of their work. Then the situation will be controlled.

Adequate & timely supply of the insecticides as well as the anti malarial drugs should be maintained. These things should supply the field areas in appropriate time & in sufficient amount.

The workload of multipurpose workers should be decreased by either recruiting more staffs or by maintaining separate staff for antimalarial activities.

The most important point is literacy. Literacy campaign should be arranged in the tribals, backward classes. For that reason, they will gather the knowledge of this mortal disease. At that time people can take precaution itself.

Special vigilance is needed in the forest areas & tea gardens, which are more, exposed to the “flare ups” due to population movements, as the forest areas, tea gardens etc.

In vivo & In vitro studies for the drugs still found to be effective especially in the areas of developing resistance should be done extensively. Further advances in our knowledge in these areas are necessary. The Indian Council Of Medical Research, New Delhi, can play an important role in this regard. More research work should be done at block level also.

The use of pesticides should be done carefully, because it can be harmful to the civilians. Similarly more biological controls can be used in the district, such as larvivorous fishes, Gambusia, which is so costly. So, available low prices fishes can also be introduced such as Tilapia, Techokho etc. These species can minimize the incidence rate after eating the mosquito larvae. Citronella (lemon grass) plants should be used in more numbers. It stands good chances for culture due to favorable ecological conditions in many areas such as, tanks, ponds, canals, dams etc.

The spray operations should be performed under proper supervision & whole-heartedly. The drug distribution centers should be permitted in the remote areas with due approval of district health authority.

With the help of different meetings in block level, panchayet level, the knowledge should be arranged for gaining the knowledge. It is due to inadequate & half hearted mass health education programmes that people are still unaware of certain precautionary measures, which help in keeping safe from malaria. After the spray the walls should not be mud plastered. All food articles & eatable things should be properly protected against harmful insecticides to avoid contamination.

Generally it has been found that malaria fever cases are not reported to the malaria office & the anti-malaria workers remain in dark. It is therefore, necessary that through health education programme people should be educated to co-operate by reporting malaria cases as early as possible & obtain drugs in time. On the other hand, people should be educated to co-operate in the preparation of blood slides, which is mostly fearful matter to the illiterate people. A drop of blood for preparing a blood slide of a patient will not make him weaker, this knowledge should be given to them.

Civilians should also try to eliminate the domestic & peri domestic sources of mosquito breeding by filling up depressions, disposing of coconut shells, discarded cans & earthen vessels in such a way that water may not stagnant in them. It is very emergency to observe a dry day in a week, when all the stored water collection should be emptied. Tanks of water coolers & waters of flowerpots should be cleaned in a regular manner.

The last but not the least that, Remote Sensing technology should be implemented for mapping the breeding habitats of Anopheline mosquitoes, prediction of densities of vector species & even development of risk maps of malaria. Vector control requires knowledge of ecology of breeding & resting habitats & behavior of various specimens of mosquitoes. Periodical surveys are essential for arriving of any conclusion for developing vector control strategy. So, with the help of Remote Sensing & GIS, it will be easy. Different epidemiological conditions of the blocks & the different health status should be identified easily with the help of maps. It can help to locate the nearest health facility, to monitor the utilization of health centers, to monitor diseases & interventions over time, to determine the geographical distribution & variation of diseases.

However, the battle between man & malaria is still on. It is evident from the data that both positive & negative results have been achieved.

In the last analysis, it may not be over emphasized that malaria deserves a multiprolonged attack. A team comprising of professional workers, social scientists & administrators may be entrusted with the tusk of evolving an effective method of combating malaria from all sides & at every level. If worked sincerely such a team is sure to provide healthy results.REFERENCE:

Agarwal,A(1973): Malaria Makes a Come-back; New Scientist,Febuary 2. Ayyar et al: “Malwa region” in India a Regional Geography;Ed.Singh, R.L NGSI,Varanasi.

Baizal,H.N(1979) : Modern Text Book Of Zoology, “Invertebrates”, Universal Book Depot,Agra.Bently,C.A(1925): Malaria & Agricultural in Benagl;Bengal Secretariet Book Depot,Calcuta.Borcar et al(1967): Malaria Eradication Programme In Goa; Bull of Ind.Soc. Of Mal & other comm. Dis, Vol.IV, No.1, March 1967

Chatterjee,S.P(1964): Fifty years of Science In India, Progress of Geography, Calcutta.Covell,G& Harbhagwan(1939):. Journal of Malaria Institute Of India,5 pp.341-376.

Dhir,S.L(1968): Phasing of Malaria Eradication Programme with Particular Reference to India- a critical Study.Bull.Ind.Soc.Mal & other Comm.Dis, 5,No.1-2, March-June, pp.16-27.

Fox et al(1970): Man & Disease, The Macmillan Company,New York.

Heir,Patric(1927) : Malaria in India,Oxford,LondonHowe.G.M(1968): Some aspects of Medical Geography of UK. 21st I.G.C, New Delhi.

Learmonth.A.T.A(1984): Geography of Health-A prologue, The Indian Geographical Journal,June.Vol 59.No.1

Lepes.T(1974): Review on Malaria,WHO Bulletin, Vol 50, No 3-4pp.151-57

May,J.M(1950): Medical Geography, Geographical Review,40(1)Misra,R.P(1970): Medical Geography Of India, National Book Trust, New Delhi.

Pacholi,S(1977): Medical Geography Of Malaria In MADHYAPRADESH, The Geographer, Aligarh, Vol.xxiv, No.1.pp.31-42. .

Rao,B.Ananthaswamy(1958): Malaria in India, Ministry of Health, Government Of India,New Delhi.

WHO(1951): TRS No.39, GenevaWHO(1957): TRS No.123, “World wide Eradication Of Malaria”, Geneva WHO(1963): Terminology of Malaria & Malaria Eradication, Geneva WHO(1966): Terminology, Geneva. P.10. WHO(1970): Injection of “Cyclognail Embonate” WHO Chronicle.24.p.337WHO (1979): TRS No.579, Development in Malaria Immunology, Geneva. pp.5-65. WHO Chronicle (1980): Malaria- Drug Resistance & its Operational Implications, Volume 34, No. 11. WHO (1979): TRS No.640, WHO Expert Committee on malaria, 17th report.

The American Journal Of Tropical Medicine & Hygiene (1961): “Report & Recommendation on Malaria-A summary”, Vol.10, No.4. Indian Journal Of Entomology. Indian Journal Of Malariology(1981): Problems In Malaria Research.Rao, T.A, Vol 18,No.1, June, New Delhi. The Indian Geographical Journal (1984): Vol.59, No.1, June.

Census Of India (1991 & 2001): Report. I.C.M.R. Bulletin (Nov, 2000): Remote Sensing: A visionary tool in Malaria Epidemiology. Photonirbachak,(June,2005) : Malaria incidence & vector density in relation To climatological factors in Western Doon Valley (Uttaranchal) Tribal Health Bulletin (Jan& July, 2004): Geomatics & Ecoepidemiology. National Vector Borne Disease Control Programme. Annual Report, Of Jalpaiguri District.Monthly Epidemilogical Data Of Jalpaiguri District.

WEBSITES: www.icmr.nic.in www.cdc.gov/ncidod/eid/vol6no3/boone.htm www.malariajournal.com/content/2/1/36 www.amazon.com/Geographical-Information-Epidemiology-Advances-Parasitology/dp/0123335604 www.iirs-nrsa.gov.inwww.cdc.gov/ncidod/eid/vol6no3/beck.htm www.ncbi.nlm.nih.gov

APPENDIX

Malaria is a mosquito borne disease. Mosquito is a species under phylum Arthropoda. The classification of mosquito has been followed as it has appeared in textbook of Zoology VOL I 1972 written by T.J.PARKER & W.A.HASWELL & edited by H.J.MARSHALL & W.D.WILLAM.

SCHEME OF CLASSIFICATION

Animal kingdom is divided into 2 subkingdom Protozoa & Metazoa. Again Metazoa is divided into 2 divisions, Intervertebrate & Vertebrate. Interbrates have 2 Subdivision, Parazoa & Enterozoa. Enterozoa consists of 10 Phylum, one of them is Arthropoda. Arthropods have 7 subphylum, Onychophora, Tardigrada, Pentostomatida, Pyenogonoda, Trilobotomorpha, and Chelicerata & Mandibulata. Mandibulates are divided into 7 classes. Insecta is one of them. Pterygota is a subclass of class Insecta. Pterygota means winged animal. Pterygota has 21 orders. Mosquito is in order Diptera & suborder Nimatocera. Culicidae is the family of suborder Nimatocera. Culicidae have 2 subfamily Anopheline & Culicinae. Anopheles sp is in subfamily Anopheline & Culex sp & Aedes sp are in subfamily Culicinae.

Malaria fever is a serious disease of human being & is created by protozoan endoparasite known, as Plasmodium sp. Female Anopheles mosquito is the main vector of the disease. Any agent (living or inanimate) that acts as an intermediate carrier or alternative host for a pathogenic organism & transmits to a susceptible host is known as vector. Apart of the life cycle of the Plasmodium sp is completed within the body of the human being & part within mosquito. So they are regarded ad definitive host. 24 species of Anopheles at as vectors of malaria fever in different parts. Of which Anopheles stefensi, Anopheles philippensis, Anopheles minimus, Anopheles fluviatilis are the main causal agent of malaria.

A man attacked with malaria fever has its blood may gametocytes of Plasmodium. The gametocytes develop in the blood after 14 days of infection. Matured gametocytes migrate to the peripheral blood. The female Anopheles mosquito sucks in these gametocytes during the act of biting & blood meal. The gametocytes are taken inside the stomach of the mosquito & after sexual act of the parasite zygote is formed. The zygote (2n) divides several times to give rise to many sickle shaped sporozoites, the first division being meiotic. Sporozoits finally migrate to the salivary glands of the mosquito. When the mosquito loaded with sporozoits bites & man the sporozoits are liberated in the blood of the man. Through blood the sporozoits are taken into the liver. Within the liver the sporozoits are biologically organized to form schizonts. These schizonts multiply asexually (schizygi) to give rise to cryptozoits. The liver cells burst & liberate the cryptozoits. The liver cycle is known as preerythrocytic schiny & it takes 8 days to complete the liver cycle. Then some of the cryptozoits attack the R.B.C .One cryptozoit attack one R.B.C. The cryptozoit within R.B.C is transformed into trophozoit stage. The trophozoit of Plasmodium vivax is known as signet ring stage. Within R.B.C the signet ring becomes biologically organized to form a schizont & undergoes asexually reproduction into form 12-16 merozoits, it looks like a rosette & stage is called rosette stage. Some of the morozoits instead of attacking the R.B.C become biologically organized to form gametocytes. These merozoits are either all male or all female gametocytes. These migrate to the peripheral blood & sucked up by female Anopheles mosquito during her blood meal.

To form complete gametocytes & its migration to peripheral blood it takes 4 days. So to complete a human cycle Plasmodium vivax requires 8 days in liver + 2 days in R.B.C & 4 days in gamogony= 14 days.

Then R.B.C bursts & liberates the merozoits. The toxic substance secreted by R.B.C while it bursts, is responsible for body, shivering & rise of temperature.

TABLE 1

EPIDEMIOLOGICAL SITUATIONCURRENT YEAR 2006

Name of the block Population During the month November 2006 Progressive January-November 2006

coll exam posiive p.f death coll exam posiive p.f deathSADAR 280446 3698 3698 34 341 0 27313 27313 1270 606 0RAJGANJ 287615 9193 13719 357 198 0 67686 59885 4897 2309 1MAYNAGURI 281554 4569 4569 33 22 0 38555 37816 279 100 1DHUPGURI 379420 6535 7082 91 369 0 49590 48577 4376 743 0MAL 264711 9455 8575 1210 802 0 56659 55254 5151 2135 10METELI 105861 2951 2797 481 350 0 32552 28986 4036 1811 0NAGRAKATA 119556 5033 5629 569 61 0 45706 43658 4268 376 1FALAKATA 254027 3606 3606 60 34 0 39507 39507 1101 452 0MADARIHAT 185499 11783 11580 497 234 1 80816 80615 3397 1298 7KALCHINI 252322 9128 9128 1331 497 3 89258 84992 7644 2139 24APD I 197160 8402 10177 496 80 1 105074 1E+05 3069 1154 10APD II 196909 9074 7464 680 469 1 89146 84002 4936 2960 25KUMARGRAM 177894 5467 5279 400 284 3 60904 54084 3458 2224 12TOTAL 2982974 88894 93303 7139 3415 9 782766 7E+05 47882 18307 91

Tea estate 7896 6969 930 579 85263 77948 8280 3518Dy.CMOH-II 264 264 9 5 2855 4227 401 170Others Hospital 1760 1760 54 34 13523 13523 588 147Municipal & Corpn 420230 0 0 0 0 1Grand Total 3403204 98814 1E+05 8132 4033 9 884407 8E+05 57151 22142 92

TABLE 2.i

EPIDEMIOLOGICAL SITUATION

CURRENT YEAR 2005DURING THE MONTH DECEMBER PROGRESSIVE JANUARY--DECEMBER 2005

ID NO NAME OF BLOCK POPULATION COLL EXAM POSITIVE P.f DEATH COLL EXAM POSITIVE P.f DEATH1 SADAR 280446 977 977 83 65 0 19035 19035 1112 402 02 RAJGANJ 287615 2723 1539 113 51 0 48595 44049 3554 914 13 MAYNAGURI 281554 1531 931 25 8 29282 25593 408 115 24 DHUPGURI 379420 622 698 50 8 0 41570 37802 5206 447 25 MAL 264711 1991 1991 137 57 1 46933 46933 8037 2447 46 METALI 105861 4054 3329 546 266 9 36840 33052 4910 1944 97 NAGRAKATA 119556 3308 2585 607 76 3 45794 43264 9365 1685 98 FALAKATA 254027 1335 1335 84 29 1 30514 30514 1152 279 39 MADARI HAT 185499 2947 2882 129 27 0 46429 43246 4233 1174 2

10 KALCHINI 252322 6558 5267 1016 107 0 54664 50977 9337 1162 011 ALIPURDUAR 1 197160 2404 3704 277 218 0 32783 32783 2227 1024 1

12 ALIPURDUAR 2 196909 2877 2773 239 170 1 53224 45122 4303 1661 313 KUMARGRAM 177896 2620 1518 148 107 0 42736 33747 2870 1542 0

TOTAL- 2982976 33947 29529 3454 1189 15 5E+05 5E+05 56714 14796 3614 TEA ESTATE * 4722 7186 857 357 * 1E+05 96605 16655 4300 *

OTHERS HOSPITAL * 868 868 61 27 11706 11705 1618 202 0MUNICIPAL & CORP 420230 * * * * 0 1855 1855 248 4 0GRAND TOTAL 3403206 39537 37583 4372 1573 15 6E+05 6E+05 75235 19302 36

TABLE 2.ii

LAST YEAR 2004DURING THE MONTH DECEMBER 2004 PROGRESSIVE JAN-DEC 2004

ID NO NAME OF BLOCK COLL EXAM POSITIVE P.f DEATH COLL EXAM POSITIVE P.f DEATH1 SADAR 900 900 70 12 0 20710 20710 1202 189 02 RAJGANJ 1947 1947 104 65 0 48072 47972 9496 5591 23 MAYNAGURI 1022 1022 80 44 0 21732 21732 1130 608 14 DHUPGURI 1925 1925 542 102 0 39687 39720 9712 1868 45 MAL 2595 2595 512 167 1 50836 50838 9752 3743 216 METALI 2602 2575 643 285 6 37754 34883 8751 3909 307 NAGRAKATA 2797 2797 1014 250 2 54068 53405 15009 5183 218 FALAKATA 886 886 121 41 0 30603 30603 2846 1049 39 MADARI HAT 2023 2023 369 162 0 42881 42881 6477 1939 3

10 KALCHINI 2269 2269 789 185 0 50779 50779 10861 1951 0

11 ALIPURDUAR 1 978 978 151 43 1 25799 25504 1687 534 112 ALIPURDUAR 2 3445 4206 996 348 0 51216 50176 7190 2932 213 KUMARGRAM 2985 2985 599 297 0 38696 37906 4291 2079 0

TOTAL- 26374 27108 5990 2001 10 512833 507109 88404 31575 8814 TEA ESTATE 9184 8850 2545 1060 * 145825 137275 31777 12440 *

OTHERS HOSPITAL 675 675 197 19 0 11135 11135 2365 325 0MUNICIPAL & CORP * * * * 0 2071 2071 711 4 0GRAND TOTAL 36233 36633 8732 3080 10 671864 657590 123257 44344 88