How Odisha fought the malaria battle, and won it

 

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

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

So how did Odisha achieve this?

An additional investment of up to ₹7 crore was required to implement the project — Comprehensive Case Management Programmme — in four districts since 2013 initiated by the Indian Council of Medical Research (ICMR) to experiment with interventions. Issues such as unavailability of drugs when roads get cut off due to rain, or health workers facing difficulty in reaching remote villages when blocked by elephants, were addressed.

Apparent difference

“In under-served villages where Accredited Social Health Activists (ASHAs) were unable to reach, alternative providers like teachers, forest animators were trained to do mass screening by running blood tests and providing medication to villagers,” said MM Pradhan, Additional Director, Public Health for vector-borne disease, Department of Health, Odisha.

Four districts — Bolangir, Dhenkanal, Angul and Kandhmahal — with a total population of nine lakhs were divided into a control block and an intervention block under the CMP. In the intervention block, activities were intensified while in the control block things went on as usual.

“In hill-top areas, people were screened and even if they had no symptoms of malaria, but their blood samples showed presence of parasites, they were treated with anti-malarial drugs. Simultaneously, cases in the plains close to the hill-top were also managed,” said Pradhan. A mosquito can fly up to 5 km.

In four years, the difference was apparent. In the intervention block of Kandhamal district, for example, 810 cases were recorded in 2013. This increased to 1,514in 2014 and 1,604 in 2015. Then, they reduced gradually to 1,053 cases in 2016 and 766 in 2017.

“The cases peaked in 2014 and 2015 was due to more detection with intensified intervention,” said Anup Anvikar, Scientist, ICMR’s National Institute of Malaria Research.

However, in the control block of Kandhamal, the cases remained more or less stagnant and even spiked in one year through 2013 (1,604 cases), 2014 (1,419), 2015 (2,830), 2016 (1,242) and 2017 (1,145 cases).

Efforts are on to scale up the project in all endemic districts. States like Jharkhand, Chhattisgarh, Madhya Pradesh, and Assam, which have high incidence of Malaria, can learn from the Odisha model to replicate the success,” said ICMR Director Balram Bhargava.