L
ong before the British colonised 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 labourers 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 were 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 invloved removal of breeding
sites and later
used chemicals such as the larvicides 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.
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Indian
Medical Service (IMS) And Malaria |
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The diseases endemic to India provided a rich field for research and the work
of some of the IMS officers led to landmark discoveries. The foundation was
laid by Surgeon-Major Dempster in 1845 with his
work on the spleen rate as a reliable
guide to the incidence of malaria. Major general
Ronald Ross
carried forward this work with distinction. He identified the mosquito as carrier of the malarial parasite
in 1897-99. He was awarded the Nobel Prize in 1902 and knighted in 1911 in recognition of his outstanding
contribution. Sir Samuel Rickard Christophers, who directed the Central Malarial
Bureau from 1919 to 1924, supplemented Ross’s work. Further work was done by
John Alexander Sinton, when he was the Director of Malarial Survey of India
from 1927-38. In 1948, Henry Edward Shortt demonstrated the tissue phases of
P. vivax malarial parasite for the first time. |
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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.
The use
of pyrethrum was then expanded to Assam by Dr. D. K. Viswanathan 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.
DDT was
first used in India by the armed forces in 1944 for the control of malaria and
other
vector borne diseases. In 1945, DDT was made available for civilian use in Bombay
to
control malaria and produced some remarkable results within a very short
period. On 1st July 1945, the first civilian home was sprayed in India with
a 5% solution of DDT mixed in kerosene. In 1946, pilot schemes using DDT were
set up in
several areas, including Karnataka, Maharashtra, West Bengal and Assam. Between
1948 and
1952 the WHO set up DDT demonstration teams in Uttar Pradesh, Rayagada, Wynad
and
Malnad. Use of DDT not only helped in the control of mosquitoes and malaria,
but also improved the life expectancy. After the spraying in the Kanara
district, the population began to grow because of a decrease
in the death rate. Prior to DDT being used, the district reported
an average of
50,000 malaria cases every year, which was reduced by around 97% to only 1,500
cases after
DDT was introduced. The project was also blessed by Mahatma Gandhi.
During 1949, it is estimated that over 6 million people in Bombay were protected
from malaria through the use of DDT and that at least half a million cases of malaria
were
prevented. In the early 1950s India’s population was estimated to be around 360 million
and every year
around 75 million people suffered from malaria and approximately 800,000 died
from the disease.
Usefulness of DDT prompted the launch of the National Malaria Control Programme (NMCP) in 1953. The control
programme first set out to control the disease in the endemic and hyperendemic
areas with 125 control units. Each of these control units consisted of between
130 and 275 men and was to protect approximately 1 million
people each.
By 1958, the malaria control programme had been increased to protect at least
165 million people from the disease with 160 control units. The programme saw tremendous impact and the
annual number
of cases came down to 49151 by 1961. With this success, the programme was renamed as National
Malaria Eradication Program (NMEP) in 1958 with a belief that malaria
could be eradicated in seven to nine years. On the contrary,
malaria began to re-emerge in 1965 to reach well over 1
million in 1971. One of the
major problems with the eradication programme was that the supervisors could
not manage to
inspect all of the buildings that had been sprayed. There was a decline in the
morale of the spray men and inspectors. With the declining
number of cases, complacency set in among spray workers as
well as the general population, as people turned the sprayers
away. With the incomplete spraying operations, by 1959, resistance to DDT began to develop in certain areas
and added to the problem. Furthermore, malaria cases were not
treated properly.
With increase in malaria cases in urban areas,
The Urban Malaria Scheme
(UMS) was launched in 1971 with the objective of controlling malaria by reducing the
vector population in the urban areas through recurrent anti larval measures and detection and
treatment of cases through the existing health care services. Passive surveillance (case detection and
treatment) and anti-larval measures are the main components of UMS strategy.
The number of malaria cases
rose gradually and consistently with a peak of 6.47 million
cases in 1976. With this, the focus was again shifted to control
of malaria and in 1977 the Modified Plan of Operation (MPO)
was launched which also comprised the P. falciparum Containment
Programme (PfPC). The
objectives of the MPO were
- Effective Control of Malaria to
reduce Malaria Morbidity
- Prevent deaths due to Malaria
- Retention of the achievements gained.
Fever Treatment Deport and Drug Distribution
Centers were established for distribution of chloroquine.
Residual insecticide Spray was limited to areas with an API
(Annual Parasite Index) above two. By 1985, the
incidence rate stabilized at 2 million cases.
However, many focal outbreaks, particularly of P. falciparum
malaria and deaths from malaria have occurred throughout India
since the 1990’s and large scale epidemics have been reported
from eastern India and Western Rajasthan since 1994. Many of
these are related to irrigation projects aided by global
funding agencies.
The National Anti Malaria Programme (NAMP) was
launched in 1995 as a Centrally Sponsored
Scheme on 50:50 Cost Sharing Basis between the Centre and
the State Govts. As the Central share, the Central Govt. provides drugs, insecticides and
larvicides and also technical assistance/guidance as and when required by the State Govts. The State
Govts. meet the operational cost including salary of the staff. However, considering the
difficulties faced by the seven North-Eastern States namely Arunachal Pradesh, Assam, Manipur, Meghalaya,
Mizoram, Nagaland and Tripura, 100% Central Assistance except salary of the staff, which is
a Non-Plan activity, is being provided since December, 1994. The Union Territories without
Legislatures are also covered under 100% Central Assistance. An
Enhanced Malaria Control Project with World Bank support is being
implemented since September, 1997 covering a population of around 62.2 million in 1045 PHCs
in 100 predominantly P.falciparum malaria endemic and tribal dominated districts in the peninsular States namely Andhra Pradesh, Bihar/Jharkhand,
Gujarat, Madhya Pradesh/Chattisgarh, Maharashtra, Orissa and
Rajasthan. The project lays emphasis on Early diagnosis and prompt treatment;
selective vector control, eco-friendly methods like introduction of medicated mosquito nets (MMNs), larvivorus
fishes, bio-larvicides etc.; epidemic planning and rapid response including inter-sectoral
coordination and institutional and human resources development through training/reorientation training; strengthening
management Information System (MIS), Information, Education and Communication (IEC)
and operational research. It also aims to cover the most
problematic areas and also has the flexibility to
divert resources to any needy areas in the country in case of any outbreak of malaria.
In 2004, the integrated National Vector Borne Disease Control Programme (NVBDCP) for the prevention and control of
vector borne diseases i.e. Malaria, Dengue, Lymphatic Filariasis, Kala-azar and Japanese Encephalitis
has been launched and it has been changed to Enhanced Vector Borne Disease Control Programme (EVBDCP)
with the World Bank support. [See
NVBDCP website;
See
World Bank
Site]
Source:
Also See
History of
Origin of Malaria
Parasite And Its Spread
History of Malaria During
Wars and Upheavals
History of Malaria And Its
Famous Victims
Malaria In
Ancient
Literature
History of
Scientific Discoveries on Malaria
History of
Anti
Malaria treatment
History of Malaria
Control
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