Malaria is a major problem of the tribal areas of India. 50% of all malaria cases, 70% of all Falciparum malaria cases, and 90% of all malaria deaths occur in tribal areas.
The high incidence of malaria in tribal areas is due to a variety of factors. Standing water in streams, ponds, rice fields, irrigation projects, and even hoof prints around water pumps provide breeding grounds for mosquitos. Many people cannot afford personal protection measures, such as repellants and nets treated with insecticide.
There is also a lack of early, rational treatment. The terrain makes access difficult, and economic conditions prevent people from seeking care. Once treatment is sought, there is often a backlog of slides, which can further prevent the timely provision of care.
What we are doing
With some financial support toward bed net subsidisation, we have embarked on an aggressive campaign to improve mosquito net availability and use in families. More than 2500 nets have been distributed in this year alone. Insecticide treated bed nets are being offered at as low as Rs. 30 per net. Pregnant women are being given a bed net free upon registration due to the fact that falciparum malaria is highly lethal in pregnant women.
We also take an integrated approach adapted to the local epidemiology of malaria and its vector, focusing on building capacity of communities for malaria control at the village level. This is accomplished via training and interacting with village level volunteers and creating awareness about the disease through workshops, kala jatha, and wallpaper. We promote environmental measures such as filling ditches, soak pits, and used oil spraying. We also use of larvivorous fish to control mosquito populations, and run hatcheries at 3 sites.
Finally, we have developed a system of transporting smears from the remote villages to our Ganiyari clinic. The smear report is available to the Village Health Worker (VHW) by the same day. This leads to earlier referral of patients with severe malaria with fewer deaths. Laboratory evidence of malaria improves compliance with a full course of treatment and reduces the misuse of chloroquine. This, in turn, delays the emergence of chloroquine resistance strains of malaria.
The steps involved in the transport system are:
- VHW visits patient’s house and makes smear.
- Smear is dried, labelled and packed in a plastic box.
- Box is given to a student going to school on the main road.
- Student takes box to ‘Paan’ shop at bus stop on main road.
- Paan’ shop owner hands over box to bus conductor.
- Bus conductor drops box at Jan Swasthya Sahyog Health Centre, Ganiyari.
- Smear is stained and examined at Ganiyari.
- Smear report (along with Primaquine tablets and written advice for VHW in case of positive reports) is packed in the same plastic box as well as replacement for used slides and lancets.
- Box is handed over to the bus conductor on the return trip.