Only 60 per cent of the total plan outlay for vector-borne
diseases spent between 2007 to 2013; lack of co-ordination between
ministries and state agencies a major hurdle in implementation
Controlling
vector born diseases (VBD) like malaria is still a big challenge for
India though the programme to control them was started over a decade
ago. Diseases like malaria and kala-azar are no longer fatal like they
used to be and their incidence has also decreased significantly, but new
vector-borne infections like dengue and acute encephalitis syndrome are
on the rise and claiming lives.
One of the reasons for failure of the government that launched the
National Vector Borne Diseases Control Programme (NVBCP) in 2003 is that
it has not been fully utilising the the planned budget for VBD control.
What's more there is no synergy between different government ministries
and departments.
An analysis by Raipur-based chartered accountant, Anshuman Bardhan,
shows that actual expenditure on VBDs has been 60 per cent of the total
plan outlay since 2007 to 2013. “The low budget execution was largely
due to delays in tendering processes within the NVBDCP,” says Asheena
Khalakdina, epidemiologist with World Health Organization (WHO)-India
country office in Delhi. NVBDCP and WHO have come together to jointly
monitor the strategies and implementation of the programme to fight
infectious diseases.
The five most acute VBDs affecting India are malaria, dengue,
chikungunya, filariasis, acute encephalitis syndrome (AES) and
kala-azar.
National Anti-Malaria Programme,
National Filaria Control Programme and Kala Azar Control Programme have
been in place since the 1950s. They were merged in 2003 to form NVBDCP
and many more diseases were brought under the ambit of the programme.
The programme, formed under the Union Ministry of Health and Family
Welfare, has to coordinate with other government agencies to reduce VBDs
in India, besides providing healthcare services. The Union Ministry of
Drinking Water and Sanitation is required to ensure clean habitation and
water for consumption. The Union Ministry of Human Resource Development
has to work for awareness among students. Research agencies involved
need to find causes of the diseases and solutions.
“Most ministries work in isolation, missing a holistic approach to
reduce VBDs. But we are now concentrating on building this cooperation,”
says AC Dhariwal, director of NVBDCP. He says officials are also trying
to understand the changing trend in VBDs to formulate better
strategies.
The most worrying trend in India relates to AES, which has become
rampant since 2005. From 3,855 cases in 2008, their numbers jumped to
7,478 cases in 2013. Deaths due to AES increased from 684 in 2008 to
1,270 in 2013. AES is a group of neurological diseases, also called
brain fever, caused by wide range of viruses, bacteria, fungus,
parasites, chemicals and toxins. Despite introduction of vaccination for
Japanese encephalitis virus, the cases of JE have not decreased
significantly.
“We still have to find vectors for majority of AES cases. Our
laboratories are engaged in testing,” says Rishi Kumar Jaiswal, head of
AES in NVBDCP.
Dengue is yet another VBD that the government is not being able to
tame. From 12,561 cases in 2008 the number went up to 75,454 in 2013.
“Rapid and unplanned urbanisation is the main cause of spread of
dengue. It mainly spreads in urban and semi-urban areas where solid
waste management is poor. Deficient water supply increases water storage
by people, leading to possibility of stagnant water in which mosquitoes
breed, including those that spread dengue and chikungunya.”
Number of cases and deaths reported in recent years
| Disease |
2008 |
2009 |
2010 |
2011 |
2012 |
2013 |
| |
Total
cases |
Deaths |
Total
cases |
Deaths |
Total
cases |
Deaths |
Total
cases |
Deaths |
Total
cases |
Deaths |
Total
cases |
Deaths |
| AES |
3855 |
684 |
4975 |
799 |
5167 |
679 |
8248 |
1169 |
8344 |
1256 |
7478 |
1270 |
| Dengue |
12561 |
80 |
15535 |
96 |
28292 |
110 |
18860 |
169 |
50222 |
242 |
75454 |
167 |
| Malaria |
|
|
|
|
1599986 |
1018 |
1310656 |
754 |
1067824 |
519 |
836916 |
359 |
| Kala-azar |
33598 |
151 |
24212 |
93 |
29000 |
105 |
33187 |
80 |
20600 |
29 |
13827 |
20 |
| Chikungunya |
95091 |
|
73288 |
|
48176 |
|
20402 |
|
15977 |
|
18639 |
|
| Enlarge View |
Malaria
Pf: Plasmodium falciparum, a parasitic protozoan. It causes the most
dangerous form of malaria in which mortality is the highest.
Pv: Plasmodium vivax, a parasitic protozoan, is the most common cause of malaria. Fatality rate due to Pv is very low.
Kala-azar
- Five countries—India, Sudan, Nepal, Bangladesh and Brazil—account for 90 per cent of the global cases.
- In
India, Nepal and Bangladesh, kala-azar is found in 111 districts: 45
districts in Bangladesh, 54 districts in India and 12 districts in Nepal
- In India, it is endemic in Uttar Pradesh, Bihar, West Bengal and Jharkhand
- Over 80 per cent of all cases are reported from Bihar
Lymphatic filariasis
- India has 40 per cent of the global burden
- Present in 20 states and Union territories
- In 2004: High rate of incidence was reported in 174 districts. It decreased to 64 districts in 2012
Dengue
Case fatality ratio is the number of deaths per 1,000 diagnosed cases
Japanese encephalitis
