5L4 JounNel oF THEAvnRrcex Mosqurro Corrlrnor,AssocrerroN VoL.5,No.4

COMMUNITY BASED BIOENVIRONMENTAL CONTROL OF MALARIA IN DISTRICT, ,

V. P. SHARMA rNo R. C. SHARMA

Malaria ResearchCentre (ICMR), 22 Sham Nath Marg, Delhi-110 054, Indin

ABSTRACT. A study on the bioenvironmental control of malaria was launched in 1983 in taluka, Gujarat, with help of village communities. The implementation of strategy resulted in the successfulcontrol of lawal mosquitoesand reduction in the adult vector populations, and the impact was visible in the curtailment of malaria transmission in large rural areas.When compared with the residual spraying of insecticides under the National Malaria Eradication Programme, the alternate strategywas found feasible,socially acceptable,cost effective and brought about environmental improve- ment and awarenessin the rural areas.

laria control, and (2) develop a cost-effective INTRODUCTION model for extension to other similar areas. Re- The strategy of intradomicilary application of sults of this study are reported in this paper. residual insecticidesto interrupt malaria trans- mission is beset with many problems such as MATERIALS AND METHODS insecticide resistance,operational failures, lack of collateral benefits, environmental contami- Study sites:The study was initially launched nation and high refusal rate to spraying.In some in July 1983 in 7 villages with a population of areas mud plastering soon after spraying and about 26,000(desigtrated as complex A) and one fear ofadverse impact on cottageindustries such village was held as control. During 1983 suffi- as silk culture and beekeeping,exophilic vector cient ground work had been done to monitor the behavior and the misuseofinsecticides. etc. also impact of antilarval and anti-parasitic measures createproblems (Sharma et al. 1986). beginning from 1984. In 1985 the experiment The problem of malaria control is com- was gradually expandedto 14 more villages (des- pounded by resistanceof the Plasmodium fal.ci- ignated as complex B, population 34,000),and parumparasiteto aminoquinolines.It is perhaps during this period 3 villageswere held as control. possibleto spray residual insecticidesin malaria Until this time all the experimental and control control for some years to come, but eventually villages were monitored to study the impact of the stratery would have to be curtailed because intervention measures.The target area was ex- of social unacceptability and the high cost of panded to cover the entire Nadiad taluka com- insecticides.At present,the governmentof India prising an additional 79 villages (complex C) is spending about 45% ofthe health budget (ca. with a population of 290,000in 1986.During the US $57million) annually on malaria control, period, 5 villages in 5 surrounding talukas were and an additional equal amount is contributed held as control and impact of intervention was by the state governments.There is therefore an monitored in the 3 complexesof Nadiad using urgency to search for alternatives to spraying 10 indicator villages.During 1987the study was that would not only tackle the many faceted further extended to cover Kapadwanj taluka technical problems but would also be environ- comprising an additional 350,000 population. mentally safe and cost-effective.The alternate During 1987, 5 indicator villages were shifted strategy known as the bioenvironmental control from Nadiad to Kapadwanj taluka; thus, the of malaria was conceivedas a holistic approach total indicator villages remained at 10 although to malaria control on a sustainablebasis incor- population coverageincreased from 0.35 to 0.7 porating environmental improvement and in- million (Fie. 1). At present the work is being incomegenerating schemes (Sharma 1987). The consolidatedbefore undertaking further expan- purpose of this malaria control model was two- sion of the field work. fold; first, as and when the incidenceof malaria The was selected becauseit would go down, people's interest in vector con- was endemic for malaria with a high malaria trol would be sustained as part of the overall incidencefor severalyears as comparedto other developmental process; and second, enhanced districts of Gujarat. The studyvillages in Nadiad income of Panchayats (village councils) could taluka (subdivision of a district) had an ex- be used in vector control, as also the improved tremely high malaria incidencein the preceding economy would help fight the disease better. years with reports of deaths due to malaria. The field study was launched with the main There was evidence of DDT, HCH and mala- objectivesto: (1) demonstratethe impact of bio- thion resistancein the vector Anophel.esculici- environmental vector control methods in ma- /oclesGiles. Although the areaswere under reg- -eRreCowrRor, ru Gu.llner 515

a NADIAD TALUKA rL) -.'l ,-..:'-.L- t\t lo I" by j.

oft KAPADWANJ POP: O.34 MILLIONS oi t I( o{t

. PHASEA o PHASE B o PHASEC

Fig. 1. Location of: (a) Kheda district in Gujarat, (b) Nadiad and Kapadwanj Taluka and the project extension to Mehemadabad Taluka, (c) complex A, B and C villages in Nadiad. Note: Control villages K1 1984, K2 1985, K3 1986-187. Monitoring was done in all villages of complex A in 1984, complex A and B in 1985 and villages 1-10 in 1986 and in 1987 in villages 1-5 in Nadiad and 6-10 in Kapadwanj.

Table 1. Composition of anophelinesin the experimental villages. 1984

Control Experiment Control Experiment Control Experiment Control Experiment Speciesl (1)' (7) (3) (21) (5) (10) (5) (10) An. culicifacies 6.1% 4.74Vo 25.47a 4.4Vo 2.3Vo 1.53% 4.35% 2.54% (9.80)3 (87.78) (4.76) (11.76) An. stepherci 0.30% O.l1Vo o.a% o.t2vo 1.8% 0.4tvo o.55vo l.09Vo (3.66) (16.52) (r1.60) (?.40) An. annulnris 8.00Vo 4.967o 5.44% 3.25Vo 3.0r% 0.66vo 2.177o 1.35% (13.85) (13.37) (15.33) (7.42) An. subpictre 84.5r% 90.65% 67.90Vo 92.L8% 92.73% 97.34% 92.87Va 95.0OVo (17.89) (84.71) (18.21) (10.62) Total no. checked 12,446 71,984 15,954 73,156 12,023 t6,272 33,348 25,648 I Other anophelineswere negligible.Above results are basedon total mosquitoescollected during monitoring of populations. ' No. of villagesare given in parentheses. 3z-values, significant at l% level.

ular insecticidal spraying with HCH or mala- 1). Breedingof An. stephensiwas restrictedto thion, people of the area suffered from repeated intradomestic containers and wells whereasAn. attacks of malaria. Initial surveys showed that culicifacieshad extensivebreeding grounds.The somevillages were locatedin low lying areasand most preferred breeding sites of An. culicifacies there wereinnumerable larval mosquito habitats were rain water puddles, river bed borrow pits, such as ponds, seepagewater, intradomestic and irrigation channels, hoof prints, rice fields and peridomestic sites, drains, rivers, canals, wells, other clean water collections.Anopheles subpic- borrow pits, puddles,hoofprints and rain water tus breedsin almost everyplace such as all types pools,etc. The anophelinefauna consistedof 16 ofponds, seepagewater, wells and rice fields. At species,of which An. culfuifacies and An. ste- most places,mixed breedingwas encounteredin phensi Liston, were the primary and An. annu- which An. culicifacieslarvae were found in small LarisYan der Wulp, secondary vectors of ma- numbers.Anopheles stephensi was found breed- laria. In comparing the results of experimental ing in wells and the intradomestic containers. areas with control, it was revealed that there Culexbreedingwas mainly confined to stagnant was reduction in the proportion of vector popu- polluted water, wells and ponds.Anophel.es sub- lations at the expenseof An. subpirtus Grassi. pictus is not a vector (Rao 1984), but was the This was found significant for each year (Table most prominent speciesand constituted about 516 JouRuer, oF THE AvpRrceN Moseurro CoNrRor, AssocrerroN VoL.5,No.4

907oofthe anopheline fauna. In addition,Culex 120 quinquefasciarlusSay was commonly encoun- tered in almost all types of waters. Adult mos- { quitoes densities were monitored by the suction

tube method. For this purpose a 15 min collec- o tion was made from one room, and a total of 2 @ human and 2 mixed dwellings and 2 cattle sheds weresearched in eachvillage. = +---+ coNTR0L Interuention strdtegy and some results: The 20 following antivector and antiparasitic measures H EXPERIMENTAL 0 were integrated to control malaria under the Jon Fab Mor Apr Moy Oct Nov Occ bioenvironmental control strategy. I 1987 1. Sourcereduction and larual control: Breed- Fig, 3. Mosquito breedingpositivity in wells with ing in intradomestic containers was checkedon guppies. a weekly basis,and containers found positive for breeding were emptied or destroyed. In water troughs used for washing clothes and also a tially repaired by the project staff but main- sourceof drinking water for cattle, guppy fishes tained by the owners as a result of health edu- (Poecilia reticulata) were used, which almost cation. Flowing water on the street which sup- completely controlled larval mosquitoes. Sur- ported heavy Culet breeding was eliminated by veys showedthat about l-7Vo of the containers promoting construction of soakagepits. So far were found positive for mosquito breeding as about 2,000soakage pits have been constructed against 7-29% in the control villages; statistical which do not support any mosquito breeding. analysisshowed a significant differencebetween Major earthwork was carried out to fill and level percent breeding in control and experimental Iow lying areas, borrow pits, depressionsand villagesat the t% level t : 2.83,which was taken roadsideditches which may hold waste water or as evidencefor the effect of destruction in the rain water. Four tractors with hydraulic trollies preceedingweeks (Fig. 2). There was no adult for transporting earth are engagedin earthwork emergencefrom the containers in the experi- through village panchayats.The tractors, diesel mental villages since the larvae were destroyed fuel and driver belong to the Centre, but labor on each survey. Of the total containers positive, is supplied free by the village panchayats or An. stephensi breeding during 1986 and 1987 individuals. Reclaimed land has been brought was 82Voand,57% in experimentalvillages as under cultivation, and eucalyptus trees have against 94% and 867o in the control villages, been planted in marshy areas becauseof their respectively. Breeding in unused/abandoned high water requirement. As a result some mar- wells was controlled by the application of J.-2kg shy areashave already becomedry. expanded polystyrene (EPS) beads (R. C. 2. Biologicalconfrol Surveysofthe fish fauna Sharma et al. 1985).Wells treated with EPS of Nadiad taluka revealed that there were at beadshave been negative for mosquito breeding least 27 species of indigenous fishes. Feeding for over 3 years,and EPS beadshad to be applied tests showedthat at least 14 specieswere larvi- again only when removed by villagers for irri- vorous. The guppy, a native of South America, gation due to drought. Villages of the Kheda was introduced into India in 1908 (Jhingran district have a rural water supply. AII leakages 1985) for mosquito control. It was found in the in taps, pipeline and tube wells, etc., were ini- wild and had the maximum potential as a bio- logical control agent (Sharma et al. 1987). Guppy fishes are used extensively in all the experimental villages. In wells, guppy fishes (Poecilia reticulata\ applied at 15-20 per well wereused to control mosquitobreeding. Surveys showedthat during the year mosquito breeding positivity was reduced from 77 to 10% in the wells treated with guppies as against from 100 to 47% in the untreated wells in the control area (Fig. 3). For an effectivecontrol of breedingin the ponds, margins were kept clean to enable the fishes to feed upon the larvae on the edges. Guppiesare being massproduced in the villages JFMAM.J J ASOND.J FMAM J JA SONDJ FMAM J JASOND I tg8s | 1986 | 1987 | in a variety of ponds and cement tanks that Fig. 2. Positivity of intradomestic containers for otherwisewould lie abandonedand provide mos- mosquito larvae. quito breeding sites, particularly during and Mer,enrl CoNrRor- rN Gu.lnRer 5t7

after the rains. At present 94 hatcheries have and other developmentaland income generating been established by the project in the village schemes. ponds with an estimated stock of 20 million 5. Enuironmental irnprouement and income guppies.The fishes multiply in the ponds with- generating schernes:During the intervention out any efforts or input at a negligible cost in phase a dumping ground with borrow pits sup- way of supervision. All requirements for larvi- porting heavy mosquito breedingwas cleanedby vorous fishes are met from these ponds. motivating village youths and converted to a 3. Surueillance and treatnxent: Weekly sur- playground. In many arcas Eucalypfus were veillance was organized by the project staff to planted to convert marshy areas into dry land. detect all parasite positive casesthrough house Waste land was used to promote social forestry to house visits and antimalarials were admin- with the objective to make the land productive istered based on recommendations from the and increase income of the panchayats. So far National Malaria Eradication Programme about 1 million saplings of all types including (NMEP). Blood smearswere prepared from fe- Euralyptus (24.7%)were planted with the as- ver casesand given 600 mg chloroquineas pre- sistance of the panchayat and forestry depart- sumptive treatment. The slides were brought to ment. In addition, decentralized nurseries the laboratory, stained and examined for the funded by the NWDB were encouraged;and presenceof malarial parasites. Results of slide during 1987,270,000 trees were donatedfor farm examination were communicated within 48 h, forestry. During the last 2 years about 3,000 and all parasite positive caseswere given a rad- improvedchulhas (wood stoves) were installed, ical treatment. This comprised an additional and other sourcesof alternate energl such as dose of 900 mg chloroquine in divided dosages solarcookers and bio-gasplants werepromoted and 45 mg primaquine (gametoc5rtocidal)for P to prevent deforestation. Ponds infested with fal.ciparumand 75 mg primaquine (anti-relapse) water hyacinth support mosquito breeding on at 15 mg/day for 5 days to P. uiuax cases.Chil- the margins since the denseweed cover doesnot dren were given proportionately lower dosages. support fish survival. AIso the drying and reced- P Lasmodiumf alciparurn recrudescences were ad- ing ponds producedinnumerable puddles pro- ministered 2 tablets of Metakelfin and 45 mg tected by hyacinth. These inaccessiblemarshy primaquine. areas become important Culex brceding sites, 4. Health edu.catinnand community partici- and there was no simple method to control mos- pation: Peoples'participation through health ed- quito breeding. Therefore, all ponds infested ucation received maximum emphasis. In order with water hyacinth were cleanedmanually at a to educateall sectionsof the village, community cost of about Rs. 70,000(US $4,700).Panchay- health camps were organizedand interpersonal ats sharedthe expenditureto the extent of about discussionswere held in all villages,intervention 40-60%.This has eliminated a major Culexpro- measures were exhibited and demonstrations duction site and enriched the ecology.For the were arranged in schools and market places. first time, flamingos were sighted in Nadiad Folders, charts, pamphlets and other health ed- taluka in almostall ponds.In addition,ponds of ucation material was prepared and distributed. 3-5 ha were converted to the production of In addition, TV prepared at least edible fishes like the Chineseand common carp 10 short video films, and these were periodically on experimental basis; e.g.,4 ponds taken from telecast. These activities produced tremendous the villages in complex-A producedfishes of Rs. positive responsesfrom the communities. Fe- 1.0lakh (US $6,700)in 1986and 1.7Iakhs (US male health visitors arranged special meetings $12,000)in 1987.Although carps are larvivorous on a routine basis to educate women, children in their juvenile stages,carp rearing was intro- and people of low socioeconomicstatus. As a duced primarily as a means to increaseincome result, large numbers of people participated in of the panchayats. Money collected from the vector control work individually and in groups sale of fishes was diverted for vector control (known as Shram dan) to carry out major earth- work by hiring labor for the earthwork, and in work. Patients with fever started to approach one village an underground sewerwas laid. our staff for blood examination. People who 6. Inter-agencycooperatiou In the implemen- could not participate in our activities made cash tation of various programs, help and technical donations for vector control, and so far Rs. 2.5 advicewas solicited from various agencieswork- lakhs : US $17,000has been received.Com- ing in the area, such as the departments of munities also participated in the social forestry health, social forestry, irrigation and drainage, programwhich consistedofplanting treesin the fisheries,Gujarat energy developmentand pan- waste land belonging to panchayats and also chayats, etc. At present, all activities in the farm forestry under the decentralizednurseries experimental areas are being carried out by the schemeof the National Wasteland Development project staff. It is envisagedthat as and when Board (NWDB) of the governnment of India, the program is implementedby the state govern- 518 JounNer,oF THEAnrpRrcaN Moseurro CourRor,Assocrerrou VoL.5,No.4 ment, other departments would directly partic- application was not producing the desired re- ipate through a coordinating agency in preven- sults. The impact of intervention measureswas tive and corrective measuresrelated to disease visible in the reduction of total water surface vectorcontrol. area inside the village and in the agricultural fields, Mosquito breeding in houses and peri- was almost completely RESULTS AND DISCUSSION domestic containers eliminated. Well breeding was completely sup- In India resurgenceof malaria started in the pressedwith the help of EPS beads, although late 1960s,and malariacases increased from 0.1 some breeding was found in used wells treated million in 1965to 6.5 million in 1976 (Sharma with fishes. Breeding was however occasionally 1984).Reasons for this resurgencewere identi- encounteredin somepermanent ponds along the fied as technical, financial and administrative shallow margins, but its intensity was greatly (Sharmaand Mehrotra 1982).Following resurg- reduced in most areas. Together, these sites ence,malaria outbreaks including deaths due to produced considerable mosquito populations, malaria have been reported from many areas and therefore control of vector specieswas em- (Sharma et al. 1984, 1985; Chandrahas and phasized as far as possible. As a result, there Sharma 1983,Ansari et al. 1984,Malhotra et al. was significant reduction in man-hour collec- 1985).One sucharea with outbreakswas a group tions of An. culicifaciesfrom 1984 to 1987 (Fig. of villages in Nadiad taluka, Kheda district, in 4), and Anopheles stephensi populations were which DDT and malathion were being sprayed reduced to very low numbers. The antilarval to contain transmission (Sharma et al. 1986). measutesadopted also resulted in considerable There were no suitable replacementinsecticides reduction in the densities of other anophelines available at affordable prices that could be used and Culex mosquitoes.Anopheles subpictus pop - in place of malathion; thus, this situation was ulations remained high throughout the year and unlikely to improve. As a result, our interest in the impact of minor engineering works on An. the control of malaria by the biological and subpictuswas visible only during the peak den- environmental management methods was rea- sity period in Septemberwhen the experimental wakened.Even a cursory review ofliterature on villages had densities,e.g., 150 to 200 man-hour this aspect of diseasevector control shows in- density (MHD) as against 300 to 400 MHD in numerable examples of successful control by the control villages.The differencewas found to environmental management methods through- be statistically significant atthe IIVo level (t: out the world, beginning from the classicalwork 7.77, for 1987). This was mainly due to innu- on malaria control by Sir Ronald Ross (1910). merable breeding sites available including the Other notable examples are malaria control in ricefields in which 80-97% of the immatures the USA in the TennesseeValley (TVA 1947, were comprisedof An. subpictusand ca. 5% An. Gartrell et al. 1981),in Malaysia(Field and Reid culicifacies. 1956) and Indonesia (Snellen 1987), and the Weekly active and passive surveillance was control of dengue hemorrhagic fever in Singa- sponsoredby the project since the inception of pore (Chan and Bos 1987).There are several the study. Annual blood examination rate examplesof successfulmalaria control from the (ABER) varied from 30 to 45% in all the 3 earlydays in India, viz.,malaria control in Bom- complexesas against 10%usually targetedbased bay (Vishwanathan 1950), antimalaria opera- on fortnight surveillance under the program tions in irrigated areas by Clyde (1931) during (NMEP). Higher ABER in projectarea ensured the Sarda canal construction, malaria control in the Irwin canal project (Rao and Nassiruddin 1945) and the Cauveri-Mettur project (Russell and Knipe 1942).Other examplesinclude con- trol of rural malaria caused by An. fluuiatilis 30 James by de-weeding(Vishwanathan, 1946), 61. growing shade-lovingplants over the tea garden drains to control An. minimus Theobald (Covell E 1955)and recentexamples of malaria and filar- o- iasiscontrol by Sharma(1987), Dua et al' (1988) I z10 and Rajagopalanet al. (1987).The implemen- : tation of bioenvironmental control methods, 5 vector control by the integrationof biolog- viz., 0 ical control methods and environmental modi- i rvavr.tlsoro'lrvAMr TasoNDJFMAMJ JASoNDJFMAMJJA5oN0 rg8r I rgss 1 19sG I tssz I fication and management methods in Nadiad I taluka of Kheda district produced encouraging Fig. 4. Density of adult Anopheles culicifaciesin results particularly at a time when insecticidal human dwellings,Nadiad. DEcEMBER1989 MALARIA CoNrnol Itt Gu.llnar

Table 2. Spray history and malaria cases(Kheda district).

Rural areas outside experimental Nadiad taluka complex villages of Kheda district B Spray spny Spray Spray Year history +ive/Pf history +ivelPf history +ive/Pf history +ive/Pf 1981 HCH/MAL 3,534/685 HCH/MAL r,9r0/34 HCH/MAL 11670/303 HCH/MAL 66,884/1,403 1982 HCH/MAL 2,080/e3 HCH/MAL 2,022/8 HCH/MAL rr,27r/r3r HCH/MAL 51,460/869 1983 DDT/HCH 418/89 DDT/HCH 474/4 DDT/HCH 3,253/54 DDT/HCH 28,247/r,045 1984 BC 14r/64 DD"I/BHC/ L37/39 DDT/BHCI r,274/32 DDT/BHC/ L6,422/635 MAL MAL MAL 1985 BC 68/28 BC 86/24 DDT/MLL 906/187 DDT/MAL 6,585/428 1986 BC 62/30 BC 68/16 BC 496/165 No spray 7,753/r,400 1987 BC 230/50 BC 177/56 BC 880/265 No spray t4,257/t,744 Source:NMEP. BC, Bioenvironmental control. 1+ivelPf-Total millions/ Plasnodium falniparum cases, detection of more malaria cases,although radi- sincethe start of the experiment.During 1987 cal treatment alone in such areas has not there has been an increase in malaria casesin brought down transmission to very low levels Nadiad taluka. Similar increaseof a little higher over the years. As an example,in Rameswaram magnitude was recorded in all the surrounding island the ABER is generallybetween 50 to 607o; areasunder insecticidal spraying.The slide pos- and it was I29Vo duting the 1979 epidemic,but itivity rate (SPR) of Nadiad and its 6 surrouding persistent transmission was maintained in the talukas (seelocation in Fig. 1) is given in Fig. 5. island in the successiveyears (Chandrahaset al. It may be noted that the district was under DDT 1984).Table 2 gives the spray history and ma- and malathion spraying since at least 1961,but laria casesin the experimental areas of Nadiad no spraying was done in 1986.In 1987 all rural taluka and rural areas of the entire Kheda dis- areas were sprayed except the Nadiad and Ka- trict. It should be pointed out that Kheda dis- padwanj experimental talukas. Kapadwanj ta- trict had experienced an epidemic of malaria luka was included in the experimental area in before the start of experiment; i.e., in Nadiad 1987.The slide positivity rate in Nadiad showed taluka there were 17.114 cases in 1981 and a decliningtrend until 1986and an increasing 15,373cases in 1982.At that time, in Nadiad trend in 1987.This increasein SPR,if compared taluka some villages were sprayed with HCH with neighboring talukas, revealedthat in some and some with malathion. In subsequentyears insecticide-sprayedtalukas the increasein SPR DDT was sprayed,and there was a considerable was significantly large as compared to Nadiad reduction in malaria cases,This reducedtrans- and Kapadwanj talukas. In other sprayed talu- mission was perhapsthe combination of various kas the SPR remained similar to Nadiad or factors such as the natural decline during the Kapadwanj. The study therefore showed that postepidemic period (in this region malaria bioenvironmental control strategyproduced sat- peaksat an interval of 5 to 7 years) and may be isfactory results when comparedto insecticidal perhapsdue to better performanceof DDT (sus- spraying in terms of malaria control. The strat- ceptibilif data are not available) as it was not ega therefore succeededin maintaining trans- sprayedfor severalyears. In addition, poor sur- mission at low levels as envisaged,which was veillance may have masked some of the inci- otherwise possibleto a certain extent by spray- dence.In areaswhere bioenvironmental control ing the residual insecticides.It should be men- was implemented, the incidence of malaria was tioned that the spraying technique loses its ef- greatly reduced. When these data were com- fectivenessover a period of time due to insecti- pared with talukas outside the experimental cide resistance and social unacceptability, but areas,there was a parallel reduction in villages the impact of the alternate strategy increases under DDT spray. Therefore, it may be con- with the passageof time as more and more areas cludedthat the strategy of bioenvironmental vs. becomefree from mosquito production as a re- the spraying was comparablein its effectiveness sult of environmental modification. during the declining or interepidemic period. Gujarat state had undergoneserious drought This period may be 5 to 7 years or more, and its conditions for severalyears until 1987,and there impact during epidemic or ascending malaria waspopulation movementfrom drought affected trends could not be ascertainedas the epidemic areas to the Kheda district. Random checks of situations are now building up for the first time migrant populations showed 30-40 SPR, and JouRNar,oF THE AvsnrcaN Moseurro CoNrRor, AssocrerroN

60 s0 Pettqd

_40 (L hJ3 Motor F <3 E

F ; F2 a Nod od Thos.o Molor M bod Kwonl Anond Pstlod s.no. Eorsod Comboy Anond o (Tolukosof Khedodistrict) (L etrj Nodiod (n'lJ Thosro

Mehemdobod

0 r985 1986 t987 Fig. 5. Impact of intervention in Nadiad and neighboring talukas. In 198? Kapadwanj taluka was also included in the experimental area. Malaria incidence was highest in Nadiad before the project was launched (seeinset). Note that malaria was contained in Nadiad and Kapadwanj without insecticidal spraying.

Table 3. Actual cost of malaria control per million population in lakh rupees. Bioenvironmental* DDT HCH Malathion Pay and allowances 43.00 27.19 27.r9 27.L9 Capital (depreciation) 5.50 Antimalarials r.20 1.20 7.20 1.20 Insecticides 34.00 37.00 199.00

Total 49.70 62.39 65.39 227.39 * Calculation basedon 0.7 million population currently under protection.

6O% of these were P. falciparum and,40% P. methodhas many collateralbenefits which can- uiuor. Although the migrant population was not not be easily expressedin monetary terms. Be- included in Table 1, there is a strong possibility causeof the promising results of the Kheda of enhancedindigenous transmission and that a experiment,the strategywas launchedin phases large number of cases may have gone unre- at 9 other sites in the country in a mission mode corded. Another peculiar feature was a sudden under the scienceand technology project of the spurt of P. uiuaxin the Iast quarter of 1987when government of India. Each of these sites repre- usually P. falciparum peaks. Reasons for this sents a different type of malaria problem. Re- phenomenon are not very clear but may be the sults of the scienceand technology project will result of drought conditions or migration. The determine the future applicability of the bio- experiment is continuing to study the impact of environmental control of malaria in different alternate strategy during epidemic situations malaria endemic zonesof the country. and dynamics of malaria transmission. Costwise,a straight comparisonof actual cost CONCLUSIONS of malaria control by the two methods showed that per capita cost by the bioenvironmental 1. Bioenvironmentalcontrol of malaria so far strategywas lowest,as shown in Table 3 (Anon- has shown that the strategy is effective in the ymous 1987).In addition, the bioenvironmental control of malaria in comparisonto the spraying, DECEMBER1989 Mnr,nRrlCoNrnor. rN Gu.rener at least during the interepidemic period which A three year report of the malaria clinic in Hald- may be an interval of 5 to 7 years or more. wani. district Nainital. U.P. Indian J. Malariol. 2. The strategy has very high social accepta- 22:.123-726. Rajagopalan,P. K., K. N. Panicker and P. K. Das. bility and provides severalcollateral benefits to 1987. Control of malaria and filariasis vectors in the society. SouthIndia. ParasitologyToday 3:233-241. 3. In comparison to residual spraying of in- Rao, B. A. and M. Nassiruddin. 1945.Malaria in lrwin secticides, bioenvironmental strategy is the Canal area, Mysore state. Part II. J. Malaria Inst. cheapestmethod of malaria control. India 6:109-128. 4. Malaria control should be primarily based Rao, T. R. 1984. The anophelines of India. Malaria on the bioenvironmental control strategy fol- ResearchCentre, Delhi. Iowedby a limited role for insecticides.Residual Ross,R. 1910.The prevention of malaria. John Mur- ray, London. spraying should be applied to tackle epidemics Russell,P. F. and F. W. Knipe. 1942.A demonstration or situations not amenable to control bv the project in the control of rural malaria by anti-larval alternate strategy. measures.J. Malaria Inst. India 4:615-631. Sharma,R. C., D. K. Gupta and V. P. Sharma.1987. Studies on the role of indigenousfishes in the con- trol of mosquitobreeding. Indian J. Malariol. 24:73- ACKNOWLEDGMENTS 77. Sharma,R. C., R. S. Yadav,and V. P. Sharma.1985. We are grateful to Dr. (Mrs.) Aruna Srivas- Field.trials on the application of expandedpolysty- tava of the center for her help in the preparation rene (EPS) beads in mosquito control. Indian J. of this manuscript and for statistical analysis of Malariol. 22:107-109. data. Sharma,V. P. 1984.Drug resistant Plasmodiumfalri- parum malaria in India, p. 169-184. In: V. P. Sharma (ed.), Proceedingsof the Indo-UK Work- REFERENCES CITED shop on Malaria. Malaria Research Centre, New Delhi, India. Anonymous.1987. In-depth evaluationof the com- Sharma, V. P. 1985. Malaria: current situation and munity basedintegrated vector control of malaria future control strategies,pp. 99-114. fn; W. A. Sid- projectin Kheda(Gujarat) October, 1987. diqui (ed.), Proc. ofthe Asia and Pacific conference Ansari.M. A.. C. P. Batraand V. P. 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