Report on Malaria Prevalence Survey in Jhapa 2008 with Preliminary Results Ba h u n d a n g i Sh a n t i na g a r Kh u d u n a b a r i Bu d h a b a r e Ar j un d h a r a Sanischare MechinagarN.P. Dhaijan Da m a k N. P. Su r u n g a Sa t as i dh a m Anarmani La k h a n p u r Gh a i l ad u b b a Duwagadhi Ch a r p a n e Jy a m i rg a d h i To p g a c h c h i Sh i v ag a n j Garamani Dh a r a m p u r Dangibari Ch a n d r a g a d h i Ga u r a d a h a Ha l di ba r i BhadrapurN.P. Ma h a r a n i jh o d a Sh a r a n a m a t i Ch a k c h a k i Pa n c h g a c h h i Go l dh a p Ko h a b a r a Ma h e s h p u r Ju r o p a n i Ba i gu n d h u r a Ma h a b h a r a Ta g a n d u b b a Ja l t h a l Ra j g a d h Pr it hi vi na g a r Kh a j ur g a c h h i Ku m a r k h o d Ko r o b a r i Ga u r i ga n j Ba l u b a r i Ba n i y a n i Gh e r a b a r i Pa t ha r i ya Pa t ha m a r i Ke c h a n a Ministry of Health and Population Department of Health Services District Public Health Office, Jhapa, Nepal 1 Foreword Malaria is still one of the major public health problems in Jhapa. There is always a place in the system for review of the program and its strategy in time to time on the basis of situation of affected population. So, a scientific study is necessary to be conducted in between certain time intervals in the program. District Public Health Office (DPHO) has conducted a survey with the objective of finding out the prevalence of malaria and underlying malarial problems by age, sex and ethnicity in the district. The study was undertaken from September to October 2008. There was one Plasmodium mixed case detected among 3905 and also 14 malarial cases were reported within 3 months period in the study. That is significantly lower than the year of 2006. With this data we can say that the trend of prevalence of malaria is decreasing in Jhapa. I would like to thank to DoHS, Epidemiology and Disease Control Division, Global Fund (GFATM) and Eastern Regional Health Directorate for technical guidance and financial support. I also would like to thank to all of my research team who have worked hard in their field work. Nawa Raj Subba Senior Public Health Administrator 2 Contents S.No. Contents Page No. 1 Background 5 2 Statement of the Problem 6 3 Rational of the study 8 4 Objectives of the Study 8 5 Methodology 9 6 Findings 11 7 Discussion 23 8 Conclusion 24 9 References 29 10 Annexes 25 3 Acronyms CBO : Community Based Organization CBS : Central Bureau of Statistics DPHO : District Public Health Office EDPT : Early Diagnosis and Prompt Treatment INGO : International Non Governmental Organization NGO : Non Governmental Organization P : Plasmodium RBM : Roll Back Malaria VDC : Village Development Committee WHO : World Health Organization 4 Malaria Prevalence Survey in Jhapa 2008 1. Background Malaria is one of the oldest diseases. It was known to the ancient Greeks with its typical symptoms of fever, chills and headache. It was treated with various herbs and even with mantras (black magic). In earliest days, the causative factors of the disease thought to be bad air, bad water, bad weather, swampy area in the terai region, etc. Some of the herbs used for treatment were cinchona bark, chiraita, titepati1. Malaria has infected humans for over 50,000 years and may have been a human pathogen for entire history of our species. Malaria is a vector borne infectious disease cause by protozoan parasite. It is wide spread in tropical and Africa. Each year there are approximately 515 million on cases of Malaria is commonly associated with poverty but it is also a cause of poverty and a Major hindrance to economic development. Malaria is one of the most common infectious diseases and a public health problem. The disease is cause by protozoan parasite of the genus plasmodium. Only the four type of plasmodium can infect the human. The most serious forms of the diseases are cause by Plasmodium Falciparum and Plasmodium Vivex but other related species, P. Ovale, P.Malariae can also affect humans. P. ovale, P.Malariae are not found in Nepal. This group of human pathogenic plasmodium species is usually related to as Malaria Parasites. Malaria Parasite is transmitted by infected female Anopheles Mosquito. The parasites are multiply with in Red Blood Cells, causing the symptoms that include the symptoms of anemia (shorthorn of breath, tachycardia) as well as the general symptoms such as fever, chills, nausea, flue likes illness and in severe cases , coma and death. In Nepal, malaria has been called by different names- judi tap (hot chills), and judi-bukhar (fever of swampy area), and kam jwaro (shivering fever) in hilly region1. The malarial control program in Nepal was initiated in 1954 through the Insect Borne Disease Control Program supported by USAID. In 1958, the malarial eradication program, the forst national public health program in the country was launched with the objective of eradicating malaria from the country. Due to various reasons above objective could not be achieved and consequently the eradication concept was reverted to control program in 1978. Following the call of WHO to revamp to malaria control programs in 1978, Roll Back Malaria (RBM) initiative was launched to address the perennial problem of malaria in hard core forested, foot hills, inner terai and hill valley areras. Government of Nepal has set objectives2 in malaria program as reduction of malaria morbidity by 50 percent by the year 2010 (baseline 2002), prevention of mortality due to malaria by 90 percent, prevention and control of epidemics (P. falciparum), and community mobilization and partnership. Likewise strategies are early diagnosis and prompt treatment (EDPT), integrated vector management, outbreak management and strengthening district laboratories. 5 Jhapa is a district having a population 688,109 according to census undertaken by CBS 20013. Jhapa has got Human Development Index4 (HDI) as 0.578. Jhapa also has vast areas of forests, such as Deonia, Charali, Charkose Jhaadi, Hadiya, Sukhani, Jalthal, and others. It's name itself is derived from the Rajbanshi word "jhapa" meaning "canopy", which suggests that the area was a dense forest in the past. It was once such a dense and dangerous forest that it was called Kaalapaani and prisoners were sent here to die of malaria and other diseases in the jungle5. Jhapa district falls under sub-tropic zone where summer is very hot snd winter cool. Mansoon brings rainfall. Temperature ranges from to degree celcius. Jhapa receives 250 to 300 cm of rainfall a year, and mostly during the monsoon season in the summer, and its hilly northern area receives more rainfall than the south. Its major rivers, like the Mechi River, Kankai Mai, Ratuwa, Biring, Deuniya,(Aduwa), (Bhuteni)(Dhangri), Hadiya, and Ninda,Krishne Khola, Gauriya, Ramchandre etc provide water for irrigation. Due to its alluvial soil best suited for agriculture, Jhapa has been the largest producer of rice and is therefore known as the Grain Grocery of Nepal. Besides cereal crops like rice and wheat, it is also one of the largest producers of jute, tea, betel nut, rubber and other cash crops. There are 47 VDCs and 3 municipalities in Jhapa . VDCs are as Anarmani, Arjundhara, Bahundangi, Baigundhara, Balubari, Baniyani, Bhadrapur, Budhabare, Chakchaki, Chandragadhi, Charpani, Damak, Dangibari, Dhaijan, Dharmpur, Dhulabari, Duhagadhi, Garamani, Gauradaha, Gauriganj, Ghailadubba, Gherabari, Golchhap, Haldibari, Jalthal, Juropani, Jyamirgadhi, Kakadvidta, Kechana, Khajurgachhi, Khudnabari, Kohabara, Korabari, Kumarkhod, Lakhanpur, Mahabhara, Maharanijhoda, Maheshpur, Mechinagar, Panchganchi, Pathabhari, Pathariya, Prithivinagar, Rajghadh, Sanischare, Satasidham, Shantinagar, Sharanamati, Shivaganj, Surunga, Taganduba, and Topgachchi. Municipalities are Damak, Mechinagar and Bhadrapur. 2. Statement of the Problem At present about 100 countries in the world considered as malaria affected countries. More than 2.4 billion of the world populations are still at risk. The incidence of malaria worldwide is estimated to be 300-500 million clinical cases each year. Malaria is thought to kill between 1.1 to 2.7 million people worldwide each year of which about 1 million are children under the age of 5 years. These childhood deaths resulting mainly from cerebral malaria and malaria also contributes indirectly to illness and death from respiratory infections, diarrhea diseases and malnutrition. Malaria cases in south east Asia Region have remained static and about 2.6 million cases were reported during 2000, although the estimates fluctuates between 20-23 million. An estimated 1.3 billion people or 85% of total population of south east Asia region are at risk of malaria 30% of this population lives in areas with moderate to high risk of malaria, mainly in India, Myanmar and Thailand.