Journal of Communicable Diseases Volume 52, Issue 4 - 2020, Pg. No. 1-11 Peer Reviewed & Open Access Journal Research Article An Investigation into Outbreak of Malaria in Bareilly District of Uttar Pradesh, India S Kamal1, Ramesh Chandra2, KK Mittra3, SN Sharma4 1,2,3Regional Office of Health & Family Welfare, Govt. of India, Kendriya Bhawan, 9th Floor, Aliganj, Lucknow, (U.P.), India. 4National Centre for Disease Control, MOH & FW, Govt. of India, 22, Sham Nath Marg, Delhi, India. DOI: https://doi.org/10.24321/0019.5138.202034 INFO ABSTRACT Corresponding Author: Uttar Pradesh is the largest state of India and is comprised of 75 S Kamal, Regional Office of Health & Family revenue districts. It has vast area of 243,286 km² and 230 million Welfare, Govt. of India, Kendriya Bhawan, 9th population (199.81 million as per 2011 census) with population density Floor, Aliganj, Lucknow, (U.P.), India. of 828 persons per km². The topographical & environmental conditions E-mail Id: including availability of rich irrigation facilities provide congenial [email protected] conditions for development of different vectors transmitting various Orcid Id: diseases. All the six Vector Borne Diseases (VBD) namely malaria, https://orcid.org/0000-0002-3358-1572 dengue, Chikungunya, Japanese Encephalitis (JE), Kala-azar & Lymphatic How to cite this article: filariasis are prevalent in Uttar Pradesh and are now modifiable in the Kamal S, Chandra R, Mittra KK, Sharma SN. An state since 2016. Among these, malaria, JE, dengue etc. are epidemic Investigation into Outbreak of Malaria in Bareilly prone and claim lives during outbreak, if remained unattended in light of District of Uttar Pradesh, India. J Commun Dis the NVBDCP operational guidelines. During July/ August, 2018, district 2020; 52(4): 1-11. Bareilly experienced outbreak of malaria, which claimed several lives according to various reports appeared in the media. A team of Officers Date of Submission: 2020-09-11 from Regional Office for Health & Family Welfare (ROH & FW), Lucknow Date of Acceptance: 2020-12-09 visited Bareilly district of UP during September, 2018 to assess the various factors responsible for the present outbreak and to guide & support the district health authorities for proper implementation of the various intervention measures to contain the outbreak. The detailed investigations revealed that the reasons for outbreak may be assigned to the excessive rainfall in the district, poor surveillance due to inadequate number of peripheral health workers, lack of laboratory facilities and improper monitoring & lack of timely actions. The screening of people for malaria with bivalent antigen based RDT kits reflected high malaria positivity bothPlasmodium vivax (P.v.) & Plasmodium falciparum (P.f.) incidence but no fever related death was confirmed due to malaria. Keywords: Malaria outbreak, Plasmodium vivax, Plasmodium falciparum, RDT Kits, Slide Positivity Rate, Annual Parasite Incidence Introduction with population density of 828 persons per km.² About two third population resides in rural areas and mainly Uttar Pradesh is the largest state of India and is comprised depend on agricultural practices as the Indo - Gangetic of 75 revenue districts. It has vast area of 243,286 km² and plain is contributing a lot in the fertile agricultural region 230 million population (199.81 million as per 2011 census) for the development of not only the state but India as Journal of Communicable Diseases (P-ISSN: 0019-5138 & E-ISSN: 2581-351X) Copyright (c) 2020: Advanced Research Publications Kamal S et al. J. Commun. Dis. 2020; 52(4) 2 a whole. Since this area is traversed be a number of big for malaria action programme in the country in 1995 and1 & small rivers, provide good opportunity & facility for Moreover, the process indicators were developed, which irrigation of the crop fields. The co-lateral outcome of gave the details of various processes to be carried out at the irrigation facility led to the public health problem each level from primary health care to the top most level as every third person suffered due to malaria with high as well as assessment parameters to evaluate whether mortality & morbidity prior to the independence. The the implementation is going in right track or not,3 when National Malaria Control Programme (NMCP) was launched the disease has been planned for elimination from the in 1953 with organized control efforts by performing Indoor country.7,8 Insecticidal Spray (IRS) inside the human dwellings with Even with the availability of the strong implementing the help of only introduced insecticide DDT 50% wdp. technical guidelines, outbreaks of malaria are still occurring This IRS tool success led to implement National Malaria in various parts of the country as well as state. District - Eradication Programme (NMEP) in 1958 by bringing the Bareilly (28.3670º N, 79.4304ºE) reported high pyrexia and malaria incidence to 0.10 million in 1965, thereby eradicated causalities through various media reports. The present the dreadful disease from almost major parts of India. The paper reflects the efforts made to (a) Investigate the cause malaria free areas were handed over to the basic health of the unprecedented incidence, (b) Suggest the appropriate services for maintaining the malaria free status in the area intervention measures to contain the epidemic, and (c) but the expectation reversed due to occurrence of local & indicate the correctional actions & necessary steps for focal outbreaks of malaria with high morbidity & mortality, future program implementation in more effective way in thereby increasing the toll of malaria cases to 6.47 million the district. in 1977. Thus, in order to overcome the resurgence of malaria cases, Modified Plan of Operation (MPO) was Methodology launched in 1977, the successful implementation of which In order to find out the facts and the ground realities brought down the malaria cases between 2-3 million but of the incidence, the office of the Chief Medical Officer, large scale malaria epidemics occurred again in 1994 in District Malaria (VBD) Officer, District Hospital, Bareilly, 2 different parts of India, led technical officers to think over District Surveillance Unit (IDSP), CHC - Majhgawan (28.3051º this issue seriously. Various technical, operational, financial N,79.2761ºE), CHC-Bhamora (28.2090ºN,79.2983ºE) & & administrative issues were experienced to contribute CHC - Faridpur (28.2091º N, 79.5378ºE), and two worst 3 the resurgence of malaria. In order to ensure effective affected villages - Dhakora under CHC-Majhgawan and implementation of the programme, National Vector Borne village - Sendhi under CHC - Bhamora were visited to find Disease Control Programme (erstwhile National Malaria out of the operational aspects of various activities including Eradication Programme) on the basis of recommendations vector prevalence and control measures in the field areas of group of experts, formulated the operational guidelines of Bareilly district of Uttar Pradesh (Figure 1). Figure 1.Map of District- Bareilly, Uttar Pradesh, India ISSN: 0019-5138 DOI: https://doi.org/10.24321/0019.5138.202034 Kamal S et al. 3 J. Commun. Dis. 2020; 52(4) The office of District Malaria Officer/ VBD Officer was visited district IDSP unit, Bareilly without preparing any blood to find out and analyze the old record pertaining to malaria smear from fever cases (Table 2), Moreover, when RDT epidemiological situation of the district during past three kits were also not supplied to him equal to the number of years, the staff availability for implementing Vector Borne tests performed by him from 2015 to 2018 (till the visit of Disease Control Programme, the availability of logistic/ the team). Only 100 RDT kits were supplied to him on 09- infra-structure in the district, the details of intervention 05-2015 and no replenishment was done thereafter. This measures undertaken by the district so far, the details of discrepancy in the report submitted by CHC to district IDSP fever outbreak in the district & reasons of the same. The unit was a matter of serious concern and to be looked into information on the details of deaths occurred in the district by district and state health authorities, in order to avoid & death audit done by the authorities of PHCs, if the death false reporting in future. The LT was imparted malaria considered due to malaria on prescribed format of National orientation training at State Malaria (VBD) Head quarter, Vector Borne Disease Control Programme (NVBDCP) of Lucknow conducted from January to March, 2018. The Government of India & the vector prevalence in area and Superintendent of CHC was also not serious & vigilant for its role in the present outbreak was also gathered. The supervising the work of sub-ordinates and ability for holding malaria epidemiological reports for the last three years, the responsible position, because the technician was not human resource details, intervention measures details were performing the examination & accordingly not reporting obtained from the District Malaria (VBD) office, Bareilly, malaria positives in L-Form of IDSP, when this CHC was Some other reports were obtained from CHC-Majhgawan, most affected area of the district among all the CHCs/PHCs. Bhamora & Faridpur and IDSP Unit Bareilly. Entomological The CHC- Bhamora, was the next highest fever affected surveillance was undertaken in village - Dhakora under CHC CHC, and with a population of about 2.50 lakh. This CHC -Majhgawan and village - Sendhi under CHC-Bhamora. The has 174 villages, out of which 120 villages are in the grip data obtained were analyzed and findings are presented of fever. However, no suspected death due to unidentified in this communication. fever has been reported from any of the villages of this Result and Discussion CHC, but IDSP list has included one fever associated death The details of the fever affected CHCs/PHCs depicting from one village. malaria incidence are reflected in Figure 2A, 2B & 3A, 3B. The CHC - Faridpur is the highest fever affected CHC, and It is evident from the figures that the most malaria affected has about 3.00 lakh population.