Political apathy, unplanned urbanisation make vector-borne diseases hard to control in India

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

 
By Jyotsna Singh
Last Updated: Thursday 17 September 2015

imageControlling 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

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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

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  • 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

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  • 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
 

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Case fatality ratio is the number of deaths per 1,000 diagnosed cases

 
Japanese encephalitis

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Report: A global brief on vector-borne diseases

Feature: Perceptions regarding mosquito borne diseases in an urban area of Rajkot city

Feature: Neglected funding for vector-borne diseases: A near miss this time, a possible disaster the next time

Feature: Integrated disease vector control of malaria: A success story based in Assam, Northeastern India

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