With Proper Prevention and Cure Victory over Malaria is Sure! Flipbook on Malaria Prevention and control

With Proper Prevention and Cure Victory over Malaria is Sure! Flipbook on Malaria Prevention and control

Malaria Malaria is a public health problem in several parts of the country. About 80% cases of malaria are found in tribal, hilly and other inaccessible areas. Around 2 million cases of malaria have been reported by the Indian surveillance system in the past few years. As per the data published in 2011, 753 deaths were recorded due to malaria. Number of malaria cases have increased due to migration of people from malaria endemic areas to other new places. Therefore, the situation of malaria in India poses a great threat to life and is thus a constant challenge to the Indian health system. Pregnant woman and children below five years of age are at a higher risk of acquiring infection and are therefore more vulnerable. With the aim of Malaria control, the Government of India has framed technical guidelines and policies under National Vector Borne Disease Control Programme (NVBDCP). Village level health workers (ASHA, AWW, MPHW, Malaria worker) have an important role to play in malaria prevention. They can educate the community by disseminating malaria prevention messages and can also inspire the community to get fever diagnosed and undergo complete treatment in case of malaria. This flipbook has been developed in order to facilitate a healthy and meaningful discussion between the community and village health workers. It contains information about the symptoms of malaria, its treatment, prevention and control. Discuss with community on all the information provided and take help of the images that have been showcased in this flipbook wherever needed. Encourage people to follow correct health practices. Through this, you can help reduce the number of malaria cases in your village, district and state. i

How to Use the Flipbook? Use this flipbook to inform the community about malaria parasite 1, vector 2, symptoms of malaria, early detection and treatment, prevention and the national programme on malaria. How to Use this Flipbook Review the flipbook in advance to familiarise yourself with the contents and messages. Each page is accompanied by important messages that summarise the key points. Use visuals to illustrate the points that you are talking about. Use anecdotes (from your area) on each topic for discussion. After discussing the issues as mentioned on each page, reiterate the important messages. Within the community Build rapport with the group members. Gather your audience and seat them comfortably, in a semi-circle facing you. All the group members should have a good view and hear you clearly. Face the audience and hold the flipbook in such a way that the audience can see the picture and you can see the points that need to be discussed and messages that need to be given out. Speak clearly, loudly and slowly. Use simple words, phrases and language. Check with them if they are able to hear you clearly. Ask them how they interpret the pictures and whether these pictures remind them of something or somebody. Explain each picture to the audience and allow enough time per picture to discuss the main points. Repeat the explanation if necessary. Ask the audience to repeat the key points to ensure that they understand the messages. Encourage and prompt the audience to ask questions to clarify their doubts and express their thoughts. NO question is silly or dumb. Thank the audience at the end of the session, reminding them to come back if there is a follow up session. 1 Parasite is a living organism that lives in the body of other organisms and acquires nutrition from the host. Certain parasites can cause diseases in human beings. 2 Vector is an organism that transmits parasites from one human to other. ii

Index Malaria How to Use this Flipbook Anecdotes on Malaria i ii v What is malaria? 1 Causes of malaria 2 Malaria mosquitoes 3 Common symptoms of malaria 4 Symptoms of severe and complicated Malaria 5 Diagnosis of Malaria 6 Malaria Treatment 7 Importance of mosquito nets 8 Using Insecticide Treated Mosquito Nets (ITMNs/LLINs) 9 About Insecticide Treated Mosquito Nets (ITMNs/LLINs) 10 Prevention of malaria through Indoor Residual Spray (IRS) 11 Ways of controlling mosquito breeding 12 Government Services 13

Anecdotes on Malaria I. Delay in diagnosis and treatment Seven year old Munni lived with her family in a village. She got fever from which she recovered without medication but again after two days she got fever with chills and was shivering. She was given a herbal concoction kadha prepared from Gangasiuli leaves, pepper and honey. But there was a rise and fall in her body temperature (intermittent fever) and she was getting weaker. Since the fever did not subside, Munni s father visited a local chemist and gave her the medicines prescribed by the local chemist. But her fever was not coming down. Then the family members got worried and took the girl to the nearest government hospital. Her blood was tested and she was admitted to the hospital for treatment as well but it was too late then... Even after trying hard, the doctor could not save Munni s life. Discussion points In your opinion what led to Munni s death? What is the correct way to treat fever? Do you think that Munni s family had knowledge about malaria? What did you learn from this situation? II. Correct knowledge can prevent malaria Rani is pregnant and she consults ASHA in her village regularly. Therefore, when Rani got fever, ASHA suggested that she should go for a blood test as soon as possible. She was diagnosed with malaria. Her treatment was started instantly due to which Rani and the baby in her womb are safe today. Her husband Raju got the house sprayed with insecticide (IRS) so that none of the family members would get infected with malaria in the future. Now they use insecticide treated mosquito net (ITMN) while sleeping. Discussion points: According to you, what should be done in case of fever? What did Raju do for malaria prevention? What did you learn from this situation? v

Question: What do you understand from the given illustrations? Discussion points: What is malaria? Can malaria be fatal? What is malaria? Malaria is an infectious disease caused by the parasite belonging to genus Plasmodium. This parasite is transmitted by female Anopheles mosquitoes. What can happen if malaria is not treated? If not treated, malaria fever will repeatedly occur in short intervals. If malaria is not treated timely and completely, the patient gets weaker and suffers from anemia which can further result in death. Pregnant woman, her child in the womb as well as children below five years of age are at a higher risk and are more vulnerable to malaria. Key messages: If malaria is not treated on time, then the patient may die. Pregnant woman, her child in the womb and children below five years of age are at a higher risk and are more vulnerable to malaria. 1

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Question: What do you understand from the given illustrations? Discussion points: Causes of malaria Characteristics of malaria parasite Causes of Malaria Malaria is caused by the parasite, Plasmodium. Types of malaria parasite There are four species of Plasmodium parasites that infect human. They are P. falciparum, P. vivax, P. malariae and P. ovale. P. falciparum and P. vivax are found in all parts of our country. The other two parasites are rare and mostly found only in hilly and forested areas. Malaria caused by P. vivax is not very severe, but if it is not treated completely then fever may come back. Key messages: Since the consequences of infection and the type of treatment procedures depend upon the species of malaria parasite, it is essential to identify the parasites correctly. Malaria caused by P. falciparum affects the brain and may lead to severe headache, feeling of giddiness and nausea. If not treated on time, it may result in death. Since the consequences of infection and the type of treatment procedures depend upon the species of the malaria parasite, it is essential to identify the parasites correctly. 2

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Question: What do you understand from the given illustrations? Discussion points: How is malaria transmitted? Characteristics of malaria mosquitoes Malaria mosquitoes Malaria parasite is transmitted from one man to another by the bite of the female Anopheles mosquito. Hence, malaria is transmitted by mosquito bites. Main characteristics of malaria mosquitoes Malaria parasite transmitting mosquitoes breed in clean water. Stagnant or slow running water supports Anopheles breeding. For example, water bodies such as ponds, slow running streams with sandy margins, irrigation channels, paddy fields, wells etc. are some of the important breeding habitats. After seasonal rains, the number of breeding habitats increases. During day time, malaria mosquitoes rest inside the house or cattle sheds. Generally mosquitoes start biting after dusk and continue biting throughout the night. Key messages: Malaria mosquitoes breed in stagnant or slow running clean water. Generally mosquitoes start biting after dusk and continue biting throughout the night. 3

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Question: What do you understand from the given illustrations? Discussion points: Symptoms of malaria Blood test to be done within 24 hours of onset of fever within 24 hours Common symptoms of malaria The symptoms vary in the five stages of malaria: Primary Stage: uneasiness, weakness, laziness Cold Stage: fever with chill and rigour, headache, nausea Fever Stage: high fever, burning sensation, redness of skin, headache, vomiting, rapid breathing Sweating Stage: fever comes down, excessive sweating Symptomless interval: during this phase the patient does not show any symptom and remains normal On the onset of fever (within 24 hours) visit a nearby health facility (ASHA/PHC) and get a blood test and treatment done. Key messages: Be aware of the symptoms of malaria in case of fever. On the onset of fever (within 24 hours), visit a nearby health facility (ASHA/PHC) and get blood tested and treatment done. 4

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Question: What do you understand from the given illustrations? Discussion points: Symptoms and signs of severe malaria Symptoms and signs of severe malaria If malaria is not treated immediately after early detection, then it develops into severe and complicated malaria that could be fatal. In case of severe and complicated malaria, patients suffer from continuous high fever along with any of the symptoms listed below: Difficulty in sitting, weakness and partial unconsciousness Difficulty in breathing Severe anemia Unconsciousness and convulsions Difficulty in swallowing liquid and vomiting Change in urine colour and/or reduction in volume. Key messages: In case of high fever, if any of the given signs and symptoms are seen, the patient should immediately be taken to the nearest government health centre (PHC/ sub-centre/district hospital). It is very important to recognise the signs and symptoms of severe and complicated malaria so that the patient can be admitted in the hospital soon; else it may cause death. 5

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Question: What do you understand from the given illustrations? Discussion points: Rapid Diagnostic Test (immediate testing) Microscopic Examination Key messages: Diagnosis of malaria Early detection and complete treatment (EDCT) is very important for malaria control. Malaria diagnosis is done by two methods-rapid Diagnostic Test and Microscopic examination of blood samples. R.D.T. R.D.T. is an immediate immune diagnostic test and is very helpful in detection of malaria. A drop of blood from finger is taken for this test. If the test result is positive, i.e. in case of malaria, health workers or ASHA can immediately start the treatment. This facility in the village is available with ASHA, malaria link workers and community workers. Microscopic Treatment If the R.D.T. result is negative but the signs and symptoms are still visible in the patient, then the blood samples of the patient should be sent for microscopic examination. Meanwhile, the patient is given full dosage of chloroquine. After the results of the blood test are available, the rest of the treatment is done according to the Drug Policy. RDT test is done by ASHA at village level. Pregnant women and children below five years are at a higher risk of acquiring infection and are more vulnerable. Therefore, they should be diagnosed as soon as possible. If the R.D.T. result is negative but the signs and symptoms are still visible in the patient, then the blood samples of the patient should be sent for microscopic examination. 6

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Causes of Malaria Day parasite P. vivax P. falciparum Treatment Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 CQ CQ CQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ SP + AS ACT (Artemisinin Combination Therapy) AS PQ AS Post Blood Test Question: What do you understand from the given illustrations? Discussion points: Treatment of malaria Care of the patient CQ = Chloroquine PQ = Primaquine SP = Sulfadoxine-Pyrimethamine AS = Artesunate Key messages: Treatment of malaria Pv Malaria is treated with dosage of Chloroquine for three days and Primaquine for 14 days. If the patient is not given Primaquine, then there is a threat of malaria occurring again even after the patient gets well. In case of Pf Malaria, treatment includes full course of ACT and Primaquine on the 2 nd day. If the patient is not given Primaquine, malaria can be transmitted to other humans through mosquito bites. Taking care of the patient Do not take medicine on an empty stomach. First dose should be given under the supervision of a health worker. If the patient vomits within 30 minutes, second dose should be given. Inform family members that if the condition does not improve within 48 hours or if it deteriorates the health worker should be contacted immediately. It is very important to undergo complete treatment so that no problem arises after recovering from malaria. During malaria, plenty of liquids should be consumed. Malaria can be prevented through early detection and complete treatment. Pv Malaria is treated with dosage of Chloroquine for three days and Primaquine for 14 days. If the patient is not given Primaquine, then there is a threat of malaria occurring again even after the patient gets well. Do not take medicine on an empty stomach. First dose should be given under the supervision of a health worker. If the patient vomits within 30 minutes, second dose should be given. 7

Treatment Table Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Causes of Malaria Parasite P. vivax P. falciparum CQ CQ CQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ PQ Post Blood Test ACT (Artemisinin Combination Therapy) SP + AS AS AS PQ CQ = Chloroquine PQ = Primaquine SP = Sulfadoxine-Pyrimethamine AS = Artesunate 7

Question: What do you understand from the given illustrations? Discussion points: Importance of mosquito nets Insecticide treated mosquito nets Importance of mosquito nets Mosquitoes that transmit malaria parasite, start biting after sunset and continue to bite throughout the night. Therefore, the chances of a person coming in contact with mosquitoes will reduce if one uses a mosquito net while sleeping at night. Using a mosquito net is an effective step for malaria prevention. In general, there are two types of mosquito nets that are being used: 1 Ordinary mosquito nets-mosquito nets that are not treated with insecticides. These ordinary mosquito nets can be treated with insecticide and will then remain effective for six months 2 Insecticide treated mosquito nets-mosquito nets that are treated with insecticides. They remain effective for three years. Why is it important to use insecticide treated mosquito nets? Key messages: All family members must use mosquito nets throughout the year while sleeping. Usage of insecticide treated mosquito nets is an effective method for malaria prevention. Insecticide treated mosquito nets are very effective in protecting one from mosquito bites because they repel mosquitoes and mosquitoes are killed when they come in contact with the nets. 8

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Question: What do you understand from the given illustrations? Discussion points: Using Insecticide Treated Mosquito Nets Key messages: Using Insecticide Treated Mosquito Nets (ITMNs/LLINs) Ordinary mosquito nets can be treated with insecticide at the time of manufacturing and also at the community level. The amount and spread of insecticide used in the mosquito net may vary if an ordinary mosquito net is treated at the community or at the individual level. Therefore, mosquito nets are being treated with insecticides at the time of manufacturing. If mosquito nets are treated with insecticides at the factory level, then one is also safe from pollution caused by these insecticides. In Malaria prone areas, insecticide treated mosquito nets are distributed free of cost by health workers for malaria prevention and safety. Please remember the following messages while using insecticide treated mosquito nets: Use mosquito nets throughout the year every night. After treatment, the smell of insecticide may remain for one or two days which will disappear within a few days. This smell does not cause any harm to people sleeping under them. While in contact with treated nets, some people may feel a tingling or burning sensation but these nets are safe for children as well. All family members must use insecticide treated mosquito nets while sleeping. Pregnant women and children below five years of age are more vulnerable to malaria. Therefore, they should sleep under an insecticide treated mosquito net. 9

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Question: What do you understand from the given illustrations? Discussion points: What should you do in relation to insecticide treated mosquito nets? What should you not do in relation to insecticide treated mosquito nets? About insecticide treated mosquito nets What you should do in relation to insecticide treated mosquito nets: While sleeping, either indoors or outdoors, use insecticide treated mosquito nets everyday. After using the insecticide treated mosquito net, fold and keep it properly in a neat and clean place everyday. When dirty, wash the insecticide treated bed net in clean, soap-free water by rubbing it mildly. After a mild wash, dry the net in shade. What you should not do in relation to insecticide treated mosquito nets: Do not use insecticide treated mosquito net for catching fish. Do not sell or gift the insecticide treated mosquito net. Do not use any detergent or soap for washing it. Do not use hot water to wash it. Do not wash it more than three-four times in a year. Do not keep or dry the insecticide treated mosquito net directly under the sun. Key messages: In Malaria prone areas, insecticide treated mosquito nets are distributed by the government. Use this net everyday for malaria prevention. 10

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Question: What do you understand from the given illustrations? Discussion points: Spraying of insecticides Important areas for spraying Key messages that should be remembered about spraying Prevention of malaria through Indoor Residual Spray (IRS) Indoor Residual Spray (IRS) is a very important method to reduce the population of mosquitoes (especially before the mosquito breeding season). After biting humans, mosquitoes rest in the inside walls of the house. These mosquitoes come in contact with the insecticide and get killed. Therefore, the insecticide should be sprayed on the inside walls of the house. Spraying should be done only on the inside walls of the house and not on the outside walls and cattle shed. If spraying is done there, then mosquitoes will come inside the house and the frequency of biting will increase. Key messages: Empty all the rooms for spraying and cooperate with the spraying team. Do not mud plaster the walls for six months post spraying. Important points to be noted with regard to spraying: Be at home when the spraying team visits your house. Before spraying, empty all the rooms and cover all consumable items. Cooperate with the spraying team. Due to spraying, the walls can become whitish in colour or can smell bad because of D.D.T. This is very usual after spraying and it is important for malaria prevention. Do not mud plaster the walls for six months post spraying. 11

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Question: What do you understand from the given illustrations? Discussion points: Larvivorous fish that eats mosquito larvae Ways of controlling mosquito breeding Key messages: Ways of controlling mosquito breeding Gambusia fish live in water and feed on larvae of all mosquitos breeding on the surface. Other ways of controlling mosquito breeding: Filling up of breeding places of mosquitoes, dirty and shallow pits etc. Covering drinking water in houses. Making arrangements for water drainage. Cleaning small water storage containers once a week. Larvivorous fish that eat mosquito larvae should be released in all permanent and clean water sources in the village and small pits and trenches should be filled. Keeping one s house and nearby areas clean is everybody s responsibility. 12

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Question: What do you understand from the given illustrations? Discussion points: Government health services for malaria prevention Using government health services for malaria prevention Government services Government provides the following services for malaria prevention: Diagnostic and treatment facilities are available free of cost at all health centres and government hospitals. Medicines are made available with ASHA/Community workers in rural areas for providing easy access to anti-malarial drugs to the community. To improve malaria related services, village level workers are being trained on a regular basis. Hatcheries have been established in India to promote the use of larvivorous fish for vector control. To prevent mosquitoes from coming inside the house, the government has made provision to spray insecticides (IRS) Insecticide treated mosquito nets have been distributed in high risk malaria prone area. For diagnosis of malaria at village level, rapid diagnostic kits are available with ASHA volunteers Key messages: Medicines are made available with ASHA/ Community workers in rural areas for providing easy access to anti-malarial drugs to the community. 13

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Important messages related to malaria: If malaria is not treated on time, then the patient may die. Pregnant woman, her child in the womb and children below five years of age are at higher risk and are more vulnerable to malaria. Since the consequences of infection and treatment procedures depend upon the species of malaria parasite, it is essential to identify the parasites correctly. Generally, mosquitoes start biting after dusk and continue biting throughout the night. On the onset of fever (within 24 hours), visit a nearby health facility (ASHA/PHC) and get blood tested and treatment done. In case of high fever, if any of the given signs and symptoms are seen, the patient should be immediately taken to the nearest government health centre (PHC/sub-centre/district hospital). Diagnosis of malaria is done by ASHA at the village level. If the R.D.T. result is negative but signs and symptoms are still visible in the patient, then blood samples of the patient should be sent for microscopic examination. Malaria can be prevented through early detection and complete treatment. Pv Malaria is treated with dosage of Chloroquine for three days and Primaquine for 14 days. Do not take medicine on an empty stomach. First dose should be given under the supervision of the health worker. If the patient vomits within 30 minutes, second dose should be given. All family members must use mosquito nets throughout the year while sleeping. Usage of mosquito nets is very useful for malaria prevention. Pregnant woman and children below five years of age are more vulnerable to malaria. Therefore, they should sleep under insecticide treated mosquito nets. In Malaria prone areas, insecticide treated mosquito nets are distributed free of cost by the government. For malaria prevention, use these nets everyday while sleeping. Empty all rooms while spraying (IRS) is going on and cooperate with the spraying team. Do not mud plaster walls for six months post spraying. Larvivorous fish that eat mosquito larvae should be released in all permanent and clean water sources in the village and small pits and trenches should be filled. Keeping one s house and nearby areas clean is everybody s responsibility Medicines are made available with ASHA/Community workers in rural areas for providing easy access to anti-malarial drugs in the community.

People are victims of malaria but they are responsible for the spread of malaria from our society. If people follow correct practices, then malaria parasites can be destroyed. There are five vital factors that are responsible for spreading malaria in any part of the country: people, mosquitoes, parasites, environment and malaria control measures. These five factors depend on the behaviour of the human being. People should have correct behaviour with regard to the life cycle of a parasite, mosquitoes, people, environmental status and control measures. Therefore at every level of communication for behaviour change, the community and the individual are very important. What can you do at the individual level? Be completely informed about malaria. Use mosquito nets while sleeping. Get correct treatment as soon as possible. Get complete treatment done. Follow prevention measures at your level. Disseminate information on malaria to other people and encourage them to get treated. What can you do at the family level? Take part and cooperate in getting your house sprayed with insecticide (IRS). Raise your voice and demand for getting spraying (IRS) done. Confirm that pregnant women and children below five years of age are sleeping under insecticide treated mosquito net. What can you do at the community level? Help to keep your village environment clean. Make the insecticide spraying process facile.

National Vector Borne Disease Control Progamme 22, Sham Nath Marg, Delhi - 110054 Phone: 011 23967745 E-mail - nvbdcp-mohfw@nic.in