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Indian Journal of Community Medicine

Community Based Integrated Malaria Control with Reference to Involvement of Social Forestry Activities: An Experience

Author(s): V.S. Malaviya, R. Kant, C.S. Pant, H.C. Srivastava and R.S. Yadav

Vol. 31, No. 4 (2006-10 - 2006-12)

V.S. Malaviya(1), R. Kant(2), C.S. Pant(1), H.C. Srivastava(1) and R.S. Yadav(1)

Abstract

Background: In view of growing problem of insecticide resistance in mosquito vectors and environmental concern, a noninsecticidal, community based integrated malaria control strategy was launched in rural areas of Nadiad taluka of Kheda district in central Gujarat, with focus on elimination of mosquito breeding places, introduction of larvivorous fishes, health education and community participation. Results: During the study period a total of 4,32,775 mosquito breeding places were eliminated and fi lled through earth work with the support from villagers. To check the mosquito breeding at door steps 2730 soakage pits were constructed and 889 unused wells were capped with expanded polystyrene (EPS) beads. On leveled land a massive tree plantation work was carried out by planting trees such as Eucalyptus (E. hybrid), Babul (Acacia nilotica), Gulmohar (Delonix regia), Kashid (Cassia siamea), Peltroform, etc through Shramdans and help from local Forest Department. In-house village nurseries and neem tree plantation was also encouraged due to its mosquito repellent action. Conclusion:The whole concept found enormous community acceptance and proved effective in reducing the mosquito population and malaria incidence.

Key words: Malaria Control, Social Forestry, Mosquito Control, Community Participation

Introduction

Malaria continues to be the major public health problem causing enormous morbidity and mortality in many tropical and sub-tropical countries. Worldwide 300-500 million malaria episodes are reported every year with around 2.7 million deaths1. Control of malaria with the use of insecticides in some areas is not very effective because of vector resistance, exophilic vector behaviour, environmental concern and low community acceptance. In view of this a demonstration-cum feasibility study with eco-friendly approach “The Bioenvironmental Control of Malaria” was launched in rural areas of the Kheda district in central Gujarat2,4. The major components of this pilot study were to deal with the immature stages of the mosquitoes and eliminate/minimize the mosquito breeding sources to bring down the adult population. Larvivorous fishes such as Guppy (Poecilia reticulata), Gambusia (Gambusia affi nis), Aplocheilus (Aplocheilus panchax) and other biological agents were introduced in permanent, semi-permanent water collections, which were otherwise unmanageable. Early diagnosis and prompt treatment was ensured for all the patients. To make programme sustainable and people oriented income generating schemes such as food fish culture and social forestry were also incorporated for community compliance. Health education at grass root level to create awareness and ensure people participation was given paramount importance. In this article the overall impact of these interventions on mosquito immatures, adult density and malaria incidence is reported.

Material and Methods

Kheda district in central Gujarat is known for high incidence of malaria and witnessed outbreaks in preceeding years. The Nadiad taluka was worst affected. Integrated Disease Vector Control (IDVC) programme was started during 1984-85 in 100 villages of the rural Nadiad taluka in three different phases after conducting preliminary surveys, performing geographical reconnaissance and collecting baseline information. Each village had large numbers of borrow pits, pools, ponds, canal seepages and uneven land, which constituted important water collection site and supporting mosquito breeding. Efforts were made to get the drainage improved in these areas, emptying out the water bodies wherever possible followed by leveling the areas with earthwork. Many seepage sites were also filled and leveled. The Malaria Research Centre, Field Station, Nadiad, provided the tractor with trolley wherever required and all earthworks was carried out by villagers themselves through “Shramdans”. Survey along the road sides and rivers revealed a large area of low lying marshes and waste land in almost all the villages an important natural resource going waste and breeding mosquitoes. A massive tree plantation programme was taken-up in these areas with the help from District Forest Department. Mostly Eucalyptus (because of its rapid water absorbing capacity) and Acacia (Babul) trees were planted on marshy and other areas. Keeping in view of the increasing demand, minimizing transportation and enhance rural economy in-house nurseries and village nurseries were also encouraged with the help of National Wasteland Development Board, New Delhi. Considering the promising results of Neem oil and neem-based products in mosquito control5,7, Neem tree plantation was also taken-up at certain places between 1987-96.

Results

The source reduction activities mainly involving elimination of mosquito breeding sites through emptying, leveling, fi lling of ditches and minor engineering methods were in full swing from 1984 to 1989. A total of 4,32,775 breeding places were eliminated in the entire area during this period. For leveling of ditches 31,375 tractor trolleys were used for earthwork. Besides this, 2730 soakage pits were also constructed to avoid water stagnation at the doorsteps and 889 unused wells were capped with EPS (Expanded Polystyrene) beads, which also prevented mosquitoes to breed (Table I).

Table I. Source Reduction Activities

Year Breeding
places
eliminated
Soakage
pits
constructed
Earth work
done (tractor
trolley loads
Wells
treated with
EPS* beads
1984 8489 0 0 0
1985 128873 78 3563 168
1986 35070 755 8790 199
1987 82788 1296 9304 430
1988 112944 462 6292 31
1989 64611 139 3426 61
Total 432775 2730 31375 889
*EPS – Expanded Polystyrene Beads.

At permanent water collection sites as well as in Intradomestic water containers and used wells, larvivorous fishes were introduced at regular interval. On marshy, seepage and levelled areas a massive tree plantation work with the help of village communities, school children, Mahila Mandal (women group) and NCC Cadets was carried out. Saplings were procured from District Forest Office and distributed in respective villages. These plants were mainly of Eucalyptus (Eucalyptus hybrid) and Babul (Acacia nilotica indica). A total of 8,13,222 plants were planted in the entire Nadiad taluka during this period. After plantation a fence of barbed wire or thorny hedge was also made so as to protect the plants from cattle/animals. Village panchayats took responsibility of watering these plants. At some places this work was done by school children. Plants were also distributed to schools, Ashrams, temples and other voluntary agencies of the villages. Beside the Nadiad taluka 24,156 plants were planted in adjoining Kapadwanj taluka in 1988 and 1,93,088 trees were planted in other talukas of Kheda, Vadodara and Panchmahals districts. A break-up of tree plantation work in different villages (Complexes) during different years is shown in Table II.

To meet the increasing demand, acquire self-suffi ciency and to improve village economy social forestry work was started in 1987. Initially 11 village nurseries were started in 10 villages. The money for the purchase of polythene bags, manure and seeds was given through fi nancial assistance from National Wasteland Development Board and owner was paid for raising each plant @ Rs 0.45 per plant. During 1987-89, on an average 11-12 village nurseries each year in about 10 villages were in progress. A total of 7,81,556 saplings were raised in these nurseries. Mainly plants like Eucalyptus (Eucalyptus hybrid), Babul (Acacia nilotica indica), Kasid (Cassia siamea), Gulmohar (Delonix regia) Neem (Azadirachta indica), Bougainvillia (B. glabra), Badam (Terminalia catappa), Peltroform and Amla were raised. Because of good fuel and fodder utility Acacia plantation was encouraged and moreover animals also do not harm this plant that increase its survival and suits to arid and semi-arid dry climate of the area and demands less attention.

An area of about 15,548.50 sq mt covering 8 villages contributing mosquito breeding was leveled and used for tree plantation and plant species like Eucalyptus (in an area of 947.7 sq mt) and Kashid, Peltroform, Gulmohar, Bougainvillia etc (in an area of 13590.50 sq mt) were planted. During 1987 a total of 7600 Neem trees were planted in 14 villages whereas, in 1995 and 1996 a total of 673 and 205 Neem plants were planted. Recently a nursery of Neem plants in village Pij has also been attempted.

A survey conducted in 1996 revealed that in most of the villages, plants have grown and mosquito breeding has also been checked. Moreover it has also provided clean and improved environmental conditions. As a result of intervention measures taken the well positivity was kept under control in experimental area (6.9%), whereas it was quite high (29.3%) in control area. Similarly Intra-domestic positivity was found below 5 per cent in experimental areas in contrast to >24 per cent in control area8. Signifi cant reduction was also observed in man hour density of total mosquitoes as well as malaria vector An. culicifacies3. The API (Annual Parasite Incidence) and SPR (Slide Positivity Rate) which was >20 in 1981-82 before the study started also came down drastically during peak period of vector control operations and this was also evident in decline in spleen rate as well as in sero-epidemiology4. While doing, cost-benefit analysis Sharma and Sharma9 found that controlling malaria through bio-environmental methods in 2.7 million population of entire Kheda district was cheaper in comparison to all other available insecticides.

Social forestry activity may not be directly responsible for malaria control but permanent reduction in mosquito breeding sources and earth reclamation helped in reduction of mosquito vector population and the disease incidence which was refl ected in different malaria indices. Besides, there was also wide public awareness as was evident in terms of community participation and enhancement in their knowledge and practices2-4. The approach was found cost effective, long lasting and environment friendly in contrast to age-old insecticide based strategy of malaria control, which moves within the social fabric of the society, and boosts the rural economy as well. This model can be used in other places in concordance with sound surveillance system to control mosquitoes and malaria resurgence.

Table II. Year-Wise Tree Plantation in Different Talukas

Taluka No. of villages 1984 1985 1986 1987 1988 1989 Total
Nadiad (Divided complexes)
A 7 69750 42928 1707 42719 2113 7880 167097
B 14 NP 53878 1535 36054 31635 15650 138752
C 79 NP 4200 50324 169078 151373 132398 507373
Total 100 69750 101006 53566 247851 185221 155928 813222
Kapadvaj 161 NP NP NP NP 24156 NP 24156
Grand Total 261 69750 101006 53566 247851 209277 155928 837478

NP – No plantation
Other talukas of Kheda, Vadaodara and Pancmahals district = 193088.
Total trees planted = 1030466.

Acknowledgement

Authors are thankful to Dr V.P. Sharma, Former Director, Malaria Research Centre, Delhi for suggesting this innovative idea, providing necessary help and constant encouragement during the course of the study. Thanks are also due to Forest Department, Kheda (Govt. of Gujarat) for time-to-time assistance.

References

  1. Kondrachine, AN., Trigg P.I. Global overview of malaria. Indian J. Med. Res., 1997; 106: 39-52.
  2. Sharma, V.P., Sharma, R.C., Gautam, A.S. Bioenvironmental control of malaria in Nadiad, Kheda district, Gujarat. Indian J. Malariol., 1986; 23: 95-117.
  3. Sharma, V.P., Sharma, R.C. Community based bioenvironmental control of malaria in Kheda district, Gujarat, India. J. Am. Mosq. Control Assoc., 1989; 5: 514-521.
  4. Sharma, R.C., Gautam, A.S., Bhatt, R.M., Gupta, D.K., Sharma V.P. The Kheda malaria project: the case of environmental control. Health policy and Planning, 1991; 6: 262-270.
  5. Rajni Kant, Bhatt, R.M. Field evaluation of mosquito repellent action of neem oil. Indian J. Malariol., 1994; 31: 122-125.
  6. Sharma V.P., Nagpal, B.N., Srivastava Aruna. Effectiveness of neem oil mats in repelling mosquitoes. Trans. Royal Soc. Trop. Med. Hyg., 1993; 87: 626.
  7. Sharma V.P., Ansari, M.A. Personal protection from mosquitoes (Diptera: Culicide) by burning neem oil in kerosene. J. Med. Entomol., 1994; 31: 505-507. 8. Rajni Kant, Bhatt, R.M., Gupta, D.K., Sharma, R.C., Srivastava, H.C., Gautam, A.S. Observations on mosquito breeding in’ wells and its control. Indian J. Malariol, 1993; 30: 215-220.
  8. Gupta, D.K., Bhatt, R.M., Sharma, R.C., Gautam, A.S., Rajni Kant. Intradomestic mosquito breeding sources and their management. Indian J. Malariol, 1992; 29: 41-46.
  9. Sharma, R.C.,Sharma, V.P. Cost-effectiveness of bioenvironmental control of malaria in Kheda district, Gujarat. Indian J. Malariol., 1986; 23: 141-145.

(1)Malaria Research Centre, Field Station, Civil Hospital, Nadiad
(2)Indian Council of Medical Research (ICMR), Ansari Nagar, New Delhi
E-mail: [email protected]
Received: 14.10.04

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