MUMBAI IS STATE’S MALARIA CAPITAL

Of 1.38L Positive Cases In Maharashtra In 2010-11, Nearly 55% Came From The City

Mumbai's ignominious reputation as the state's malaria capital got cemented further as new figures revealed that the city registered nearly 55% of Maharashtra's 1.38 lakh positive cases in 2010-11, pushing it into the league of the country's worst affected states.
Nearly 80,000 cases in Greater Mumbai tested positive for malaria between April 2010 and March 2011, according to statistics recently compiled by the Maharashtra government. This was roughly six times the number recorded in secondworst Gadchiroli.
Many cite a better reporting system as the cause of the steady surge in Mumbai's malaria cases. While there were 27,417 positive instances in 2008-09, it rose to 48,341 by 2009-2010. Between April 2010 and February this year, over 13 lakh samples had been examined here for malaria, of which 75,860—or 5.5%—tested positive.
In the last three months alone, according to the Brihanmumbai Municipal Corporation (BMC), the city recorded over 12,000 malaria cases and eight deaths.
The surge has been the single biggest factor in making Maharashtra the country's fourth worst malaria-afflicted state behind Orissa, Chhattisgarh and Jharkhand. Experts blame unplanned expansion for the problem in Maharashtra, where positive cases rose from 56,852 in 2006-07 to 1.38 lakh in 2010-11.
The picture looks direr when fatalities are considered. Malaria claimed 190 lives in Maharashtra in 2010, which was only marginally less than the 214 recorded deaths in worst ranked Orissa. Here too, Mumbai played a major role. Of the 190 deaths, 129 occurred in the city.
Dr Ashish Dhariwal, the director of National Vector Borne Disease Control Programme (NVBDCP), said that Mumbai has become a bigger cause for concern than Gadchiroli and Raigad, which have reported several cases of resistance to basic malarial drugs.
"Construction work has played havoc with Mumbai's malaria scenario. We have asked the state and the civic corporation to work together," Dhariwal said.
A three-member team from the NVBDCP recently visited Mumbai to study the BMC's preparation for the rains this year. The centre has promised to help the civic body by giving it grantin-aid and commodity assistance. "We will help them procure insecticides and mosquito nets laced with insecticides besides making our experts available to them," said Dhariwal.
The corporation, however, sounded sceptical of Dhariwal's claims. A source in the BMC said that the centre used to help procure insecticides and provide medicines for malaria treatment, "all those grants stopped three years ago".
BMC's executive health officer Dr G T Ambe too said that the corporation was on its own. "Most of the expenses on procurement of oil, mosquito nets and drugs are borne by the corporation, though we do get technical know-how from NVBDCP," Ambe said.
Deadly strain losing sting over time
Mumbai: The gradual decline in cases of plasmodium falciparum malaria, considered the deadliest strain of the disease, in Mumbai has confounded many experts, particularly because the strain is taking an increasing toll in the rest of the country.
Comparative figures compiled by the state's public health department show that the percentage of p falciparum cases among all malaria numbers dropped in Mumbai from 20.20% in 2007-08 to 19.57% in '08-09. After a brief rise in '09-10 to 21.10%, the share again fell to 16.3% in '10-11.
Experts call the decline insignificant, the more so because p vivax malaria, which was rarely known to kill, has been become deadlier in the city.
Meanwhile, according to the National Vector Borne Disease Control Programme (NVBDCP), p falciparum numbers have gradually increased in India from 39% in 1995 to 52.12% in 2010, showing the parasite's new dominance.
"This only means that p vivax, which is widely seen in Asian countries, is no longer the dominant strain in parts of India. Instead, it is p falciparum. This could probably explain why the number of reported malaria deaths in India has been more than 1,000 a year," said Dr R S Sharma, an urban malaria expert at NVBDCP. He added that Mumbai was "fortunate" to have low falciparum incidence.
"Once p falciparum cases come down further, it should not be very difficult to curb deaths in Mumbai," said Sharma, who was a part of the special team that recently visited the city to study the BMC's preparations for the monsoon. He explained that incomplete treatment and resistance to basic malarial drugs, which has never been found in Mumbai, are contributing to the rise in falciparum cases across parts of India.
Dr Khusrav Bhajan, a critical care intensivist at P D Hinduja Hospital, said that a fall in falciparum cases might not be of much relevance since p vivax is gaining in potency. "Vivax is more or less behaving like falciparum. This transition has happened over the last few years."

Malaria deaths at record high in state

Pune: Malaria claimed 185 lives in the state from April 2010 to March this year, which is the highest annual number of casualties from the disease reported in the last seven years. Of the 185 casualties, Mumbai alone accounted for 137.
    These are the figures from the latest epidemiology report on malaria released by the state health department in April this year. The state registered only around 60-65 deaths in 2003-04. Pune district may have acquired immunity to the mosquito-borne disease, with just four deaths in 2010-11. Notably, Pune city and Pimpri-Chinchwad did not report a single malarial death.
    "There is a perceptible rise in malaria cases this year, which can be attributed to the huge construction activity in Mumbai and the rest of the state. Besides, consolidated surveillance has also resulted in enhanced detection of malaria cases in 2010-11," said V D Khanande, joint director (malaria) of the state health services, adding that a central government team recently evaluated the state's pre-monsoon preparations.
    As many as 1,38,605 positive cases were recorded in the state in 2010-11, which is again high as compared to 85,435 cases recorded in the previous year.
    In 2007, 67,850 cases were registered and 67,333 cases were registered in 2008. To control the growing mosquito menace, the state health department had to seek technical support and expertise from the Union government.
    S B Nadoni, senior regional director (regional office) of the Union health and family welfare, said, "Efforts to reduce the mortality rate last year met with little success. In fact, Maharashtra reported more cases and deaths. The state even sought the Centre's intervention in curbing the menace in Mumbai and other parts of the state."
    According to Nadoni, the components of the national malaria control strategy include the use of longlasting insecticides, bed nets, indoor residual sprays, early diagnosis and treatment of cases, management of the environment, forecasting, prevention and control of epidemics.
    Avinash Bhondwe, former president of the Pune unit of the Indian Medical Association (IMA), said, "The number of malaria, dengue and chikungunya cases reported by the state health department is just the tip of the iceberg. A majority of the cases remain under-reported."