Plan to eliminate malaria, kala-azar in 20 yrs

Malaria, kala-azar and Japanese encephalitis are among the most serious diseases faced by Nepalis, the rural poor in the plains — more so in the summer season. In this context, health ministry has been providing free treatment to people in some of the most affected areas in the country.

"As per the government’s direction, we have been conducting counselling classes along with offering treatment at no charge," said Dr Govind Prasad Ojha, director of Epidemiology and Disease Control Division. "We have already placed orders for insecticides and will distribute them to respective VDCs in the next few days."

The government has also launched various programmes such as detection of diseases based on clinical suspicion and active community participation. The government has also been giving priority to the diseases, especially malaria and Kala-azar, for a long time.

Along with the partners — World Health Organisation (WHO), USAID and local social organisations at district level — the government aims to eliminate the diseases. Twenty years is the target set by the WHO.

"WHO has been supporting the epidemiological division in training and capacity building, disease surveillance and research," said Dr Shatrughan Prasad Bastola, WHO national operations officer for vector borne diseases. "The financial support we provide is strictly based on the technical output."

Science still has no magic wand for any of these vector borne diseases and experts doubt that such a single solution will ever exist. Nevertheless, effective low-cost strategies are available, beginning with information dissemination about the disease and preventive measures.

Malaria has been a major problem in Nepal for a long time. In the year 2001, more than 60,000 cases were reported on medical notion, while 10,000 others were microscopically confirmed.

Symptoms of malaria appear about 9 to 14 days after the infectious mosquito bite, although this varies with different plasmodium species. Typically, malaria produces fever, headache, vomiting and other flu-like symptoms.

If drugs are not available for treatment or the parasites are resistant to them, the infection can progress rapidly and become life threatening. Malaria can kill by infecting and destroying red blood cells and by clogging the capillaries that carry blood to the brain or other vital organs.

Many children who survive an episode of severe malaria may suffer from learning impairments or brain damage. Pregnant women and their unborn children are also particularly vulnerable to malaria, which is a major cause of prenatal mortality, low birth weight and maternal anaemia.

Whereas Kala-azar, a parasitic disease spread through the bite of the sand fly, was first recorded in Nepal in 1980. More than five million people live in Kala-azar affected areas. Most of these 13 affected districts border the Bihar state of India. Some 2,000 cases of Kala-azar are reported yearly.

Leishmania, an alternative name for Kala-azar, can cause skin disease and skin lesions that resemble coetaneous tuberculosis, syphilis, leprosy, skin cancer and fungus infections.

Systemic infection in children usually begins suddenly with vomiting, diarrhoea, fever, and cough. In adults, fever for two weeks to two months is accompanied by non-specific symptoms such as fatigue, weakness, and loss of appetite.

The parasites damage the immune system by decreasing the numbers of disease-fighting cells, so death usually results from complications such as other infections rather than from the disease itself.

Preventing sand fly bites is the most immediate form of protection. Insect repellent, appropriate clothing, screening of windows and fine mesh netting around the bed (in endemic areas) will reduce exposure.

The first known outbreak of Japanese Encephalitis, on the other hand, occurred in 1978, in Rupandehi district of Lumbini zone. It was thought to have spread from the northeast states of India. The prevalence of three different strains of JE virus has been reported in Nepal. About 3,500 cases of JE are reported annually.

JE is a disease that spreads to humans through infected mosquitoes. It is one of a group of mosquito-borne virus diseases that can affect the central nervous system and cause severe complications and even death.

Most infected persons develop mild symptoms or no symptoms at all. In people who develop a more severe disease, JE usually starts as a flu-like illness, with fever, chills, tiredness, headache, nausea, and vomiting.

Confusion and agitation can also occur in the early stages. The illness can progress to a serious infection of the brain and is fatal in 30 per cent of cases. Among survivors, another 30 per cent will have serous brain damage, including paralysis.

There is no specific treatment for JE. Antibiotics are not effective against viruses, and no effective anti-viral drugs have been discovered. Care of patients depends on treatment of symptoms and complications.