Evaluation of malaria control programme in three selected districts of Assam, India.

BACKGROUND & OBJECTIVES To ensure that the activities of Malaria Control Programme were taking place in effective and judicious manner, an intensive monitoring and supervision of various activities of the programme were carried out in Karbi-Anglong, Cachar and Nagaon districts of Assam, India during July-October 2007. METHODS Questionnaire-based protocol prepared by the National Vector Borne Disease Control Programme was used to evaluate the activities. Sixteen villages belonging to five different Primary Health Centres (PHCs) of three districts were selected for investigations. RESULTS Results of monitoring of indoor residual spraying (IRS) revealed inadequate spraying coverage. Although recorded to be about 69-99%, but apparently it was 17-43% in the districts investigated. Cross-examination of 180 blood smears (90 positive and negative each) in the laboratories of the study PHCs, revealed discrepancy in the results of 67 blood smears. Maximum (44%) discrepancy was observed in positive blood smears and 30% in negative blood smears. Out of 22 Accredited Social Health Activists (ASHA) interrogated, none was found involved in antimalaria activities. However, out of 13 fever treatment depots monitored, one was found partially functional. Criteria laid down for preparation of micro action plan were not followed properly in any of the districts sruveyed. Various important components of the programme like constitution of Village Health Sanitation Committee, information education communication (IEC) activities, capacity building, use of larvivorous fishes, supervision, etc. were not exercised properly. However, 100% community acceptance was recorded for insecticide-treated bed nets in the villages surveyed. Indiscriminate use of rapid diagnostic test kits yielded poor and unsatisfactory response. Declining trend of malaria was observed during 2002-06 in Districts Nagaon and Karbi-Anglong (up to 2005). In District Cachar, however, a little increasing trend was observed during 2002-04. CONCLUSION The results of this investigation revealed that the malaria control programme had been jeopardized seriously due to improper implementation of vector control measures, lack of adequate professional support and varied commitment on the part of the State Government. It can be concluded that long-term malaria control strategy should be based on generation of increased awareness on the disease and various methods of its control, health care access and administrative commitment for increased prosperity in resource-poor settings. The observation also necessitates further in-depth evaluation with appropriate regular active surveillance round the year with prompt detection and treatment facilities in order to control malaria effectively in these districts.