scholarly journals Socio-economic determinants of malaria in tribal dominated Mandla district enrolled in Malaria Elimination Demonstration Project in Madhya Pradesh

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ravendra K. Sharma ◽  
Harsh Rajvanshi ◽  
Praveen K. Bharti ◽  
Sekh Nisar ◽  
Himanshu Jayswar ◽  
...  
Keyword(s):  
Water Supply ◽  
Low Income ◽  
Malaria Elimination ◽  
Rural Areas ◽  
Agricultural Land ◽  
Malaria Incidence ◽  
Central India ◽  
Madhya Pradesh ◽  
Demonstration Project ◽  
Environmental Interventions

Abstract Background Malaria is known as a disease of poverty because of its dominance in poverty-stricken areas. Madhya Pradesh state in central India is one of the most vulnerable states for malaria morbidity and mortality. Socio-economic, environmental and demographic factors present challenges in malaria control and elimination. As part of the Malaria Elimination Demonstration Project in the tribal district of Mandla in Madhya Pradesh, this study was undertaken to assess the role of different social-economic factors contributing to malaria incidence. Methods The study was conducted in the 1233 villages of district Mandla, where 87% population resides in rural areas. The data was collected using the android based mobile application—SOCH for a period of 2 years (September 2017 to August 2019). A wealth index was computed along with analysis of the socio-economic characteristics of houses with malaria cases. Variables with significant variation in malaria cases were used in logistic regression. Results More than 70% of houses in Mandla are Kuccha (made of thatched roof or mud), 20% do not have any toilet facilities, and only 11% had an annual income of more than 50,000 INR, which converts to about $700 per year. Households with younger heads, male heads, more number of family members were more likely to have malaria cases. Kuccha construction, improper water supply, low household income houses were also more likely to have a malaria case and the odds doubled in houses with no toilet facilities. Conclusion Based on the results of the study, it has been found that there is an association between the odds of having malaria cases and different household variables such as age, gender, number of members, number of rooms, caste, type of house, toilet facilities, water supply, cattle sheds, agricultural land, income, and vector control interventions. Therefore, a better understanding of the association of various risk factors that influence the incidence of malaria is required to design and/or deploy effective policies and strategies for malaria elimination. The results of this study suggest that appropriate economic and environmental interventions even in low-income and poverty-stricken tribal areas could have huge impact on the success of the national malaria elimination goals.

scholarly journals A model for malaria elimination based on learnings from the Malaria Elimination Demonstration Project, Mandla district, Madhya Pradesh

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Harsh Rajvanshi ◽  
Praveen K. Bharti ◽  
Sekh Nisar ◽  
Himanshu Jayswar ◽  
Ashok K. Mishra ◽  
...  
Keyword(s):  
Case Management ◽  
Vector Control ◽  
Capacity Building ◽  
Malaria Elimination ◽  
Lessons Learned ◽  
Madhya Pradesh ◽  
Demonstration Project ◽  
Bed Nets ◽  
Field Staff ◽  
Pharmaceutical Industries

Abstract Background Malaria Elimination Demonstration Project (MEDP) was started as a Public-Private-Partnership between the Indian Council of Medical Research through National Institute of Research in Tribal Health, Govt. of Madhya Pradesh and Foundation of Disease Elimination and Control of India, which is a Corporate Social Responsibility (CSR) initiative of the Sun Pharmaceutical Industries Limited. The project’s goal was to demonstrate that malaria can be eliminated from a high malaria endemic district along with prevention of re-establishment of malaria and to develop a model for malaria elimination using the lessons learned and knowledge acquired from the demonstration project. Methods The project employed tested protocols of robust surveillance, case management, vector control, and capacity building through continuous evaluation and training.  The model was developed using the learnings from the operational plan, surveillance and case management, monitoring and feedback, entomological investigations and vector control, IEC and capacity building, supply chain management, mobile application (SOCH), and independent reviews of MEDP. Results The MEDP has been operational since April 2017 with field operations from August 2017, and has observed: (1) reduction in indigenous cases of malaria by about 91 %; (2) need for training and capacity building of field staff for diagnosis and treatment of malaria; (3) need for improvement insecticide spraying and for distribution and usage of bed-nets; (4) need for robust surveillance system that captures and documents information on febrile cases, RDT positive individuals, and treatments provided; (5) need for effective supervision of field staff based on advance tour plan; (6) accountability and controls from the highest level to field workers; and (7) need for context-specific IEC. Conclusions Malaria elimination is a high-priority public health goal of the Indian Government with a committed deadline of 2030. In order to achieve this goal, built-in systems of accountability, ownership, effective management, operational, technical, and financial controls will be crucial components for malaria elimination in India. This manuscript presents a model for malaria elimination with district as an operational unit, which may be considered for malaria elimination in India and other countries with similar geography, topography, climate, endemicity, health infrastructure, and socio-economic characteristics.

scholarly journals Significance of training, monitoring and assessment of malaria workers in achieving malaria elimination goal of Malaria Elimination Demonstration Project

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Harsh Rajvanshi ◽  
Sekh Nisar ◽  
Praveen K. Bharti ◽  
Himanshu Jayswar ◽  
Ashok K. Mishra ◽  
...  
Keyword(s):  
Case Management ◽  
Vector Control ◽  
Malaria Elimination ◽  
Disease Surveillance ◽  
Training Session ◽  
Central India ◽  
Malaria Diagnosis ◽  
Demonstration Project ◽  
National Goal ◽  
Health Delivery

Abstract Background The Malaria Elimination Demonstration Project (MEDP) maintained a workforce of 235 Village Malaria Workers (VMWs) and 25 Malaria Field Coordinators (MFCs) to conduct disease surveillance, case management, IEC/BCC activities, capacity building, and monitoring of vector control activities in 1233 villages of Mandla, a high malaria endemic district of Madhya Pradesh in central India. Methods The induction training was conducted for 3 days on malaria diagnosis, treatment, prevention, and ethics. All trainings were assessed using a pre and post-training assessment questionnaire, with 70% marks as qualifying threshold. The questionnaire was divided into three thematic areas viz. general knowledge related to malaria (KAP), diagnosis and treatment (DXRX), and vector control (PVC). Results In 2017, the project trained 330 candidates, followed by 243 and 247 candidates in 2018 and 2019, respectively. 94.3% candidates passed after a single training session. Almost all (95%) candidates showed improvement in knowledge after the training with 4% showing no effect and 1% showing deterioration. Progressive improvement in scores of 2017 cohort was seen along with significant improvement in performance of candidates in 2019 after the introduction of systematic monitoring and ‘shadowing’ training exercises. Conclusion The project has successfully demonstrated the value of recruitment of workers from the study area, outcome of training, and performance evaluation of field staff in malaria elimination programme. This careful strategy of recruitment and training resulted in a work-force that was capable of independently conducting surveillance, case management, vector control, and Information Education Communication/Behaviour Change Communication (IEC/BCC). The learnings of this study, including the training modules and monitoring processes, can be used to train the health delivery staff for achieving national goal for malaria elimination by 2030. Similar training and monitoring programmes could also be used for other public health delivery programmes.

Intergroup Inequality in Wealth Ownership in Rural India: Caste, Tribe and Religion

2020 ◽  
Vol 6 (2) ◽  
pp. 117-132
Author(s):  
Nitin Tagade ◽  
Sukhadeo Thorat
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Agricultural Land ◽  
Wealth Inequality ◽  
Sample Survey ◽  
Rural India ◽  
Unequal Distribution ◽  
Majority Population ◽  
Intergroup Inequality ◽  
The Impact

In India, the rural economy still remains crucially important in the economic wellbeing of the majority population. The low income and high poverty in rural areas are closely associated with unequal distribution of income-earning assets, particularly agricultural land and non-land capital assets. In this article, therefore, we try to understand the intergroup inequality in wealth ownership across caste, ethnic and religious groups in rural India based on the 2013 data from the All India Debt and Investment survey carried out by National Sample Survey Office. The results indicate high interpersonal wealth inequality so also the intergroup wealth inequality at the aggregate level and by type of assets in rural India. The impact of caste on the ownership of wealth clearly indicates high ownership among Hindu high caste and Hindu other backward caste at the cost of low wealth share or ownership of the SC/ST indicating the existence of graded inequality.

scholarly journals Locating water distribution reservoirs in rural Andean areas: a methodological approach

2020 ◽  
Vol 10 (2) ◽  
pp. 309-319
Author(s):  
Nadya Lizeth Serrano Abarca ◽  
Welitom Ttatom Pereira da Silva
Keyword(s):  
Water Supply ◽  
Low Income ◽  
Rural Areas ◽  
Water Distribution ◽  
Water Movement ◽  
Methodological Approach ◽  
Pressure Control ◽  
Supply System ◽  
Water Supply System ◽  
Mountainous Region

Abstract This study aimed to present a methodology for locating water distribution reservoirs in rural Andean areas (isolated areas, low-income population, mountainous region). The research methodology consisted of the following steps: (1) description of the problem; (2) development of the DR location protocol; (3) obtaining an algorithm; (4) calibration and adjustment; and (5) application. The obtained algorithm was based on the classification and overlapping operations of five-parameter maps (pressure limits – pressure in the water supply system from 5 to 40 mH2O; supply by gravity – guarantee of gravity as energy for water movement; accessibility – use of unprotected areas or with restricted occupation; stability, greater distance from geological fault; and, proximity to population concentration, shorter distance between population centres). The overlapping of these parameters enabled us to identify a region of candidate points and select the best location point for the reservoir. The algorithm was applied to a real case indicating satisfactory results. A methodology for locating water distribution reservoirs in rural areas that have important economic constraints, difficult access (mountainous region) and high geospatial dispersion was found. Improvements in methodological steps can still be considered, for example, forecasting the use of pressure control devices in the water supply system.

scholarly journals A study of malaria vector surveillance as part of the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ashok K. Mishra ◽  
Praveen K. Bharti ◽  
Anup Vishwakarma ◽  
Sekh Nisar ◽  
Harsh Rajvanshi ◽  
...  
Keyword(s):  
Insecticide Resistance ◽  
Vector Control ◽  
Malaria Vector ◽  
Sibling Species ◽  
Malaria Elimination ◽  
Madhya Pradesh ◽  
Demonstration Project ◽  
Anopheles Culicifacies ◽  
Vector Density ◽  
Anopheles Fluviatilis

Abstract Background Understanding of malaria vector density, distribution, insecticide resistance, vector incrimination, infection status, and identification of sibling species are some of the essential components of vector control measures for achieving malaria elimination goals. Methods As part of the malaria elimination demonstration project, entomological surveillance was carried out from October 2017 to October 2019 by collecting indoor resting mosquitoes using hand catch method. Susceptibility test was done for determining the insecticide resistance status of vector mosquito Anopheles culicifacies using standard protocols by the World Health Organization. The cone bioassay method was used for determining the efficacy and quality of insecticide sprayed. Mosquitoes collected from different ecotypes were identified and processed for parasite identification, vector incrimination and sibling species determination. Results The two known malaria vector species (Anopheles culicifacies and Anopheles fluviatilis) were found in the study area, which have been previously reported in this and adjoining areas of the State of Madhya Pradesh. The prevalence of An. culicifacies was significantly higher in all study villages with peak in July while lowest number was recorded in May. Proportion of vector density was observed to be low in foothill terrains. The other anopheline species viz, Anopheles subpictus, Anopheles annularis, Anopheles vagus, Anopheles splendidus, Anopheles pallidus, Anopheles nigerrimus and Anopheles barbirostris were also recorded in the study area, although their prevalence was significantly less compared to the An. culicifacies. In 2017, An. culicifacies was found to be resistant to dichloro-diphenyl-trichloroethane (DDT) and malathion, with possible resistance to alphacypermethrin and susceptible to deltamethrin. However, in 2019, the species was found to be resistant to alphacypermethrin, DDT, malathion, with possible resistance to deltamethrin. The bioassays revealed 82 to > 98% corrected % mortality of An. culicifacies on day-one post-spraying and 35 to 62% on follow-up day-30. Anopheles culicifacies sibling species C was most prevalent (38.5%) followed by A/D and E while B was least pre-dominant (11.9%). Anopheles fluviatilis sibling species T was most prevalent (74.6%) followed by U (25.4%) while species S was not recorded. One An.culicifacies (sibling species C) was found positive for Plasmodium falciparum by PCR tests in the mosquitoes sampled from the test areas. Conclusion Based on the nine entomologic investigations conducted between 2017–2019, it was concluded that An. culicifacies was present throughout the year while An. fluviatilis had seasonal presence in the study areas. Anopheles culicifacies was resistant to alphacypermethrin and emerging resistance to deltamethrin was observed in this area. Anopheles culicifacies was confirmed as the malaria vector. This type of information on indigenous malaria vectors and insecticide resistance is important in implementation of vector control through indoor residual spraying (IRS) and use of insecticide-impregnated bed nets for achieving the malaria elimination goals.

scholarly journals Unlicensed medical practitioners in tribal dominated rural areas of central India: bottleneck in malaria elimination

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Mrigendra Pal Singh ◽  
Sunil Kumar Chand ◽  
Kalyan Brata Saha ◽  
Neetiraj Singh ◽  
Ramesh C. Dhiman ◽  
...  
Keyword(s):  
Malaria Elimination ◽  
Rural Areas ◽  
Central India ◽  
Medical Practitioners

Safe greywater reuse to augment water supply and provide sanitation in semi-arid areas of rural India

2010 ◽  
Vol 62 (6) ◽  
pp. 1296-1303 ◽  
Author(s):  
S. Godfrey ◽  
P. Labhasetwar ◽  
S. Wate ◽  
B. Jimenez
Keyword(s):  
Water Supply ◽  
Low Income ◽  
Rural Areas ◽  
Urban Areas ◽  
Water Reuse ◽  
Cost Effective ◽  
Open Defecation ◽  
Fourfold Increase ◽  
Semi Arid ◽  
Greywater Reuse

Water reuse is recognized as a tool to increase water supply in peri-urban areas of semi-arid and arid regions of the world. However, it is an option rarely explored for rural areas in developing countries, and has not been documented extensively in the scientific literature. This paper presents results from 6 greywater reuse systems which were built with the objective to augment water supply and to provide sanitation in rural low income areas of Madhya Pradesh, India. The systems are based on reclaiming greywater from bathing for the use in toilet flushing and kitchen garden irrigation. The reuse systems were implemented based on the scientific rationale presented in the WHO (2006) guidelines. The paper presents evidence from the operation and evaluation of the greywater treatment plants under field conditions between 2005 and 2008. The paper concludes that greywater is a highly cost effective solution for water scarcity. In this study, reusing greywater resulted in a 60% increase in water availability, a reduction in open defecation and a fourfold increase in food availability.

scholarly journals Water crises in a water-rich country: case studies from rural watersheds of Nepal's mid-hills

Water Policy ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 826-847 ◽  
Author(s):  
Anup Gurung ◽  
Sanot Adhikari ◽  
Raju Chauhan ◽  
Sudeep Thakuri ◽  
Selina Nakarmi ◽  
...  
Keyword(s):  
Rural Communities ◽  
Water Resources ◽  
Water Supply ◽  
Coping Strategies ◽  
Case Studies ◽  
Low Income ◽  
Rural Areas ◽  
Poor Households ◽  
Ground Survey ◽  
Drying Up

Abstract The main objective of this paper is to assess the water crisis in Nepal by conducting a series of case studies in rural watersheds in the mid-hills. This was achieved through the applied qualitative method, especially combinations of desk study/structured searches, consultation, and field observation. The ground survey revealed that most of the rural communities in the mid-hills have an unreliable water supply. According to the local stakeholders, 20–25% of water resources have dried up as compared to 20 years ago. Drying up of water resources disproportionately affects women and girls in rural areas as women are responsible for household chores, including fetching drinking water. The findings also revealed that low-income households bear a disproportionate coping burden as compared to elite groups, as they often engage in coping strategies such as collecting water from distant water sources, which is labor- and time-intensive, and also yields smaller quantities of water. Assuming that unreliable water supplies will continue to exist in rural areas of the mid-hills for the foreseeable future, there is a critical need to consider which, if any, coping strategies will be most effective in ensuring that poor households will have access to safe and sufficient water supply.

scholarly journals Monitoring of the Village Malaria Workers to conduct activities of Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Harsh Rajvanshi ◽  
Praveen K. Bharti ◽  
Ravendra K. Sharma ◽  
Sekh Nisar ◽  
Kalyan B. Saha ◽  
...  
Keyword(s):  
Case Management ◽  
Vector Control ◽  
Malaria Elimination ◽  
Urban Areas ◽  
Monitoring And Evaluation ◽  
Educational Status ◽  
Madhya Pradesh ◽  
Demonstration Project ◽  
Monitoring Tool ◽  
Field Workers

Abstract Background The capacity of the field staff to conduct activities related to disease surveillance, case management, and vector control has been one of the key components for successfully achieving malaria elimination. India has committed to eliminate malaria by 2030, and it has placed significance on monitoring and evaluation at the district level as one of the key strategies in its national framework. To support and guide the country’s malaria elimination objectives, the Malaria Elimination Demonstration Project was conducted in the tribal district of Mandla, Madhya Pradesh. Robust monitoring of human resources received special attention to help the national programme formulate a strategy to plug the gaps in its supply chain and monitoring and evaluation systems. Methods A monitoring tool was developed to test the capabilities of field workers to conduct activities related to malaria elimination work. Between November 2018 to February 2021, twenty-five Malaria Field Coordinators (MFCs) of the project utilized this tool everyday during the supervisory visits for their respective Village Malaria Workers (VMWs). The data was analysed and the scores were tested for variations against different blocks, educational status, duration of monitoring, and post-training scores. Results During the study period, the VMWs were monitored a total of 8974 times using the monitoring tool. Each VMW was supervised an average of 1.8 times each month. The critical monitoring indicators scored well in all seven quarters of the study as monitored by the MFCs. Monitoring by MFCs remained stable at 97.3% in all quarters. Contrary to expectations, the study observed longer diagnosis to treatment initiation time in urban areas of the district. Conclusion This study demonstrated the significance of a robust monitoring tool as an instrument to determine the capacity of the field workers in conducting surveillance, case management, and vector control related work for the malaria elimination programme. Similar tools can be replicated not only for malaria elimination, but other public health interventions as well.

scholarly journals Abdominal Wall Hernias: An Epidemiological Profile and Surgical Experience from a Rural Medical College in Central India

2021 ◽  
Vol 07 (01) ◽  
pp. e41-e46
Author(s):  
Bharati Pandya ◽  
Tanweerul Huda ◽  
Dilip Gupta ◽  
Bhupendra Mehra ◽  
Ravinder Narang
Keyword(s):  
Abdominal Wall ◽  
Low Income ◽  
Rural Areas ◽  
Abdominal Wall Hernia ◽  
Central India ◽  
Morbidity And Mortality ◽  
Hernia Surgery ◽  
Female Ratio ◽  
Surgical Methods ◽  
Groin Hernias

Abstract Background Abdominal wall hernia is a common surgical entity worldwide with groin hernias having the most common presentation among them. They are a cause of morbidity and mortality if not addressed in time. A variety of surgical methods are available for the repair of hernias. The tension-free repair using synthetic mesh has the least recurrence and is the most accepted. Aim To describe the surgical burden and clinical profile of abdominal wall hernias as well as experiences in their management in a rural setup. Methods This was a retrospective observational study of all the cases of abdominal wall hernias presenting to various surgical divisions of Mahatma Gandhi Institute of Medical Sciences, Sevagram, during a two-year period from December 2011 to November 2013. Relevant details were collected from the hospital information statistics and patient file records and analysis of obtained data was done. Result A total of 910 out of 90,056 surgical outpatients (10.10%) seen during this period had abdominal wall hernias; 816 (89.67%) got operated. A total of 163 (20%) of 816 were operated in an emergency. Groin hernias were the most common 653 (80%), followed by incisional 82 (10%), umbilical and paraumbilical 41 (5%), epigastric 33 (4%), and rarer hernias in 8 (1%). Of 816 operations, 24 (2.9%) had recurrent hernias and 83 (10.17%) were pediatric patients. Male to female ratio was 9:1 in adults and 4:1 in children. The median age among adults was 49 years (range: 14–95 years), and among the pediatric age group, it was 7 years (range: 3 months–14 years). The majority of the adult patients were from a low-income group and presented more than 2 years after symptoms appeared. Comorbid conditions encountered were hypertension in 212 (26%), diabetes in 155 (19%), chronic airway disorders in 449 (55%), cardiac problems in 163 (20%), obesity in 10 (1.2%), and chronic renal failure and liver disorder in 82 (1%). Predisposing factors in the majority of the patients were chronic cough 449 (55%), prostatic problems in 187 (23%), chronic constipation in 163 (20%), previous surgeries in 82 (10%), obesity in 10 (1.2%), and ascites in 9 (0.1%). Hernia surgery was performed laparoscopically in 51 (6.25%) patients. Simultaneous other surgeries were performed in 130 (16%) patients. Mortality occurred in 2 (0.24%) patients operated in emergency, and chief morbidity was due to wound infection in 25 (3%) and chronic pain in 30 (3.9%) patients. Conclusion Abdominal wall hernias are common clinical entities. Although the pattern of presentation and management is similar, the challenges faced in a rural setup are due to ignorance, social inhibitions, and financial restraints, leading to delayed presentations which increase their morbidity and mortality. Health programs and surveys to increase awareness in rural areas as well as cutting down on expenses could help these patients.

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