MALARIA STATUS AND CONTROL DURING FISCAL

YEAR 2074/75 CARRIED BY NEPAL GOVERNMENT

A CASE REPORT

SUBMITTED TO:

SUJIT KUMAR YADAV

INSTRUCTOR AT BIRAT MULTIPLE COLLEGE
BIRATNAGAR, MORANG, NEPAL

SUBMITTED BY:

RICHA POKHAREL
BATCH: 2075/076

CONTENTS PAGES
Declaration i

Letter of Approval ii

Acknowledgement iii

List of Abbreviation iv

1 BACKGROUND 1

Goal 2

Objective 2

Strategies 2

MATERIAL AND METHODS 2

Study Areas 2

Method 2

MAJOR ACTIVITIES AND ANALAYSIS 3

RESULTS 6

DISSUSSION AND CONCLUSIONS 6

RECOMMENDATIONS 6

REFERENCES 6

DECLARATION
I hereby declare this report has been prepared by myself from the collected information provided by

“Department of health service” (DOHS) annual reports 2074/2075 B.S. Literature were reviewed from

The various source for the secondary information. This reports contents the information about the

“Malaria status and Control” during fiscal year 2074/2075 carried by Nepal Government. The data in this

report “Malaria status and Control” are tried to adopt as the recent and updated as possible.

Date: ……………………………………

……………………………… ..

Richa Pokharel

page i

LETTER OF APPROVAL
This is to endorse that the report entitled “Malaria Status and Control” during Fiscal year

2074/2075 carried by Nepal Government has been carried out by the candidate of Zoology

for the partial fulfillment of Bachelor’s degree of science in Zoology. First year. She worked

enthusiastically with sincere interest throughout this project. This report embodies their own

and has been done under my supervision. I hereby, approve this report for the submission in

the examination.

Date: ………………………..

………………………… ..

Mr. Sujit Kumar Yadav

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ACKNOWLEDGEMENTS

It is a great opportunity for me to write about “Malaria Status and Control”. I have collected the
information through different books and websites.
I would like to thank all the authorities of “Department of Health services” (DOHS), Teku Kathmandu,
Nepal especially for helping me by giving the valuable information regarding Malaria.

I would like to thank my friends for making me understanding the different system of legal research and
conceptual problem.

Date………………………..

…………………………… ..

Richa Pokharel

Page iii

LIST OF ABBREVIATION

ANC - Antenatal Care

EDCD - Epidemiology Disease Control Division

 FCHV - Female Community Health Volunteer

EWARS -Early Warning And Reporting System

IRS - Indoor Residual Spraying

MDIS - Malaria Disease Information System

LLIN - Long Lasting Insecticidal Nets

WHO - World Health Organization

Page iv

1. BACKGROUND

Nepal’s malaria control programme began in 1954, mainly in the Tarai belt of central Nepal with support
from the United States. In 1958, the National Malaria Eradication Programme was initiated and in 1978
the concept reverted to a control programme. In 1998, the Roll Back Malaria (RBM) initiative was
launched for control in hard-core forests, foothills, the inner Tarai and hill river valleys, which accounted
for more than 70 percent of malaria cases in Nepal. Malaria is a greater risk in areas with an abundance
of vector mosquitoes, amongst mobile and vulnerable populations, in relatively inaccessible areas, and
during times of certain temperatures.

Malaria risk stratification 2018 was tailored to suit the changing epidemiology of malaria in the country
and to ensure appropriate weightage is allotted to key determinants of malaria transmission as
recommended by external malaria program review. Malaria data from last three years reveals that even
within Rural Municipalities or Municipalities, malaria is concentrated within some wards while other
wards remain relatively free of malaria. In these settings, transmission is typically sufficiently low and
spatially heterogeneous to warrant a need for estimates of malaria risk at a community level, the wards.
In order, to refine the risk stratification at the community level and thereby define the total population at
risk of malaria; malaria risk micro- stratification was conducted at the wards level of Rural Municipality
or Municipalities.

The methodology used recent malaria burden data supplemented by information on the spatial
distribution of key determinants of transmission risk including climate, ecology, and the presence or
abundance of key vector species and vulnerability in terms of human population movement. The method
was based on 2012 and 2016 micro-stratification study and it was recommended by Epidemiology and
Disease Control Division (EDCD) and Malaria Technical Working Group (TWG). EDCD provided the overall
oversight of the study.

Disease burden, geo-ecology & entomological risk, and vulnerability were given a defined weight and
each ward received a weightage response on the three determinants. A median annual API was
calculated for each ward based on the last 3 years (16th July 2015-15th July 2018) malaria burden data
of the ward and a mean API was derived from the 3 years median API. A standard deviation was
calculated and 2 X SD + mean was taken as a high disease burden ward and the ward was allotted 100 %
of total disease burden weight (0.6). Similarly, moderate and low disease burden wards were identified
and allotted their weightage response. Receptivity was allotted a total weight of 0.3, which was further
divided into eco-environment (0.1) and presence of vectors (0.2). Vulnerability was allotted a total
weight of 0.1, which was further divided, and weightage response was allotted as: high mobility areas
(0.1) and moderate (0.05) to low (0.01) mobility areas. The weightage response of each determinant for
a ward was calculated and the summation of the three determinants was converted into percentage. A
cut off percentage of 75 or more was agreed as the criteria to define a high-risk ward.

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1.1 Goal
To reduce the morbidity by 50% and mortality by 75% due to malaria and to attain malaria free Nepal by
2025.

1.2 Objectives

*To promote the implementation of evidence based strategies for malaria control.

*To facilitate the access of populations at risk to effective treatment of malaria.

*To strengthen capacity building for malaria control.

*To develop an integrated vector management (IVM) approach for prevention and control.

1.3 Strategies

The strategy to achieve the targets was identified as follows:

i) To strengthen strategic information for decision making and implement surveillance as a core
intervention towards malaria elimination.

ii)To further reduce malaria transmission and eliminate the foci wherever feasible.

iii)To improve quality ensure and universal access to early diagnosis and effective treatment of malaria.

iv)To develop and sustain support through advocacy and communication, from the leadership and the
communities towards malaria elimination.

v)To strengthen programmatic technical and managerial capacities towards malaria elimination.

2. MATERIALS AND METHODS

2.1 Study Areas

Jhapa, Morang, Sunsari

2.2 Methods

The data were collected from annual report published by EDCD.

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3. Major Activities
• 610,252 LLIN was distributed as mass distribution and 54,786 LLIN was distributed to pregnant women
at their first ANC visits.

• Conducted the ward-level micro-stratification of malaria cases in 44 districts.

• Introduced case-based surveillance system, including web-based recording and reporting system for
districts. The MDIS is now fully operational.

• Orientated district and peripheral level health workers on case based surveillance and response.

• Conducted a national malarial vector survey.

• Carried out detailed foci investigation at more than four sites.

• Revitalized the malaria microscopy quality assurance system with collaboration between the
Epidemiology and Disease Control Division (EDCD) and VBDRTC, with technical assistance from WHO.

• Orientated district health workers and FCHVs on the government’s malaria elimination initiative and
their role in detecting cases and facilitating early treatment.

• Orientated mother groups and school children on malaria prevention and the need for early diagnosis
and prompt treatment.

• Conducted quarterly and annual review meetings for district and central level staff. Participants
reviewed data from peripheral facilities and revised it based on suggestions.

• Conducted operational research on malaria vector behaviour and insecticide resistance.

• Conducted regular vector control (indoor residual spraying) biannually across high and moderate risk
districts.

• Conducted detailed case based investigation and fever surveys around positive index cases.

• Conducted integrated entomological surveillance around twelve different site of thought-out the
country.

• Celebrated World Malaria Day on 25 April.

Achievements

Nepal achieved MDG 6 ahead of time by reducing malaria morbidity and mortality rates by more than 50
percent in 2010. Despite political instability, Nepal’s malaria programme has successfully implemented
planned interventions to eliminate the remaining active malaria foci (VDCs). MoH, with support from its
EDPs, has implemented a strong malaria control programme, steadily improving the coverage and quality
of indoor residual spraying, introducing long lasting insecticide-treated nets, and increasing access to
rapid malaria diagnosis and powerful artemisinin-based combination treatments.
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Data generated by public health care facilities in the HMIS, the Early Warning and Reporting System
(EWARS) and from studies including malaria micro-stratification show a substantial decline over the last
six years in clinical and laboratory confirmed Plasmodium falciparum and P. vivax cases. The findings of
the micro-stratification exercise (2013) reduced the number of high and moderate risk district from 31 to
25 and identified 1,254 VDCs (out of 3,972) as presenting a risk of contracting malaria. In 2073/74
(2016), micro stratification was done to assess the risk at ward level. The result was published.

• During 2004–2007, the annual parasite incidence (API) remained stable (0.26-0.27 per 1000 population
country wide), and thereafter gradually declined to the lowest level ever recorded (in 2074/75) of
0.08/1000 at risk population (calculated based on denominator set after microstratification, 2018/HMIS).

Confirmed malaria cases increased from 1128 in 2073/74 to 1187 in 2074/75. The proportion of P.
falciparum infections is decreased and accounted for 7.1 percent of all cases in current year.

• The trend of clinically suspected malaria cases is also decreasing, mainly due to the increased
coverage of RDT, microscopic laboratory service at peripheral level and regular orientation and onsite
coaching of service providers. A total of 3,282 probable/clinical suspected malaria cases treated by
chloroquine through OPD were reported in 2074/75.

• There was a sharp decrease in the number of indigenous P. falciparum cases with slowly increasing
trend of indigenous P.vivax cases. But cases being identified in new areas, especially in mountian, hilly
and terain, suggest that P.vivax malaria remains a challenge for the elimination of malaria in Nepal. This
raises the need for new country specific elimination strategies.
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Malaria epidemiological information of 2073/74 to 2074/75

Items /indicators 2072/73 2073/74 2074/75

Total population at Risk 13767000 14944174 15177434

Slide collection Target 150000 150,000 150,000

Total slide examined 116276 118165 207581

Total positive cases 991 1128 1187

Total indigenous cases 506 492 557

Total imported cases 485 636 630

Total P. falciparum (Pf) cases 162 148 82

% of Pf of total cases 16.34 13.1 6.9

Total indigenous Pf cases 70 52 10

% indigenous Pf cases 43.21 35 12

Total imported Pf cases 92 96 72

% imported Pf cases 56.79 65 88

Total P. vivax(Pv)cases 829 980 1105

Total indigenous Pv cases 436 440 547

% indigenous Pv cases 52.6 44.9 49.5

Total imported Pv cases 393 540 558

% imported Pv cases 47.4 55.1 50.5

Annual blood examination rate 0.84 0.09 1.4

Annual parasite incidence 0.07 0.08 0.008

Items /indicators 2072/73 2073/74 2074/75

Annual Pf incidence 0.012 0.01 0.01

Slide positivity rate 0.85 0.95 0.57

Slide Pf positively rate 0.14 0.13 0.04

Probable/clinical suspected malaria

cases (not tested but treated by
10642 3904 3282
chloroquine)

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5. RESULTS
Malaria Cases and incidence in Jhapa, Morang, Sunsari

Study Area (District) Case Death

Jhapa 7 0

Morang 6 0

Sunsari 5 0

6. DISCUSSION AND CONCLUSION

Thus, out of three districts given the highest prevalence of malaria is in Jhapa and in Morang and
Sunsari.

7. RECOMMENDATIONS
• Low blood slide examination rates for malaria elimination programme.
• Orientation and training on malaria programme to health workers.

• Malaria case reporting and case investigation.

8. REFFERENCES
* Google/ wikipedia.com

* Annual Report Department of Health Service 2074/075

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