CHAPTER 6: COMMUNICABLE DISEASES — SORTED QUESTION LIST

🔴 MALARIA (Long Essay Questions)

1. Strategies under National Vector Borne Diseases Control Programme (NVBDCP)
2. General guidelines for treatment of uncomplicated malaria as per National Drug Policy on March 2013
3. Write a brief note on integrated vector control
4. Reasons for persistence of malaria, ABER and API and importance of APP
5. Epidemiology of malaria and vector control strategies to prevent malaria in your PHC area
6. Clinical feature, mode of transmission and chemoprophylaxis of malaria
7. Instruction to health workers in the urban center for surveillance of fever cases
8. Long-term control measures for an outbreak of malignant malaria cases by the Block Medical Officer of Health
9. National Anti-Malaria Programme
10. Epidemiological aspects of kala-azar and strategies for control of disease (in a rural area)

🔴 MALARIA (Short Notes)

1. Discuss surveillance of malaria
2. Malariometric measures
3. Slide positivity rate
4. Major epidemiological types of malaria
5. Aedes aegypti index
6. Radical treatment for vivax malaria
7. Factors responsible for resurgence of malaria
8. Approaches of malaria control
9. Difference between mosquito and sandfly
10. Enumerate the causes of resurgence of kala-azar
11. Enumerate mosquito-borne diseases
12. Integrated vector management
13. Man-made malaria
14. Comment on malaria week
15. Measures for control of urban malaria

🔴 AIDS / HIV (Long Essay Questions)

1. Epidemiology of AIDS
2. National AIDS Control Program along with NACO
3. Various methods by which the disease can be prevented
4. Name of common STDs, measures for prevention and control with reference to HIV/AIDS
5. Syndromic approach in management of STDs
6. Role of (pre-test and post-test) counseling in controlling HIV/AIDS
7. As a BMOH, role of arranging health education programme in your area regarding HIV
8. One pregnant woman whose husband was found to be HIV positive, came to OPD on 2nd trimester, management of the case and advice for the couple

🔴 AIDS / HIV (Short Notes)

1. What do you mean by HIV/AIDS?
2. Clinical manifestations / WHO criteria for diagnosis of AIDS and its control
3. What is ARC?
4. Mention modes of transmission of HIV/AIDS
5. List vertically transmitted diseases, prevention of parent to child transmission of HIV
6. Explain role of high-risk group and bridge population in HIV transmission / AIDS is no longer limited to high-risk population
7. HIV is a behavioral disease
8. Enumerate the various RTI/STI syndromes
9. Common complication of STDs
10. Describe risk factors of HIV/AIDS
11. ICTC should be supported by ART/link ART center
12. Opportunistic infections in AIDS
13. What is window period?
14. Contact tracing in STIs
15. Screening for diseases in blood bank
16. Universal precaution
17. Describe in brief the guidelines for PEP in HIV/AIDS (post-exposure prophylaxis) in health care settings
18. Treatment 2.0 of HIV and AIDS

🔴 TUBERCULOSIS (Long Essay Questions)

1. Discuss the epidemiology of tuberculosis
2. Define goals and objectives of RNTCP. Describe various components of DOTS strategy
3. National Program on Control of Tuberculosis in India including strategies and components in RNTCP
4. The diagnostic process for initiation of treatment of TB under RNTCP
5. Category I and II and MDR, XDR TB
6. RNTCP in Bihar or any state of India
7. Cardinal symptoms for pulmonary TB, organogram of RNTCP in a primary health center area
8. Different levels of prevention and mode of interventions as applied to pulmonary tuberculosis

🔴 TUBERCULOSIS (Short Notes)

1. RNTCP gives priority on detection of New Smear Positive cases
2. Sputum smear examination is the method of choice for case finding in TB
3. Passive surveillance in tuberculosis
4. Collection of sputum sample in tuberculosis
5. Describe in details DOTS plus

🔴 REMAINING QUESTIONS (Other Topics — in original order)

1. Diseases of public health importance in NVBDCP and its principles
2. Epidemiology of lymphatic filariasis and its control in India
3. Epidemiology, clinical presentations and classification of Dengue fever and its control
4. The arboviral diseases, epidemiology, clinical features, control of Japanese encephalitis
5. Clinical feature, diagnosis, treatment, control of Chikungunya fever
6. Problems, epidemiological factors and prevention of rabies
7. WHO categories of exposure in rabies
8. Prevention of human rabies
9. What is pre-exposure prophylaxis?
10. Measures for minimizing human rabies in the area
11. Epidemiology of leprosy
12. Classification, diagnosis and treatment (MDT as per WHO) of leprosy
13. Brief control methods with reference to NLEP
14. Different modes of intervention under levels of prevention in relation to leprosy
15. The steps for elimination of leprosy
16. Diagnosis of plague and its control measures
17. Epidemiology of poliomyelitis
18. Polio eradication in the light of epidemiological factors influencing poliomyelitis
19. AFP in brief, various strategies for eradication of poliomyelitis including the surveillance of AFP, environmental surveillance
20. Different levels of prevention and modes of intervention can be applied to poliomyelitis
21. The epidemiology, prevention and control of hepatitis B in India
22. Epidemiology, clinical features, diagnosis, management and prevention and control of swine flu (H1N1) / swine flu / diagnosis and prevention of swine flu
23. Integrated Disease Surveillance Programme (IDSP)
24. Mode of transmission of arthropod-borne diseases / What are the arthropod-borne diseases, control of vectors?
25. Environmental control - best approach to control of arthropods
26. Define blanket treatment with examples
27. Assessment of filarial control programme
28. Why filariasis never causes explosive epidemic?
29. What is night blood examination?
30. Suraksha clinic
31. The different presentation of leprosy to be encountered in out-patient department of hospitals
32. Leprosy eradication is very difficult to achieve
33. Indicators that are used by health workers to assess the disability of leprosy cases in field level
34. Lepromin test
35. Lepra reaction
36. Fixed virus
37. Essen regimen and rabies immunoglobulin for passive immunization in post-exposure
38. Hepatitis B infection should be considered more dangerous than HIV infection
39. Blocked flea / Partial blocked fleas are more dangerous
40. What is provocative poliomyelitis
41. Cyclops
42. What is Chandler's index?
43. Epidemiology and prevention of Ebola virus disease / Ebola virus disease
44. All influenza pandemics were caused by influenza virus A and not by B or C
45. What is antigenic shift and antigenic drift?
46. SAFE strategy for trachoma
47. Inappropriate and inadequate use of antibiotics leads to antimicrobial resistance
48. What is the criteria for successful parasitism?
49. Australia antigen
50. Serological marker of Hepatitis B
51. Measures to prevent entry of yellow fever into India
52. India is yellow fever receptive area

• All AIDS/HIV questions are grouped together (Long Essay first, then Short Notes)
• All Malaria questions are grouped together (Long Essay first, then Short Notes)
• All TB questions are grouped together (Long Essay first, then Short Notes)
• No duplicates were found in the original list (all questions were unique)
• The remaining topics (Leprosy, Rabies, Polio, Hepatitis, Filariasis, etc.) follow in their original order

CHAPTER 6: COMMUNICABLE DISEASES — FULLY SORTED

🔴 MALARIA

1. Strategies under National Vector Borne Diseases Control Programme (NVBDCP)
2. Diseases of public health importance in NVBDCP and its principles
3. General guidelines for treatment of uncomplicated malaria as per National Drug Policy on March 2013
4. Write a brief note on integrated vector control
5. Reasons for persistence of malaria, ABER and API and importance of APP
6. Epidemiology of malaria and vector control strategies to prevent malaria in your PHC area
7. Clinical feature, mode of transmission and chemoprophylaxis of malaria
8. Instruction to health workers in the urban center for surveillance of fever cases
9. Long-term control measures for an outbreak of malignant malaria cases by the Block Medical Officer of Health
10. National Anti-Malaria Programme

🔴 AIDS / HIV & STIs

🔴 TUBERCULOSIS

🔴 LEPROSY

🔴 POLIOMYELITIS

🔴 RABIES

🔴 HEPATITIS

🔴 FILARIASIS

🔴 VECTOR-BORNE & ARTHROPOD-BORNE DISEASES (General)

🔴 INFLUENZA & VIRAL RESPIRATORY DISEASES

🔴 PLAGUE

🔴 TRACHOMA & ANTIMICROBIAL RESISTANCE

🔴 PARASITOLOGY / GENERAL MICROBIOLOGY

🔴 SURVEILLANCE & PUBLIC HEALTH PROGRAMMES

🔴 MALARIA — Long Essay Questions

Q1. Strategies under National Vector Borne Diseases Control Programme (NVBDCP)

• Active and passive surveillance of fever cases
• Peripheral fever treatment depots (FTDs) at village level
• Rapid Diagnostic Tests (RDTs) for quick diagnosis
• Complete treatment with ACT (Artemisinin Combination Therapy) for P. falciparum
• Radical treatment with Primaquine for P. vivax (14 days)

• Indoor Residual Spraying (IRS) with DDT / Malathion / Synthetic pyrethroids
• Larval source management - anti-larval measures (Paris green, Temephos)
• Biological control - Gambusia fish, Bacillus thuringiensis israelensis (Bti)
• Personal protection - insecticide-treated bed nets (ITNs), Long-Lasting Insecticidal Nets (LLINs)
• Environmental management - drainage, filling of breeding sites

• Sentinel surveillance sites
• Stockpiling of drugs, insecticides, diagnostics
• Rapid response teams at district level

• Behaviour Change Communication (BCC)
• Inter-sectoral convergence (with water, sanitation, agriculture departments)
• Capacity building of health workers (ASHAs, ANMs, MPWs)
• Public-private partnership

• Focus on tribal, forest, hard-to-reach areas
• Annual Blood Examination Rate (ABER) target: minimum 10% of population
• Slide Positivity Rate (SPR) and Annual Parasite Incidence (API) monitoring

• API < 1 per 1000 population = elimination target
• District-wise mapping of malaria burden
• HMIS reporting

🔴 MALARIA — Q2

Q2. Diseases of Public Health Importance in NVBDCP and its Principles

1. MALARIA

• Caused by Plasmodium species (P. vivax, P. falciparum, P. malariae, P. ovale)
• Vector: Female Anopheles mosquito
• Public health importance: Leading cause of fever-related morbidity in India; P. falciparum causes cerebral malaria and death
• High burden states: Odisha, Jharkhand, Chhattisgarh, MP, NE states

2. DENGUE

• Caused by Dengue virus (4 serotypes - DEN 1, 2, 3, 4)
• Vector: Aedes aegypti (day-biting mosquito)
• Public health importance: Urban epidemic potential; Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS) are life-threatening
• No specific treatment; only supportive care

3. CHIKUNGUNYA

• Caused by Chikungunya virus (Alphavirus)
• Vector: Aedes aegypti and Aedes albopictus
• Public health importance: Causes debilitating joint pain; large urban outbreaks possible

4. JAPANESE ENCEPHALITIS (JE)

• Caused by JE virus (Flavivirus)
• Vector: Culex tritaeniorhynchus mosquito
• Public health importance: High case fatality rate (20-30%); neurological sequelae in survivors
• Endemic in UP, Bihar, Assam, West Bengal

5. KALA-AZAR (Visceral Leishmaniasis)

• Caused by Leishmania donovani
• Vector: Female sandfly (Phlebotomus argentipes)
• Public health importance: 100% fatal if untreated; target for elimination (< 1 case per 10,000 population at block level by 2023)
• Endemic in Bihar, Jharkhand, UP, West Bengal

6. LYMPHATIC FILARIASIS

• Caused by Wuchereria bancrofti
• Vector: Culex quinquefasciatus
• Public health importance: Causes lymphoedema, hydrocele, elephantiasis - permanent disability; huge social stigma
• Target: Elimination as public health problem

• ABER (Annual Blood Examination Rate) - target ≥ 10%
• API (Annual Parasite Incidence) - target < 1 for elimination
• SPR (Slide Positivity Rate)
• ABER for Filariasis - Microfilaria rate

🔴 MALARIA — Q3

Q3. General Guidelines for Treatment of Uncomplicated Malaria as per National Drug Policy on March 2013

TREATMENT OF P. vivax (Uncomplicated)

• Primaquine is given to eliminate hypnozoites (dormant liver stage)
• Contraindicated in G6PD deficiency, pregnancy, infants < 6 months
• G6PD testing before Primaquine in endemic areas

TREATMENT OF P. falciparum (Uncomplicated)

In NE States (where resistance is high):

In Rest of India:

TREATMENT OF MIXED INFECTION (P. vivax + P. falciparum)

• Treat as P. falciparum with ACT (3 days)
• Add Primaquine 0.25 mg/kg/day for 14 days (for vivax radical cure)

TREATMENT OF P. falciparum IN PREGNANCY

SEVERE / COMPLICATED MALARIA

• Artesunate IV/IM is drug of choice (replaced Quinine)
• Artesunate 2.4 mg/kg IV at 0, 12, 24 hours, then daily
• Shift to oral ACT once patient can tolerate oral medication
• Manage complications: cerebral malaria, hypoglycemia, severe anemia, renal failure

KEY POINTS OF 2013 POLICY:

1. ACT replaced Chloroquine as first-line for P. falciparum across India
2. Artesunate IV replaced Quinine for severe malaria
3. Primaquine single dose (0.75 mg/kg) added for P. falciparum to kill gametocytes and reduce transmission
4. 14-day Primaquine mandatory for P. vivax radical cure
5. Chloroquine monotherapy no longer recommended for P. falciparum
6. RDT (Rapid Diagnostic Test) to be used where microscopy not available before starting treatment
7. Do not start treatment without parasitological confirmation (microscopy or RDT)

• Chloroquine alone for P. falciparum
• Artemisinin monotherapy (to prevent resistance)
• SP (Sulfadoxine-Pyrimethamine) as first-line

🔴 MALARIA — Q4

Q4. Write a Brief Note on Integrated Vector Control (IVC) / Integrated Vector Management (IVM)

• Defined by WHO (2004)
• It is the cornerstone of NVBDCP vector control strategy

• Single method of vector control is insufficient
• Insecticide resistance developing in vectors
• Environmental concerns with chemical use
• Cost-effectiveness demands combination approach
• Multiple diseases share same vector (e.g., Aedes for Dengue + Chikungunya)

COMPONENTS OF INTEGRATED VECTOR MANAGEMENT:

1. CHEMICAL METHODS

• Spraying of insecticides on indoor walls and surfaces
• Kills mosquitoes when they rest on walls after blood meal
• Insecticides used: DDT, Malathion, Synthetic Pyrethroids (Deltamethrin, Cyfluthrin)
• Done twice a year in high-transmission areas

• Thermal fogging or cold fogging
• Used during outbreaks of Dengue / Chikungunya
• Kills adult mosquitoes in the air
• Pyrethrum extract used

• Application of chemicals to breeding sites
• Temephos (Abate) - organophosphate larvicide
• Used in water bodies where biological control not feasible

2. BIOLOGICAL METHODS

• Gambusia affinis and Poecilia reticulata (Guppy fish)
• Introduced into wells, ponds, rice fields
• Eats mosquito larvae
• Most widely used biological control in India

• Bacillus thuringiensis israelensis (Bti) - kills Anopheles and Aedes larvae
• Bacillus sphaericus - kills Culex larvae
• Eco-friendly, no harm to non-target organisms

• Cyclops (copepod crustacean) - predator of Aedes larvae
• Used in water storage containers

3. ENVIRONMENTAL MANAGEMENT

• Elimination / modification of breeding sites
• Draining stagnant water, filling low-lying areas
• Proper solid waste disposal
• Covering water storage containers

• Permanent changes - land filling, drainage construction
• Irrigation management - intermittent irrigation in rice fields

• Temporary changes - flushing canals, changing water salinity

4. PERSONAL PROTECTION MEASURES

• Insecticide Treated Nets (ITNs) - impregnated with Permethrin/Deltamethrin
• Long Lasting Insecticidal Nets (LLINs) - effective for 3-5 years without re-treatment
• Repellents - DEET (Diethyl toluamide), Neem oil
• Protective clothing - full sleeves, light colors
• Wire mesh on windows and doors
• Mosquito coils, mats, vaporizers

5. LEGISLATIVE / REGULATORY MEASURES

• Anti-larval bylaws by municipal corporations
• Penalty for allowing mosquito breeding in premises
• House-to-house inspection during outbreaks
• Container index surveys

6. COMMUNITY PARTICIPATION

• Jan Andolan (public movement)
• Dry Day - every Friday (emptying water containers)
• School health education
• Self-help groups involvement
• ASHAs and AWWs as frontline workers

PRINCIPLES OF IVM (WHO):

• Delays insecticide resistance
• More cost-effective
• Environmentally safe
• Sustainable long-term impact
• Covers multiple vector-borne diseases simultaneously

🔴 MALARIA — ALL REMAINING QUESTIONS (Q5 to Q21)

Q5. Reasons for Persistence of Malaria, ABER, API and Importance of APP

• Drug resistance - Chloroquine resistance in P. falciparum
• Multiple Plasmodium species (P. vivax relapses from hypnozoites)
• Artemisinin partial resistance emerging in NE India

• Insecticide resistance in Anopheles mosquitoes (to DDT, HCH)
• Multiple vector species (An. culicifacies, An. stephensi, An. fluviatilis, An. minimus)
• Behavioral changes in vectors (outdoor resting, early biting)
• Adaptability to new breeding sites

• Deforestation, mining, construction activities creating new breeding sites
• Irrigation projects, dams, waterlogged areas
• Urbanization - An. stephensi thriving in urban water storage
• Climate change - extending transmission season and geography

• Poverty - poor housing, no bed nets
• Migration of labor (tribal workers, construction workers) from high endemic to low endemic areas
• Forest dwellers, tribal populations - difficult to reach
• Low health-seeking behavior

• Inadequate surveillance (low ABER)
• Irregular / incomplete treatment
• Shortage of drugs, RDTs, insecticides
• Weak health infrastructure in tribal/remote areas
• Poor inter-sectoral coordination

• Irregular IRS coverage
• Resistance to insecticides not monitored regularly
• Inadequate BCC activities

ABER - Annual Blood Examination Rate

• Definition: Number of blood smears examined per 100 population per year
• Formula: ABER = (Blood smears examined in a year / Total population) × 100
• Target: Minimum 10% of the population (i.e., ABER ≥ 10)
• Significance:
  • Measures intensity of surveillance
  • Low ABER = poor surveillance = underreporting
  • High-risk areas need higher ABER

API - Annual Parasite Incidence

• Definition: Number of confirmed malaria cases per 1000 population per year
• Formula: API = (Confirmed malaria cases in a year / Total population) × 1000
• Classification by API:

• Significance:
  • Best single indicator of malaria burden
  • Used for resource allocation
  • Monitors programme progress
  • India's target: API < 1 (elimination)

SPR - Slide Positivity Rate

• Formula: SPR = (Positive slides / Total slides examined) × 100
• If SPR > 5% = high transmission area

APP - Annual Falciparum Incidence / Annual P. falciparum Proportion

• Definition: Proportion of P. falciparum cases among total malaria cases
• Formula: APP = (P. falciparum cases / Total malaria cases) × 100
• Importance of APP:
  • P. falciparum causes severe and fatal malaria
  • High APP = high risk of cerebral malaria, death
  • Guides choice of drug (ACT needed for P. falciparum)
  • Identifies areas needing intensive intervention
  • Districts with high APP get priority for ACT supply and LLINs
  • Monitors shift from P. vivax to P. falciparum dominance

Q6. Epidemiology of Malaria and Vector Control Strategies to Prevent Malaria in Your PHC Area

• Plasmodium vivax - most common in India (~50%)
• Plasmodium falciparum - most dangerous (~45-47%)
• P. malariae, P. ovale - rare
• P. knowlesi - zoonotic, emerging in NE India

• Universal susceptibility
• Partial immunity develops after repeated infections
• High-risk groups: children < 5 years, pregnant women, non-immune migrants, tribal populations
• Sickle cell trait provides some protection against P. falciparum

• Female Anopheles mosquito (20 species in India, 6 are major vectors)
• Major vectors:
  • An. culicifacies - rural plains
  • An. stephensi - urban, breeds in overhead tanks
  • An. fluviatilis - hilly, forest areas
  • An. minimus - NE India
  • An. sundaicus - coastal areas
  • An. dirus - forest areas

• High temperature (20-30°C), high humidity
• Rainy season (July-November) - peak transmission
• Stagnant water bodies for breeding
• Forest and tribal areas - high burden

• Bite of infected female Anopheles (mainly between dusk and dawn)
• Blood transfusion, needle sharing, congenital (rare)

• P. vivax / P. ovale: 12-17 days (can be up to 6-12 months with hypnozoites)
• P. falciparum: 9-14 days
• P. malariae: 18-40 days

• 90% of cases from 8 states: Odisha, Chhattisgarh, Jharkhand, MP, Maharashtra, Gujarat, Rajasthan, NE states
• Odisha alone contributes ~25-30% of national malaria burden
• Urban malaria rising (An. stephensi)

• Weekly anti-larval operations in all known breeding sites
• Application of Temephos (Abate) to water bodies
• Releasing Gambusia fish in ponds, wells, irrigation channels
• Filling and draining of small water collections
• Oiling of water surfaces

• Indoor Residual Spraying (IRS) twice a year before transmission season
• Space spraying / fogging during outbreaks
• Use of Pyrethrum space spray

• Distribution of LLINs (Long Lasting Insecticidal Nets) to high-risk families
• Promotion of repellents, mosquito coils
• Health education on protective clothing

• Maintaining ABER ≥ 10%
• Active fever case detection by MPW/ASHA every 2 weeks
• Passive surveillance through OPD
• Malaria clinic in high-burden PHCs

• Blood smear / RDT for all fever cases
• Immediate treatment: ACT for P. falciparum, Chloroquine + Primaquine for P. vivax
• Follow-up to ensure complete treatment

• Friday "Dry Day" - emptying water containers
• Involving Panchayati Raj institutions
• ASHA home visits for fever surveillance

• Weekly reporting of cases to district
• Immediate reporting of outbreaks / deaths

Q7. Clinical Feature, Mode of Transmission and Chemoprophylaxis of Malaria

• P. vivax / P. ovale: Every 48 hours (tertian / benign tertian fever)
• P. falciparum: Every 48 hours (malignant tertian - irregular initially)
• P. malariae: Every 72 hours (quartan fever)

• Anemia (due to RBC destruction)
• Splenomegaly (repeated infections)
• Hepatomegaly
• Jaundice
• Thrombocytopenia

• Cerebral malaria - altered consciousness, seizures, coma
• Blackwater fever - massive hemolysis, hemoglobinuria (black urine)
• Algid malaria - circulatory collapse, shock
• Severe anemia (Hb < 5 g/dL)
• Acute Renal Failure (ARF) - "big spleen disease"
• Hypoglycemia
• Pulmonary edema / ARDS
• Abnormal bleeding

• Mosquito injects sporozoites during blood meal
• Bites mainly between dusk and dawn

• Blood transfusion with infected blood
• Needle/syringe sharing (IV drug users)
• Congenital malaria (mother to child transplacentally)
• Organ transplant

• Casual contact, respiratory route, fecal-oral route

• Travelers to endemic areas
• Military personnel in jungle/forest operations
• Non-immune migrants
• Pregnant women in high endemic areas

• Chloroquine weekly is safe throughout pregnancy
• Doxycycline and Primaquine are CONTRAINDICATED in pregnancy

• Chemoprophylaxis NOT recommended as a routine public health measure in India
• Used only for specific high-risk groups (military, travelers, epidemic situations)

Q8. Instruction to Health Workers in the Urban Centre for Surveillance of Fever Cases

• Visit every household at least once a fortnight
• Record all fever cases in the past 2 weeks
• Examine all fever cases: take blood smear / use RDT
• Maintain house register (name, age, sex, fever history)
• Any fever > 2 days = suspect malaria = take blood smear immediately

• Ensure all fever patients visiting PHC/dispensary are screened for malaria
• Maintain OPD fever register
• Refer severe cases to hospital immediately

• Collect thick and thin blood smear from ALL fever cases
• Label slides properly (name, age, date, village)
• Send slides to laboratory same day
• Do NOT wait for results - give presumptive treatment if RDT not available

• Give RDT result-based treatment immediately:
  • P. vivax positive: Chloroquine + Primaquine
  • P. falciparum positive: ACT + single dose Primaquine
• Ensure complete treatment - directly observed for at least 3 days
• Refer complicated/severe cases to hospital

• Identify and map all breeding sites in the area
• Weekly source reduction activities (drain stagnant water, fill pits)
• Anti-larval operations: apply Temephos to overhead tanks, construction sites, coolers
• Advise household members to cover water containers, use bed nets, repellents
• Coordinate with municipal corporation for IRS

• Collect mosquito larvae from breeding sites (monthly)
• Note Anopheles species
• Report to PHC / District Malaria Officer

• Maintain:
  • Fever register
  • Blood smear register
  • Treatment register
  • Breeding site register
• Weekly report to MO-PHC
• Immediately report any cluster of cases (≥ 3 linked cases) = suspected outbreak

• Intensify house-to-house visits (daily)
• Emergency fogging / IRS
• Mass fever survey
• Inform District Rapid Response Team

• Educate community about:
  • Malaria symptoms
  • Early treatment-seeking
  • Mosquito prevention (dry day every Friday)
  • Proper use of bed nets
  • No self-medication

Q9. Long-Term Control Measures for an Outbreak of Malignant Malaria Cases by the Block Medical Officer of Health

• Most dangerous form - causes cerebral malaria, death
• Outbreak = unusual increase in cases beyond expected level

• Confirm outbreak - verify case reports, examine slides
• Inform District CMO / State surveillance unit
• Form Rapid Response Team (RRT)
• Mobilize emergency drug supplies (ACT, Artesunate injectables), RDTs

• Increase ABER to > 10% of population
• Daily house-to-house fever surveys during outbreak
• Set up temporary fever treatment posts in affected areas
• Sentinel surveillance at PHC and sub-centres

• Ensure all P. falciparum cases get complete ACT (3 days)
• Directly Observed Treatment for first 3 days
• Hospitalize all severe/complicated cases
• Ensure adequate stock of Artesunate IV/IM for severe cases
• Follow up all cases after treatment

• IRS: Two rounds per year (pre-transmission season)
  • 1st round: Before monsoon (May-June)
  • 2nd round: Post-monsoon (October-November)
• Larviciding: Regular weekly anti-larval operations
• Biological control: Release of Gambusia fish in permanent water bodies
• Environmental management: Permanent drainage of waterlogged areas, filling of pits
• LLINs: Distribute Long Lasting Insecticidal Nets to all households in high-risk areas (100% coverage)
• Insecticide resistance monitoring: Test vectors for resistance, rotate insecticides if needed

• Train all health workers (MPW, ASHA, ANM) in malaria case detection and treatment
• Ensure uninterrupted supply of drugs, RDTs, slides at all levels
• 24-hour fever clinic at PHC level
• Referral linkage for severe cases (PHC → CHC → District Hospital)

• Coordinate with PWD for drainage improvement
• Coordinate with irrigation department for intermittent irrigation
• Coordinate with municipalities for waste disposal, construction site monitoring
• Involve Panchayati Raj Institutions

• Mass awareness campaigns - radio, TV, loudspeaker
• Involve village health committees, SHGs
• Friday "Dry Day" - compulsory in all households
• Promote bed net use - especially for children and pregnant women

• Weekly review of cases - is the outbreak declining?
• Monitor API, SPR, ABER regularly
• Entomological surveillance - adult density, larval indices
• Monthly review meeting at block level
• Adjust strategies based on data

• Pregnant women: Weekly Chloroquine prophylaxis + LLINs
• Children < 5 years: Priority for LLINs, early treatment
• Migrant workers: Screen on arrival, treat immediately

Q10. National Anti-Malaria Programme (NAMP)

• 1953: National Malaria Control Programme (NMCP) launched
• 1958: National Malaria Eradication Programme (NMEP) - target was eradication
• Cases reduced from 75 million (1953) to 100,000 (1965)
• 1970s: Resurgence due to DDT resistance, drug resistance, administrative failures
• 1977: Modified Plan of Operation - realistic goals
• 1995: Enhanced Malaria Control Project (World Bank funded)
• 1997: Merged into NVBDCP
• 2007: National Vector Borne Disease Control Programme

1. Reduce malaria morbidity and mortality
2. Prevent deaths due to P. falciparum
3. Achieve API < 1 (elimination)
4. Prevent re-introduction of malaria after elimination

• ABER ≥ 10% in all districts
• RDT at village level by ASHAs
• ACT for P. falciparum, CQ + Primaquine for P. vivax

• IRS in high-risk areas only (API > 2)
• LLINs for tribal/forest/hard-to-reach populations
• Anti-larval measures
• IVM approach

• Mass media campaigns
• Malaria week (last week of April)
• School health education

• Training of all health workers
• Malaria Technical Supervisor (MTS) at block level

• Prepositioning of drugs/RDTs at district level
• Rapid Response Teams

• Cases reduced from 2 million/year (2000) to <5 lakh (recent years)
• Malaria deaths reduced significantly
• India removed from WHO "high burden" list in 2022

🔴 MALARIA — SHORT NOTES (Q11 to Q25)

Q11. Discuss Surveillance of Malaria

• Health worker visits households fortnightly
• Examines all fever cases
• Takes blood smear / RDT
• ABER ≥ 10% ensures adequate active surveillance

• Patient self-reports to health facility
• OPD-based detection
• Cheaper but misses many cases

• Selected sites (hospitals, PHCs) provide detailed data
• Quality-assured data for trend analysis

• ABER (target ≥ 10%)
• API (target < 1)
• SPR (Slide Positivity Rate)
• SFR (Slide Falciparum Rate)

• MPW maintains fever register, blood smear register
• Weekly report to PHC → CHC → District → State → Centre
• Immediate notification of outbreaks

Q12. Malariometric Measures

Q13. Slide Positivity Rate (SPR)

• Definition: Percentage of blood slides examined that are found positive for malaria parasites
• Formula: SPR = (Number of positive slides / Total slides examined) × 100
• Significance:
  • Measures intensity of malaria transmission
  • SPR > 5% = high transmission
  • SPR < 2% = low transmission / near elimination
  • Used alongside ABER - high ABER + low SPR = good control
  • If ABER is low, SPR may be artificially high (only sick patients tested)
• Slide Falciparum Rate (SFR): Proportion of slides positive for P. falciparum specifically

Q14. Major Epidemiological Types of Malaria

Q15. Aedes aegypti Index

• Aedes aegypti is the vector for Dengue, Chikungunya, Zika, Yellow fever
• NOT a malaria vector (included here as it appears in the short notes list under vector-borne diseases chapter)

• HI > 1% = risk of Dengue epidemic
• BI > 5 = epidemic risk
• BI > 20 = high epidemic risk

• Guides larvicidal operations
• Identifies high-risk localities
• Monitors effectiveness of vector control

Q16. Radical Treatment for Vivax Malaria

• Purpose: To eliminate hypnozoites (dormant liver stage of P. vivax) and prevent relapses
• Drug: Primaquine 0.25 mg/kg/day for 14 days
• Given along with Chloroquine (3-day course)
• Must be given under supervision

• G6PD deficiency (causes hemolytic anemia)
• Pregnancy
• Infants < 6 months
• Severe renal/hepatic disease

• P. vivax relapses every few months (up to 3-5 years)
• Worsens anemia, keeps transmission going

Q17. Factors Responsible for Resurgence of Malaria

• Insecticide resistance in vectors (DDT resistance in An. culicifacies)
• Drug resistance (P. falciparum - Chloroquine resistance)
• Change in vector behavior (outdoor resting - avoids IRS)

• Complacency after initial success
• Reduction in DDT spraying (due to environmental concerns)
• Shortage of funds, drugs, manpower
• Discontinuation of anti-larval operations

• Deforestation, irrigation expansion
• Construction projects creating breeding sites
• Climate change

• Migration of labor to/from endemic areas
• Urbanization - urban An. stephensi spread
• Civil unrest, natural disasters

• Shift from eradication to control mindset (1970s)
• Weak surveillance
• Poor inter-sectoral coordination

Q18. Approaches of Malaria Control

• Early diagnosis (microscopy / RDT)
• Complete treatment (ACT / CQ + Primaquine)
• Mass Drug Administration (MDA) in selected areas
• Chemoprophylaxis for high-risk groups

• IRS (Indoor Residual Spraying)
• Larviciding
• Biological control (Gambusia, Bti)
• LLINs / ITNs
• Environmental management
• Personal protection

• Source reduction
• Drainage improvement
• Intermittent irrigation
• Land reclamation

• IEC/BCC - community education
• Surveillance and monitoring
• Research and capacity building

Q19. Man-Made Malaria

• Irrigation projects - canals, rice fields create Anopheles breeding
• Dams and reservoirs - waterlogged margins
• Mining - open pits fill with water
• Construction sites - water accumulation, labor camps in forest areas
• Urbanization - overhead tanks for An. stephensi
• Deforestation - brings forest vectors into contact with humans
• Industrial projects - labor migration from non-endemic to endemic areas

• Environmental impact assessment before projects
• Mandatory anti-larval measures at construction sites
• Health screening of migrant workers
• Project Malaria Officer for large projects (dams, mines)

Q20. Comment on Malaria Week

• When: Last week of April (25th April = World Malaria Day)
• Organized by: NVBDCP / Ministry of Health & Family Welfare
• Theme: Varies each year (e.g., "Zero Malaria Starts with Me")

• Mass awareness campaigns - street plays, rallies, posters
• School health education
• "Dry Day" - all water containers emptied on Friday
• Distribution of bed nets
• Free blood smear examination camps
• Training of health workers
• Inter-sectoral meetings (with municipalities, Panchayats)
• Cleaning of drains, removal of stagnant water

• Raises community awareness
• Promotes early treatment-seeking
• Mobilizes community for source reduction
• International solidarity - WHO World Malaria Day (25 April)

Q21. Measures for Control of Urban Malaria

• Breeds in overhead water storage tanks, wells, coolers, ornamental fountains, construction sites

• Cover all overhead tanks, wells with lids
• Empty and scrub water coolers weekly
• Proper drainage of construction sites
• No waterlogging in low-lying areas
• Proper solid waste disposal (no discarded containers)

• Temephos (Abate) added to overhead tanks, wells (safe for drinking water)
• IRS in high-risk localities
• Space spraying / fogging during outbreaks

• Gambusia fish in ornamental ponds, open wells
• Bti application in water bodies

• Municipal bylaws against mosquito breeding
• Penalty for construction sites without anti-larval measures
• House-to-house inspection by municipal health workers
• Container index surveys

• Window/door screens in houses
• LLINs for high-risk families
• Repellents (DEET)

• Urban malaria clinics
• Fever treatment depots at ward level
• Rapid diagnostic tests
• Immediate treatment of positive cases

• Resident Welfare Associations (RWAs) involvement
• Friday "Dry Day" in all societies
• School children as change agents
• Malaria fortnight campaigns

✅ ALL MALARIA QUESTIONS ANSWERED (Q1-Q21)