Monsoon, season of malaria

Earlier this month, a 43-year-old man from Okhla industrial area was diagnosed with dengue. He happened to live in one of the more congested areas city, amidst  construction activity which has been for the last three years.

“There were cases of malaria and dengue earlier too. But since the construction started a few years ago, the cases have increased. All of them do not get reported because people go to local clinics for treatment,” says Okhla resident Zahid Hussain.

In the absence of regulations, heaps of building material are allowed to remain even after the construction work is over. This creates space for water to collect on narrow streets, allowing mosquito larvae to breed.

With an official figure of 126 cases, 2012 has reported the largest number incidents of malaria in the past four years. In 2009 there were 70 cases,  24 in 2010 and 92 in 2011. Also spread through mosquito bites, dengue cases are fewer with only 10 being officially reported in the city so far this year.

Official figures say that in 2012 so far, the maximum number of cases have come from Najafgarh which reported 26. This is followed by 24 cases from Shahadara (north),  22 from Narela, and 17 from Shahadara(south). All these areas have congested unauthorised colonies with unregulated construction.

These are relatively less well off areas, where  authorities drag their feet in providing sanitation and drainage. Clean water is in short supply.

Waterlogging is usually the main cause of  spread of vector-borne diseases like malaria, chikungunya and dengue.

“Waterlogging is the biggest reason in Delhi. Even the better off areas have this problem. The second reason is congested unauthorised colonies and lack of sanitation and drainage there. Thirdly, there is hardly any analysis to study the changing nature of mosquitoes – has there density increased; which are  chemicals to which they have they developed resistance, etc.,” says Dr Vikas Bajpai, health expert and spokesperson, Progressive Medicos and Scientists Forum.

One major paradox is that though the maximum number of cases are reported from unauthorised colonies, these localities are not taken into account while drafting the budget due to their illegal status.

“ We, of course,  go and carry out our activities there. But the problem is that all unauthorised colonies do not get covered. We have requested the government for proper budget allocation,” says Dr N K Yadav, coordinator for vector-borne diseases under the municipal corporation.

Trifurcation of the Municipal Corporation of Delhi has not affected treatment and response to vector-borne diseases.

‘People can reside in one zone and get treatment in another zone. Dividing response to communicable diseases will have an adverse impact. The older system of reporting is being continued,” says Dr Yadav.

According to official figures, total number of malaria cases reported so far this year are 126 with 51 from North Delhi Municipal Corporation, 40 from South Delhi Municipal Corporation and 35 fromEast Delhi Municipal Corporation. The current figure takes into account laboratory reports too – which  is being done for the first time.  And officials are trying to give this inclusion as the reason for the increase in numbers.

But corporation officials agree that if data from private hospitals too is included than the malaria cases figure will be close to 500.

The inclusion of lab reports can't explain away the steep increase. And as the the season for mosquito-borne diseases continues till October, the total number of cases this year will  rise further.

So far in 2012, legal notices for harbouring conditions that breed mosquitioes have been issued to 33,785 institutions and houses, and 1,075 prosecutions have been launched.  The drive to locate breeding spots found them in   34,422 houses.  

Ironically, in the previous two years  mosquito breeding was detected in more spots but the cases of malaria were far less than in the current year.  In 2010, mosquito breeding was detected in 51,089 houses, while in 2011 the figure was 43,482.

The number of prosecutions launched was also much higher – 7,484 in 2010 and 4,113 in 2011.

Experts doubt whether the effort by Delhi authorities is having an impact on combating the disease.

In 2006, a medical student at the All India Institute of Medical Sciences (AIIMS) died due to dengue. The institute immediately set up a fever clinic in response.

“Establishing fever clinics is an ad hoc measure. What is important is what is special
that they doing in these clinics; the government should be able to show they did something different. They have to havemonitoring throughout the year and deeper analysis of the situation,”says Dr Bajpai.

An official, on condition of anonymity, says the creation of the fever clinic led to a lot of fear mongering and people with normal fever and no symptom of any vector-borne disease also started pouring in at the institute.

“This created panic. Doctors were withdrawn from all departments to serve in the clinic, affecting functioning of AIIMS for other diseases. It was just to show that the State was doing something. But there should be more mature handling of such situations,” says the official.

Govt response

“This year’s expenditure on vector-borne diseases is Rs 499 lakhs. This includes insecticides, equipment, salary of the staff and travel costs,” says Dr Yadav.

He says that the corporation employs domestic breeding checkers (DBCs)from April or May till November. They go from house to house, and are supposed to check water coolers, water tanks, flower vases, terraces etc. They are also involved in educating people . And they help in emptying and cleaning water tanks and putting chemicals for killing the larvae.

But the DBCs sometimes face trouble when people do not let them enter the house. This is more so when women are alone at home.

“They are taught to tackle such situations. We sometimes change timings and ask them to go in the morning or evening. Resident WelfareAssociations (RWAs) are also involved in certain cases,” says Dr A K Bansal, medical health officer with North Delhi Municipal Corporation.

Dr Yadav says that they employ the same people every year. The residentsof the area recognise them and there are hardly any troubles. “Theyare also provided I-cards to ensure people cooperate with them,” he added.

An official says government buildings are most neglected because there is no individual responsibility on anyone.

“A nodal officer is appointed in every government building to check for collected water there. We conduct training for these officers and RWA representatives. These people also help in educating others. RWAs are encouraged to spread awareness in their respective localities,” says Dr Bansal.

Remedies

“Other agencies of the government also have to work towards tackling the diseases. For example, there should be proper water supply.  Areas where there is a shortage of water or the supply is irregular, people tend to store water and except for drinking water, do not cover covered it adequately. These are high potential places for growth of mosquitoes,” says Dr Yadav, adding that a similar argument goes for the drainage system too.

He says the corporation goes for fogging only when a case is reported. Fogging is a costly affair; diesel to run the machine and insecticies are expensive. Insecticides cannot be used beyond a point because mosquitoes tend to developresistance to them. Also, they are unhealthy for people.

“We have installed a software linking 33 government hospitals with themain office to avoid any time lag in tracking malaria cases. Till now it took two or three days for the  municipal corporation headquarters to know about a detected case as the informationwould come through fax or post. Now these hospitals have to just update on computer and we get to know immediately. This has helped in quicker response in preventing further cases,” informed Dr Yadav.

Detection of even one case means that there is at least one infected mosquito in an area which can bite more people. Thus, every day counts in taking action. The internet log contains name, gender, age, and the address of the infected person.

Despite all this, it is an open secret that cases of malaria and dengue are under-reported in the city.

“Cases are under-reported not only because the government has not issued strict directives, but also because the State does not want to show the high number of cases in the capital of the country. Even government officials become conservative in collecting the data,” says Dr Bajpai.