How Odisha took bite out of malaria: strategy and ASHA soldiers on ground

The Survey states that Odisha brought about the highest reduction in malaria cases among children below five years but also notes that “major focus of SBM has been on making villages Open Defecation Free (ODF)”.

Senior professionals in the state, however, disagree with the analysis. “There is no scientific link between controlling malaria and building toilets,” said Dr Pramila Baral, state director, National Vector-Borne Disease Control Programme (NVBDCP).

“It is entirely due to the state government efforts, its political and bureaucratic commitment, and ASHAs on the ground,” she emphasised.

How it was achieved

The state government relies on a three-step project to keep malaria in check, executed by 47,147 ASHAs trained in diagnosing and monitoring malaria treatment. In the Early Detection and Complete Treatment (EDCT), an ASHA tests any fever case for malaria — so that treatment begins early and the parasite is killed before mosquitoes spread it.

Odisha also runs a programme called DAMAN — Duragama Anchala Re Malaria Nirakaran (or controlling malaria in remote locations) — as part of which mass screenings are organised twice a year at ‘malaria camps’ in these areas: in April-June, and September-October. Under DAMAN, the entire population of these areas undergoes a malaria test, irrespective of whether one has fever or malaria symptoms. Indoor residual spray method is used, in which a residual insecticide is applied to inner walls and ceilings of houses so that malaria vectors come in contact with the insecticide.

Third, the state government has distributed nearly 1.1 crore long-lasting insecticide nets (LLINs) to combat malaria exposure during sleep. ASHA workers go door-to-door to explain nuances of the net’s use.

“For example, LLINs must not be washed with soap water. They should be hung even at day so that mosquitoes that come in contact with the insecticide die throughout the day,” said Swati Kumhari, vector-borne disease consultant for Boudh district, around 200 km to the west of state capital Bhubaneswar.

When The Indian Express visited Lokapada, a village in Harbhanga block of Boudh, ASHA Gitanjali Bhakta, 35, performed a Rapid Diagnostic Kit (RDK) malaria blood test on Arati Dehury, 60, under EDCT programme. Relying on antigen antibody interactions, RDKs are useful in places lacking quality microscopy services.

For a positive test result, Gitanjali has to ensure the patient takes the prescribed medication lasting between three and 14 days, depending whether the detected parasite is plasmodium falciparum or plasmodium vivax. She earns Rs 75 per case for the whole process — from detecting a positive case to completing the course of treatment.