Meghalaya’s Tura Model significant in reducing Malaria cases among other factors

Shillong, Nov 02: The Centre for the Study of Complex Malaria in India (CSCMİ), IIPH-Shillong (IIPH-S) hosted the stakeholder engagement meeting to share and discuss progress of work related to malaria research in Meghalaya at Pasteur Research Institute, Lawmali, Shillong on the 1st November 2021.The objective of this stakeholder meeting was to share and discuss the progress of work conducted by the Centre in the State of Meghalaya.

While speaking at the event, Dr Bibha R. Marak (Deputy Director Cum State Programme Officer of the National Vector Borne Disease Control Programme (NVBDCP), Meghalaya), informed that malaria morbidity in the State has declined by 96% and malaria mortality by 94%, keeping 2015 data as the baseline.

She also mentioned the Tura Model initiative initiated by the current Principal Health Secretary, Shri. Sampath Kumar in 2007, and how it played a big role in this significant decline in malaria cases.

It may be recalled that an analysis of the State Epidemiological Situation from 1997 to 2019 (Malaria in Meghalaya: Entomological Perspective, 2020) reveals that the State reported the highest deaths caused due to malaria in the year 2007 with 237 deaths. Out of this, 117 deaths alone were reported from West Garo Hills District.

This sudden spike in the number of deaths demanded immediate intervention as it was noted that despite technical assistance from the Centre to contain malaria, the number of deaths remained significantly high, especially in the Garo Hills region.

It was in this year that the then Deputy Commissioner of WGH district, Sampath Kumar, IAS along with the team of health professionals devised and implemented an innovative strategy that not only led to a drastic reduction in malaria mortality but set precedence for building state capability to tackle critical issues. This eventually came to be known as the ‘Tura Model’.

In fact the Meghalaya State Health Policy 2021 derives its key principles from the Tura Model success story namely- Understanding the problem, Mapping the processes, empowering the health care systems at the grassroots level, addressing the issue of Public Health by focusing not only on the Curative aspects but more so, on the Preventive as well as Enabling aspects.

One of the most important examples set by the Tura Model was the coming together of doctors from the public & private sector as well as missionary organizations and NGOs, working with a sense of urgency on the part of district administration and most importantly, building the capacity of the community through the ASHA workers at the field level to ensure that the last mile of the population is reached.

In her introductory remarks at the Stakeholder meeting, Prof. Sandra Albert (Director, IIPH-S & CSCMI) gave an overview of SCSMI. She informed that the Centre for the Study of Complex Malaria in India (CSCMI) is one of the 11 International Centers for Excellence in Malaria Research, i.e., the ICEMR initiative funded by NIH, USA.

Its key components are on building the capacity of young researchers and transfer of technology. Prof. Jane Carlton from New York University, who set up the SCSMI in Chennai, Gujarat and Orissa, reached out to the Director of IIPH-S in 2016  to initiate the epidemiology work in Meghalaya, as Malaria was endemic to Meghalaya but not much research was done here.

Thus, during the second round of ICEMR in 2017, Meghalaya was brought into the picture to take up epidemiology work, with a focus to understand what the asymptomatic status of malaria meant.

Since 2018, the CSCMI, Meghalaya has been undertaking studies in Meghalaya to assess baseline malaria epidemiology, prevalence of P. vivax, P. falciparum, and asymptomatic infections; identification of recurrent vivax infections; and risk factors that potentially impact malaria transmission.

Site selection for the epidemiological work was based on the decadal data of NVBDCP from 2006 to 2017 and since 2018 epidemiological work had been started in West Khasi Hills, West Jaintia Hills and recently in South Garo Hills.

In his presentation on the Epidemiology of malaria in low-transmission settings in Meghalaya, Dr Rajiv Sarkar presented the findings based on cross-sectional surveys conducted in 2018 and 2019.

While there has been a significant decline in malaria incidence in all 21 study villages in West Jaintia Hills and West Khasi Hills in the period 2018 and 2019, majority of those individuals who were infected were asymptomatic, giving rise to potential undetected low-intensity transmission.

He therefore cautions that the potential for malaria resurgence remains  and that constant vigilance is required to counter this threat through periodic serological surveys and surveillance for insecticide resistance, thereby ensuring effective vector-control methods.

Using molecular identification by employing DNA based techniques, Research Fellows of the Center have also identified new Anopheles mosquitoes, An. xui and An. dissidens, the first to be reported in India.

After each presentation, a question and answer round from research work on the field saw good participation from the stakeholders, which also paved way to the next step as to how the data obtained from these research could be best utilized for the better implementation of the State run programmes for malaria.

As informed in the stakeholder meeting, there are hotspots still existent in South Garo Hills, West Jaintia Hills and some parts of West Khasi Hills. Dr. Marak added, “there are threats which may lead to resurgence of malaria if we are not alert”, which include risk factors like socio-economic conditions, inaccessibility, human mobility, superstitions.

She said that due to low transmission as malaria cases have decreased, detection by simple methods may not be sensitive anymore and this may result in underestimation of the true prevalence of malaria infection.

Therefore she proposed that as a new strategy, along with early treatment and integrated vector management, new interventions like capacity building and intersectoral convergence between the public and private sectors should go hand in hand along with research work and studies.

The Stakeholder engagement meeting witnessed participation of key stakeholders from the State, including Dr. Bibha Marak (Deputy Director Cum State Programme Officer of the National Vector Borne Disease Control Programme (NVBDCP), Meghalaya), Dr. Marba Warshong (District Malaria Officer, East Khasi  Hills).

Dr. M. Sohliya (Medical Officer, NVBDCP), Dr. E. Shadap (Nodal Officer Covid- 19, Pasteur Research Institute Lawmali), Dr Rennie Orson Lakadong (Associate Professor, Allied Health Science, Martin Luther Christian University) and zonal entomologists and consultants of NVBDCP in addition to the professors and students of IIPH-S.


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