Press Releases 2004

U.S. Funds Projects to Fight Vector-Borne Diseases in South Asia

Malaria, Japanese Encephalitis, Kala-Azar Targeted With New Methods

August 20, 2004

Across South Asia vector-borne diseases have caused mortality and disease rates to soar. But for the past five years a regional health program has led to more effective diagnosis and treatment, prevention and control of environmentally linked diseases.

"We were able to come up with very specific recommendations for prevention and control, and new techniques for diagnosis and treatment," said Dr. Panduka Wijeyaratne, resident advisor for the Environmental Health Project in Nepal.

The Environmental Health Project, a $107 million global mission funded by U.S. Agency for International Development (USAID), worked on vector-borne diseases primarily in Bangladesh, Bhutan, India and Nepal and focused on three vector-borne diseases: malaria, Japanese encephalitis and kala-azar.

"These countries have had so much experience with these diseases. They are recurrent, draining a country's resources year after year," said Nihal Goonewardene, president of the International Science and Technology Institute, which works for USAID on the Environmental Health Project.

Archaic medical practices, poverty and inaccessibility to health care have allowed vector-borne diseases to gain a strong grip on the region and move across national borders, said Wijeyaratne.

One of the project's initiatives involved cross-border plans for tackling the vector-borne diseases in a more comprehensive way.

"For lesser developed countries we have helped them to take advantage of their more developed neighbors," said Wijeyaratne. "Sharing methodology and information helps stop the spread of disease."

Malaria and Japanese encephalitis, carried by infected mosquitoes, cause approximately 50,000 deaths annually in South Asia. Malaria is a parasite infection of the blood and can lead to kidney failure, coma or death.

Insecticide sprays have been used to fight malaria in the past, but this proved to be too costly for developing countries such as Nepal.

"We are training the community to administer preventative measures to their own land," said Wijeyaratne. "By treating the areas with locally made materials, such as lime, we have been able to cut down on cost and made prevention more accessible to people in rural areas."

Japanese encephalitis is a severe viral disease of the central nervous system that can cause paralysis and seizures, and if left untreated, death. There is a vaccine for Japanese encephalitis, but it has been difficult for developing countries to make the vaccine available to the public.

"They did not know how many cases existed in the country, and without knowing that information it is difficult to introduce a vaccination program," said Wijeyaratne. "We helped the country develop a database for how many people have the disease."

Another problematic disease, kala-azar, is a parasite transmitted by sand flies, and damages internal organs. The disease leads to liver and spleen enlargement and is fatal nearly 100 percent of the time if left untreated. Kala-azar affects 500,000 people annually, and approximately 90 percent of these cases occur in Bangladesh, India, Nepal and Sudan.

Previously, diagnosis for Kala-azar was very difficult, involving biopsy of the liver or spleen or puncture of the bone marrow or a lymph gland. But EHP has introduced a new diagnostic technique that requires only a finger-prick of blood. Treatment programs have also changed from an injection drug to an oral medication. This has led to more people being treated and fewer people dying.

"People had been injected with drugs and it was very painful for them. They didn't like it, which meant people stopped having the treatment, which meant they died. The death rates have been significant," said Wijeyaratne. The injection also proved too costly because patients had to be hospitalized.

The oral drug will be less painful and more accessible to people out in very rural areas because the drug won't have to be administered in hospitals, said Wijeyaratne.

"Things have started to happen, and it's very possible that South Asia can control these diseases," said Wijeyaratne.

USAID IN INDIA: In India, USAID is contributing to the government's national plan of action to combat malaria and other vector-borne diseases. Official statistics report about 2 million malaria cases and about 1000 deaths annually in India. There is no scientific estimate of the true burden of the disease, especially among the vulnerable groups of pregnant women and young children. The knowledge of doctor's drug prescribing practices, especially in the private sector, continues to be poor.

These problems are the basis for many of the Government's National Vector Born Disease Control Program (NVBDCP) goals, mainly involving the improvement of surveillance, strengthening national capacity, implanting evidence-based policies, and scaling up cost-effective and sustainable interventions.

The NVBDCP is expanding upon the Malaria Control Program to include Lymphatic Filariaisis, Kala-Azar, Japanese Encephalitis and Dengue Fever.

USAID India is complementing the NVBDCP by supporting the evaluation of the efficacy of anti-malarial drugs, assessing malaria treatment practices in the public and private sector, and validating the reporting of malaria cases and deaths (with particular attention to malaria in pregnancy). These activities will occur in the states of Jharkhand, Orissa and Madhya Pradesh.

The design of the activities was developed with the Indian Council for Medical Research/ Malaria Research Center (MRC), and the World Health Organization's South East Asia Regional Office (WHO-SEARO). The activities will also collaborate with the ongoing activities of the Centers for Disease Control (CDC).

In New Delhi, USAID Infectious Disease Fellow Christopher Barrett says, "Contributing to the national plan of action is the best way and most efficient use of resources to reduce the burden of malaria and other vector born diseases."

USAID is also supporting vector control through its support for the implementation of the Integrated Disease Control Project, a national surveillance system set to commence this year in 9 states. The project goal is to provide India with a centralized disease surveillance system capable, among other things, to provide early warning for epidemics - including those caused by insect vectors.

"Information is power," Barrett adds, "and quality surveillance will provide data that the entire health system can use to improve and strengthen services, not just for vector born or infectious diseases."