Disease specific programmes

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Polio

Definition :- Human disease involving central nervous system caused by Poliovirus
Virus is transmitted by the faecal oral route through ingestion.
WHO IN 1988 had proposed global eradication of poliomyelitis by year 2000.

Launched: 1998 in India

Ministry: Department of Health & Family Welfare.
Objective : To eradicate polio
From 1999-2000 house to house vaccination of missed children was introduced.
Of the 3 types of polio causing viruses,
Type 2 polio virus – eliminated in 1999
Type 3 polio virus – Geographically restricted to few districts of Moradabad region of western UP.
Ongoing circulation of polio virus is predominantly due to polio type 1 virus.

OPV vs IPV

WHO recommends that the OPV should be phased out worldwide and replaced by the inactivated polio vaccine (IPV).

About OPV(oral polio vaccine)

OPV was developed in 1960 by Dr. Albert Sabin. It consists of live polioviruses attenuated by extensive passage of the original wild-type stains of poliovirus in cell cultures or in monkeys in vivo. This results in mutation of the virus, which weakens its potential to cause paralysis, while maintaining the antigenity by inducing the production of antibodies by the immune systems of the human body.

The advantages of OPV are as follows:

OPV can protect children against paralysis once infected as well as limit the spread of wild virus among their contacts because OPV induces both serum immunity and intestinal immunity. Intestinal immunity limits the multiplication of wild virus inside the gut and thus reduces fecal excretion (hence possible transmission) of the wild virus.
The use of OPV can produce secondary immunization through the spread of a vaccine virus in stools, which indirectly immunizes those with secondary contacts. This is particularly important in developing countries where the sanitation status permits this spread and the immunization coverage is low.
OPV can be delivered with low cost, firstly because the price is lower than that of IPV, secondly because OPV is administered orally, and thus the vaccination does not need professionally trained health workers and injection-related supplies (e.g., syringes).
OPV is delivered orally, so unsafe injection is not an issue.

The disadvantages of OPV are as follows:

It can cause vaccine-associated paralytic poliomyelitis (VAPP), although the probability is very low (1 case per 2.5 million doses), because some people are sensitive to vaccine virus, especially those who are immunodeficient.
OPV may be less potent than IPV in inducing serum immunity in developing countries, where the infection of the intestines by other viruses may prohibit the intake of OPV. Thus it often needs repeated vaccination of up to five to 10 doses to protect all children). Tese kinds of limitations to OPV were particularly reported in India and Africa

About IPV

IPV was developed in 1955 by Dr. Jonas Salk (World Health Organization 1997a). It consists of killed viruses, which are cultivated in monkey kidney cells and activated by incubation of the viruses in 1:1000 formalin for 12-14 days at 37 C. IPV is delivered via injection.

The advantages of IPV are as follows:

It can effectively protect individual children against paralysis after three doses with a protection rate of nearly 100 percent. 28 OPV vs IPV: Past and Future Choice of Vaccine in the Global Polio Eradication Program
It does not cause VAPP because the vaccine consists of killed poliovirus.
IPV can be combined with other injectable vaccines (such as DTP and Hib) to reduce the cost of administration and increase immunization coverage.

The disadvantages of IPV are as follows:

IPV only induces serum immunity, not intestinal immunity. Thus, IPV vaccination can effectively protect the vaccinated individuals against paralysis, but does not readily protect all of them against infection with the wild virus. If vaccinated children are infected, they can become a source of infection by wild virus if their antibody levels are not high enough to stop virus excretion.
There is not a secondary immunization effect.
The cost of IPV vaccination is higher than OPV because its price is higher and it requires injections by trained health workers.
Wild poliovirus could escape from the production process.
There is a risk of unsafe injections, which can lead to transmission of blood-borne diseases.

Tuberculosis (TB)

Definition: - It is chronic infectious disease that affects lungs, intestine, meninges, bones, joints, lymph glands, skin & other tissues of body.
Most common form – Pulmonary TB
Causative agent – Mycobacterium Tuberculosis (bacteria)
Transmission – Droplet infection & droplet nuclei generated by sputum positive patients with pulmonary tuberculosis.
About 5 lakh people die of TB every year.
India accounts for 115 of world TB cases.
India is ranked 17 among high burden countries in terms of TB incident rate (Global TB Report 2009)

National Tuberculosis Programme (NTP)

Launched – 1962
Ministry: Department of Health & Family Welfare.

Objectives

(a) Long Term Objective – Reduce TB in the community to that level when it ceases to be a public health problem.

(b) Short Term Objective – To detect maximum number of TB cases.

To vaccinate newborns & infants with BCG.
To undertake the above objective in an integrated manner through all existing health institutions in country.
DOTS – Directly observed treatment short course
It is a systematic strategy adopted by WHO which is followed throughoutthe world including India.

It has 5 essential components

(i) Political & Administrative Commitment

(ii) Good quality diagnosis

(iii) Good quality drugs

(iv) Directly observed treatment under supervision (better compliance)

(v) Systematic monitoring & Accountability.

New Stop TB Strategy – Published by WHO in 2006
Has DOTS in the core with additional components to address TB/HIV & MDR-TB (Multi drug resistant tuberculosis)

Main Components

(i) Pursue high quality DOTS expansion & enhancement.

(ii) Address TB/HIV, MDR-TB & other challenges.

(iii) Contribute to health system strengthening.

(iv) Engage all health care providers.

(v) Empower people with TB & communities.

(vi) Enable & Promote research.

AIDS

Acquired Immuno Deficiency Syndrome is caused by Human Immuno deficiency virus (HIV)

Transmission

(i) Sexual intercourse between an infected & a healthy partner.

(ii) Mother to fetus (prenatally, perinatally, breast feeding)

(iii) Contaminated blood, blood products & organ donations.

(iv) Contaminated needles (intravenous drug abuse, injections)

Diagnosis – ELISA Enzyme Linked Immunosorbent Assay
Western Blot Test
Drug Treatment – Zidovudine, Stavudine & Lamivudine

ART – Antiretroviral treatment

It is a combination of at least 3 anti retroviral drugs that is given to HIV infected individuals once they reach a stage of advanced immuno-suppression
1st case of AIDS was detected in India in 1986 at Chennai.
Premiere AIDS agency is NACO – National AIDS Control Organisation.
Every state has a State AIDS Control Society run by State Government.
Government of India announced policy cum programme for providing free ART with effect from 1 April 2004.
Target Intervention (TI) projects aim to interrupt HIV transmission among highly vulnerable population which include commercial sex workers, injecting drug users, homosexuals, truckers & migrant labourers.

National AIDS Control Programme

Launched – 1989 with assistance from the World Bank & WHO
NACO was set up by Union Ministry of Health & Family welfare to implement various activities under the programme.

Phase I (1992-1999)

Aim to slow the spread of HIV to reduce future morbidity, mortality & impact of AIDS by initiating major effort is prevention of HIV transmission.

Phase II (1999-2006)

Reducing spread of HIV infection & strengthen India’s capacity to respond to HIV epidemic on long term basis.
Achievements
Scaling up PMTCT (Prevent mother to child transmission) & VCCTC series (voluntary confidential counseling & testing centre)
Recognizing need of care & support for public living with HIV & AIDS & scaling up community care centres.
Increasing access to free ART.
National AIDS Prevention & Control Policy & National Council on AIDS (NCA) chaired by the PM, provides policy guidelines & political leadership to the response.

Phase III (2007-2012)

Places highest priority on preventive efforts while at same type seeks to integrate with care, support & treatment.
Main objective is to halt & reverse the epidemic in India over next 5 years.

Highlights

Strengthen nationwide strategic information management system.
Strengthen infrastructure, systems & human resources in prevention, care, support & treatment programmes at district, state & national levels.
Provide greater care, support & treatment to people living with HIV / AIDS.
Prevent infection through saturation of coverage of high risk groups with targeted interventions & scaled up interventions in general public.

Project Sunrise

Government of India has launched Project Sunrise for prevention of AIDS in the eight North-Eastern states.
Government is working towards bringing the people living with HIV/AIDS into the national mainstream. The new initiative will cover one lakh people living with HIV/AIDS giving them treatment and care facilities free of cost.
Project Sunrise is a five year programme aimed at complementing the ongoing National AIDS Control Programme (NACP) which is to primarily improve coverage, quality and scale of HIV interventions among People Who Inject Drugs (PWID) in eight North East States.
In the entire North East States, the project will be implemented in 20 districts. The Central Government is funding the NACO projects and the amount would be transferred directly to the State AIDS Control Society through NACO.
Project Sunrise will implement more customized flexible approach so as to increase the availability and accessibility to clean needles and syringes through secondary distributors such as Government health care facilities, preferred healthcare providers, non-traditional outlets and peer volunteers.
The programme also includes lower threshold strategies to improve Opoid Substitution Therapy (OST), coverage and sensitization workshops for law enforcing officials. It also includes HIV intervention in prison settings.
The programme also aims to strengthen linkage with Ministries and Government Departments, community mobilization, intervention among Female Injecting Drug Users (FIDU), Intervention Among Spouses of PWID, establishment of Real Time Monitoring (RTM) system, Implementation of innovative approaches such as community based HIV-testing, safe disposal of used needles and syringes etc.

Iodine Deficiency Disorder Control Programme (IDDCP)

Sponsored by: Central Government
Funding pattern: Fully funded by Central Government
Launched : December 1989
Ministry / Department : Department of Health & Family Welfare
Objective: To prevent iodine deficiency disorders like incidence of
Goiter, Cretinism, physical & mental disorders in state.
To conduct IDD surveillance through medical colleges in endemic districts.
Provide medical assistance to patients suffering from Iodine deficiency.
Iodine – Essential micro-nutrient with an average daily intake of 100-150 micro grams.

Leprosy

Definition: Chronic granulomatous disease of human’s primarily involving the skin, peripheral nerves & nasal mucosa.
Causative agent : Mycobacterium leprae (Bacteria)
National Leprosy control programme was launched in 1955.
National Leprosy eradication programme was launched in 1983.
Sponsored by : Central Government
Funding Pattern: Fully funded by Central Government.
Ministry: Department of Health & Family Welfare.
Description: 10 Survey Education & Treatment (SET) centres.
3 Urban leprosy centres set up.
Multi-drug therapy was introduced.
Eligibility: Anyone can avail this scheme.
Incentives announced for Reconstructive surgery – Rs 5000 is provided to each affected person of BPL family for undergoing reconstructive surgery in identified institutions to compensate loss of wages during their stay in hospital.
India has achieved goal of elimination of leprosy as public health problem, defined as less than 1 case per 10,000 population at National level in month of 2005 as set by National Health policy 2002.

Cancer

Cancer may be regarded as a group of diseases characterized by an

(i) Abnormal growth of cells.

(ii) Ability to invade adjacent tissues & even distant organs.

(iii) The eventual death of the affected patients if the tumor has progressed beyond that stage when it can be successfully removed.

Commonest Cancer Sites

Males	Females	Both Sexes
Lung	Breast	Lung
Stomach	Cervix	Stomach
Colon	Colon	Liver

National Cancer Control Programme

Launched – 1975
Revised - 1984-85
Ministry: Department of Health & Family Welfare.
In India, there are 2 million cancer cases at any point of time with about 0.7 million new cases coming every year.

Objectives of Programme

1. Primary Prevention which includes health education.

2. Secondary Prevention which includes early detection of cancer.

3. Tertiary Prevention which includes various types of treatment – surgery, radiotherapy & chemotherapy.

New Schemes Initiated

(i) Scheme for district projects – The scheme envisage project at district level for preventive health education, early detection & pain relief measures.

(ii) Development of Oncology wings in Medical Colleges.Financial assistance of upto 1 crore is provided to State Government for purchase of cobalt unit so that radiotherapy can be provided.

(iii) Scheme for Financial assistance to voluntary organizations.

Financial assistance upto 5 lakh provided to registered voluntary organization recommended by State Government for purpose of undertaking Health education.

Blindness

Defination: - WHO has defined blindness as visual acuity of less than 3/60 (smaller) or inability to count fingers in daylight as a distance of 3 meters.
National Programme for Control of Blindness(NPCB)Launched in 1976
Ministry: Department of Health & Family Welfare.
100% Centrally sponsored programme

Kala-Azar

Also called as ‘visceral leishmaniasis’
Infectious disease caused by Leishmania donovani, a protozoal parasite.
Preventive measures – Attack on parasite, Attack on vector, Personal Prophylaxis, Use of mosquito net, Avoiding ground floor for sleeping , Periodic fumigation of sleeping quarters
Kala-azar is serious public health problem in Bihar & West Bengal.
Control programme was launched in 1990-91 (100% Centrally Supported).
National goal for elimination of Kala-azar is 2010.
National Vector Bone Disease Control Programme
NVBDCP, central nodal agency for prevention & control of vector bone diseases.

Disease	Vector	Causative Agent
Malaria	Female Anopheles	Plasmodium (Protozoa)
Dengue	Aedes mosquito	Dengue Virus
Kala-azar	Phlebotomus (Sand fly)	Leishmania donovani
Japanese encephalitis	Culex mosquito	Flavi virus
Lymphatic Filariosis	Culex mosquito	Wuchereria (Nematode)
Chikungunya	Aedes mosquito	Alpha virus

Malaria

Definition: - Protozoal disease caused by infection with plasmodium & transmitted to man by infected female anopheles mosquito.
National Malaria control programme was started in 1953.
National Anti-Malaria Programme was started in 1999.
Ministry: Department of Health & Family Welfare

Malaria Control Strategies

Early case detection & Prompt treatment (EDPT)
Government has established Drug distribution centers (DDC) & fever treatment depots (FTDS) all over the country in rural areas to detect & treat malaria in endemic areas.
Chloroquine is the main anti-malaria drug for uncomplicated malaria.

Vector control

(a) Chemical control: Use of Indoor Residual Spray (IRS) with insecticide. Use of chemical larvicide’s like Temephos (Abate) in potable water.Malathion fogging during outbreak.Aerosol space sprays of Pyrethrum extract.

(b) Biological control: Use of biocides, Use of larvivorous fishes in ornamental tanks, fountains e.g. Gambusia, Guppy.