K.M.C., Health Department is essentially guided by the measures the directorate of NAMP, Government of India, has propounded to curb malaria in high-risk areas. The NAMP (National Anti Malaria Programme) directorate considers Early Diagnosis and Prompt Treatment (EDPT), the mainstay of its plank to fight malaria especially in high risks metropolises such as this city. As per policy arrived at, one clinic per 50,000 population is to be set up, preferably adjoining a slum area, which must be manned by a trained microscopist for rapid examination of blood slides.

As regards treatment, they have very clearly suggested to give presumptive treatment to all fever cases with appropriate antimalarial drugs. The second part of the programme is the abatement of malaria transmitting species of mosquitoes, which has to be achieved by a sustainable indoor residual spraying with appropriate insecticides and larvicides with emphasis on echo friendly approaches including bio-environmental measures like use of bio larvicides, larvivorous fish, source reduction, environmental management and the enactment of civic by-laws etc. Last but not the least, health education and community participation.

A] EARLY DETECTION AND PROMPT TREATMENT:

The K.M.C. has so far established 59 malaria detection-cum-treatment centers in different parts of the city for this purpose. Blood test and treatment is free of cost. Since the prime objective of EDPT is to prevent deaths from malaria all febrile patients visiting the clinics are given full course of presumptive treatment with chloroquine and primaquine following the NAMP guidelines. Those whose blood samples are positive are given radical treatment.

B] INTRODUCTION OF MOBILE CLINIC:

The K.M.C. authorities have introduced several mobile malaria clinics to help slum-dwellers enjoy easy access to speedy diagnosis and treatment.

C] VECTOR CONTROL:

(1) Involvement of medical personnel for supervision:

Sprawling over an area of 187.33 sq.km., the KMC area is divided into 141 wards grouped under 15 Boroughs. Vector Control activities here are run by the KMC Health Department. Since 1997, 4 Dy. CMHOs, 15 Ex. H.Os have been looking after the programme. The OSD (Health) is at present the Controlling Officer.
At ward level, one M.O. now directly monitors the Vector Control activities besides other health programmes.
A specialist qualified Entomologist is in overall charge of vector control and also research on behaviour of vectors and efficacy of chemicals.

(2) Antilarval spraying:

This is being done by 3-4 Field Workers in every KMC ward under the supervision of Health Sarkar. Permanent mosquito breeding sites are treated with Bacticide (an ecofriendly bacterial toxin) and Fenthion (organophosphorous larvicide) at an interval of 7 to 10 days.

(3) Legal measures:

The KMC besides issuing notices under section 496 of the KMC Act, 1980 has been filing cases against those violating the KMC's guidelines inspite of notices against vector procreation within their premises. Over the past 5 years, more than 8000 notices were served on such offenders and 50 cases were filed in this regard in the Municipal Court. Those convicted have / had to pay a fine between Rs. 200/- & Rs. 2000/- each. This step will be intensified this year and in the following year for the benefit of the city dwellers.

(4) House to House Visit :

The Field Workers & Health Sarkars mainly perform this job besides spraying activities. About 400 Bailiffs along with the Filed Workers have been deputed to check domestic stagnant water, the chief source of mosquito breeding (Anopheles stephensi), the vector of malaria. Since April 2002, they have been deputed especially to the malaria prone Boroughs of the KMC such as no. 2 (9 wards) (10 to 12 and 15 and 20), no. 4 (10 wards) (21 - 28, 38 & 39), no. 5 (11 wards) (36,37,40 & 45 and 48 and 50) no. 6 (10 wards) (46,47,51 & 55 and 60 & 62) no. 7 (9 wards) (56 & 59,63,64,66,68 & 85) no. 8 (11 wards) (65,67,69,70 & 73,84,86,87,90) no. 9 (10 wards) (74 to 80,82,83,88) besides 120 Field workers & 30 Supervisors have been detailed through a KMC recognized agency to intensify anti-larval activities in different malaria prone wards of the city..

(5) Indoor Fogging:

P. falcifaram malaria positive household and surrounding residences are subject to indoor fogging to block the transmission of falciparum malaria as per NAMP guidelines.

(6) Indoor Residual Spraying:

In Kolkata slum dewellers suffer more from malaria than those better off because by and large the former do not use mosquito net for reason of lack of space and money. To prevent transmission of malaria among such people, KMC has resorted to spraying of an insecticide called Cyfluthrin (Solfac) indoors.

(7) Area Fogging:

Contrary to the perception of many people area fogging by vehicle mounted LECO-120 fog generating machine is useless, as has also been opined by renowned entomologists as well as NAMP. Fogging operations, mosquito-repelling coils, mats etc are all pseudoprotective. Besides, they pollute environment and are harmful to public health. KMC authorities, therefore, now rarely resort to such measures except where unavoidable.

(8) Publicity Campaign :

To increase people's awareness, IEC (Information, Education and Communication) activities - sometime by distributing leaflets, sometimes by installing hoarding, sometimes by establishing temporary kiosks in different busy intersections of the city, sometimes by sending out anti malarial messages through print and electronic media and sometimes by big or small seminars with residents of different locality, opinion builders, people's representative and KMC health personnel. The financial support for such campaign has been jointly given by NAMP and KMC authorities..

D] ACHIEVEMENTS:

Malaria has for centuries been wreaking havoc in the world. As many as 90 countries including India are endemic for this disease, where officially 300 million people now suffer and 1 million people die every year.

Against this background, what the KMC has achieved in recent years is most impressive. Going by the report by the State Health Department, number of malaria cases in the city has been brought down from an appalling 1,50,000 in 1999 to a noteworthy 48,000 in 2003. The slide positivity rate has been brought down from 32.8% to 20.8%. There has been a definite downward trend in the number of unfortunate death through malaria from 68 in 1999 to 13 in 2003.

Lastly, for translating the WHO's policy into a reality, the general people too need to join the fight by keeping all water containers properly covered, or clean these at weekly intervals. Larvivorous fish such as Lata and Tilapia may be released in wells and other such large water storage areas. It must also be ensured that rain water does not collect in and around human dwellers.

"WE SHALL OVERCOME SOMEDAY"

LET'S NOT FORGET THAT "MALARIA CONTROL---EVERYONE'S CONCERN" REMAINS THE PRIME SLOGAN OF N.A.M.P. AS WELL AS W.H.O.