HEALTH-NEPAL: Deadly Malaria Returns To Himalayan Foothills

By IPS Correspondents Reprint | | Print |

Suman Pradhan

KATHMANDU, Sep 22 1998 (IPS) - Malaria has made a deadly return to the Terai in Nepal’s Himalayan foothills, and is threatening the country’s fastest growing region after having been wiped out with insecticides in the sixties.

Health officials are admitting that malaria cases have risen every year recently and could soon touch epidemic proportions in some Terai districts, along the country’s border with southern neighbour India.

“At present the problem of malaria is mostly confined to the forested areas,” according to a recent report prepared jointly by the Ministry of Health and the US Agency for International Development (USAID). “But this could represent only the tip of the iceberg due to under-reporting of cases caused by weak surveillance”.

Until a few decades ago, the thickly-growing jungles of the Terai on both sides of the Nepal-India border were infested with the dreaded female Anopheles mosquito that spreads malaria.

But thanks to the World Health Organisation (WHO) and and USAID, the disease was brought under control three decades ago with massive use of insecticides and the number of cases dropped from 200,000 deaths in the 1950s to just over 2,000 in the sixties.

The cutting down of the vast forests for farming and the settling in the area of thousands of people from Nepal’s hills also aided the control of the insect-borne disease. Nepal’s Terai towns are still the fastest growing in the country, with families continueing to migrate there in search of work.

Government compiled statistics show that aside from malaria, kalazaar (visceral leishmaniasis) and Japanese Encephalitis routinely exact a deadly toll on the population dwelling in the hot, sweltering plains of southern Nepal.

The report paints a stark picture not just of malarial incidences, but also of other deadly diseases which were once thought to be under control here in this impoverished Himalayan Kingdom.

“Kalaazar has increased sharply to epidemic proportions with incidence rate of 39.14 per 10,000 people in 1996,” states Dr Mahendra Bista, director of Nepal’s Epidemiological and Disease Control Division. “Kalaazar, malaria and encephalitis have become a serious health problem since 1980.”

Dhruva Shrestha who has been associated with the malaria control programme for two decades, admits that “diseases (like malaria) were not thought to be public health threats since effective control programmes had kept them under control. But now there is a growing realisation that diseases are coming back”.

Indeed, in recent weeks, encephalitis has claimed 44 lives in the border town of Nepalgunj, in the country’s west. Dozens of others have been admitted to hospitals across the nation, according to media reports.

Besides, statistics also show that 10,000 cases of malaria are reported each year. Only last year, 2,953 cases of Japanese Encephalitis, a viral inflammation of the brain’s outer layer, were reported – out of which 407 died. The cases had doubled in one year, says Dr Bista.

“Vector-borne diseases are increasing in Nepal,” says the government report. “Malaria appears to be on the rise and epidemics are occurring with increasing frequency. Kalaazar, usually fatal if untreated, has been increasing steadily since 1980. Similarly, cases of encephalitis have been reported increasingly in the last several years,” it adds.

Studies also show that large proportions of Nepal’s 21.6 million population are affected. Dr P. Wijeyratne, programme director of the Tropical Disease Prevention project in the United States who is visiting Nepal estimates that “malaria is putting 70 percent of Nepal’s population at risk”.

Dr Wijeyratne, here on behalf of USAID, thinks another six million people are at risk of kalazaar and 10 million at risk of Japanese encephalitis.

Nepal’s public health officials are trying to find ways to prevent epidemics. Last week, experts from various government departments, aid agencies and public health officials met in Hetauda, a town bordering the Terai belt, to strategise.

Director-General of the department of health, Dr. Singh Karki said the “planning, implementation and effective control of infectious diseases” is a priority for the health ministry.

But like so much of Nepal’s development needs, there’s always a shortage of funds. Officials are worried that the government

may be able to spare little for control programmes and are looking for support from donors for spraying programmes and other plans.

Insecticide spraying programme would alone cost one million dollars a year, according to government officials. Building more outreach health care centres, training health personnel and procuring medicines will add to the costs.

So far, only USAID has responded to the emergency. It recently announced a package of 7.4 million dollars over five years to combat re-emerging insect-borne diseases like malaria in Nepal.