UNIT 1 NATIONAL HEALTH

PROBLEMS OF INDIA-I
Structure
1.0 Objectives
1.1 Introduction .

1'.2 Concept of National Health Problems

1.3 Communicable Disease Problems
1.3.1 Malaria and Other Vectorborne Diseases
1.3.2 Tuberculosis and Acute Respiratory Infections (ARI)
1.3.3 Dianhoeal Diseases
1.3.4 Leprosy
,1.3.5 Sexually Transmitled Diseases Including HIVIAIDS
1.4 Let Us Sum Up
1.5 Answers to Check Your Progress

After completion of this unit, you should be able to:

identify the major health problems of India, that are prevalent particularly in
your state or district;

describe the nature and extent and magnitude of these specific national health
problems with reference to co~nmunicablediseases problem; and

identify the socio-cultural and other related factors giving rise to the national
health problems.'

1.1 INTRODUCTION
During the last five decades, since the attainment of independence, considerable
progress has been achieved in the promotion of the health status of our people.
Small pox has been eradicated; plague is no longer a major problem; mortality from
cholera and related diseases has decreased. The life expectancy at birth has
1 increased. But, inspite of such impressive progress the overall health piehlre of the
country still constitutes a cause for serious and urgent concern. The high rate of .
population growth copthues to have an adverse effect on the health of the people
1 and also on the quality of life. Many communicable diseases are still to be brought
under effective control or to be eradicated. ,High incidence o f diarrhoea1 diseases
and other preventable and infectious diseases, ,especially among infants and
children, lack of safe drinking water and poor environmental sanitation, poverty and
ignorance are the major causes of high incidence iof disease and death,

We shall discuss some o'f the communicable disease problems such as malaria and
.
other vectorborne diseases, tuberculosis, diarrhoeal diseases, leprosy and sexually
transmitted diseases including human immune deficiency syndrome and AIDS. Our
public health services and community health nursing services need to be to
cope with the emerging and existing health problems.

Assessment of health status and health problem is the first; pre-requisites for any 5
planned effort to develop health care services. Analysis of the health situation helps
Rr~leof N U I M in National in assessing health ]~rohlcmsand health needs 01 tllc ~~,iilnlunity.
Problems can
Itealll~ Prtrgramrnes
further be ranked according to priority or urgency for allocation of resources.

1.2 CONCEPT OF NATIONAL HEALTH PROBLEMS

Health problems in India may be grouped under following headings like
communicable diseases, nutrition problems, environmental sanitation problems,
population problems and health care services problems.

National healtl~is one of the vital oompo~~entsof the total health of the people in the
country. Each country contributes 10 the health status 01people of the whole world.
To start with a public health progranune and their health status, we must have
baseline information about cornrnunity. So that we can compare health status of
one community or country with the other. Knowing about the level of health of
community is a useful tool. To plan interventions and to evaluate lhis also helps i n
deciding what kind of intervention are important for health problems.

Based on the severity and magnitude of a d~seaseand its vulnerability, the control
measures and priority for action is determined. Many health problems are related to
life style, man made changes in the environment and disparity and inequality in
resource distribution with in the count~yand between the countries. In developed
countries there is a shift from infectious diseases to chronic diseases such as heart
disease, cancer, stroke and diabetes. This transition is mainly due to improved water
supply, sewerage and less crowded living environment and application of ~reventive
health services such as immunization, preventive health checkups, specific
intehentions and advanced technology. Developing countries are experiencing
double burden of disease i.e., one which is caused by poverty, poor water supply
and sanitation and low standard of living and other which is due to adopting similar
life style as of developed world. We shall start our discussion on problems of
communicable diseases as a major health problem.

1.3 CONIILMUNICABLEDISEASE PROBLEMS .

Communicable diseases continue to be one of our major health problems. This is

primarily in India due to our pdor so~io-ecotlomicstatus. Poverty, illiteracy.and
ignorance which causes heavy toll on our morbidity and mortality of our li,fe.
The factors which influence health'lie both within the individual and the society in
which he lives. This means the individual's genetic factors and the environmental
factors prcdispose the individual to nlany health problems. The health 'of an
individual afid whole communities is influenced by heredity, environment,life-style,
socio-economic conditions, health and family welfare services, education, food and
agriculture, industrial and rural development, etc. By constantly altering the ,
environnient or ecosystem by activities like urbanization, industrialization,
deforestation, land reclamation, construction of high rise buildings in cities and
growth of slums, we have created new health problems. Construction of caials,
dams and lakes favour the breeding of mosquitoes. The poor sanitation around,
unplanned living areas and slutns and the ancient social problems of prostitution a n d
drugs, smoking have taken newer problems of STD and AIDS along with old
problems of tuberculosis and leprosy. Communicable disease like malaria, ,

tuberculosis, diarrhoea] diseases, acute respirntoiy infections, leprosy, filaria, ADS

and others like Kala-azar, meningitis, viral hepatitis, encephalitis, enteric fever and
helmenthic infestation are the other importa~llcommunicable diseases in India. Most
of these diseases can be easily prevented or treated with minimum input of
resources, Most of the developed countries of the world have overco~nemany of
these problems by measures like improving environment, standard of living and
specific preventive measures. Let us further st-udy these problems.-We shall begin
with malaria and other vector borne diseases.
 National Nealtll
.s/EaEasiaand Other Vectorborne Diseases Prol)len~sof Indin-I
.&ria
.dialaria is caused by infection with specific sporozooa parasites of the genus -
plasmodium and transmitted to man by certain species of infected, female
Anophelles mosquito, and is clinically characterised by episodes of chills and fever
with periods of latency, enlargement of spleen and secondat7 anaemia. A typical
attack comprises of three successive stages: (i) Cold Stage - Characterised by
sudden onset offever with rigor and sensation of extreme cold, which lasts for 15
minutes to 1 hour; (ii) Hot Stage - The temperature rises high and the patient feels
hot and has /severe headache. This stage lasts for 2-6 hours; (iii) Sweating Stage -
Fever comes down with profuse sweating and lasts for 2-4 hours. Thc whole
episode of cold, hot and sweating occurs with definite intermittent periodicity
repeating every third or fourth day depending upon the species of the parasite
involved. The [act that human ~nalarialparasite is transmitted by the bite offemale
Anopheles mosquito was established by Sir RonalRoss in 1897 while working on a
hypothesis, in Secunderabad in Andhra Pradesh. The incubation period is ~lsually
10-12 days.
In your course on Applied Sciences, Block 3 and 4 (BNS- 102: Microbiology), you
have studied life cycle of parasites and vectors. As we proceed with each probletn
ygu may please review the life cycle of the particular parasile arid veclor that
causes communicable diseases.
Magnitude of the Problem of Malaria
The overall situation of malaria in the world shows that 48 per cent of populatio~l
live in malaria endemic areas. In our country, the magnitude of the problem was
great. There was no aspect of life in our country which was not affcctcd either
directly or indirectly by malaria. In 1953, the government li~unehedthe National
Malaria Control Programme (NMCP), to control malaria. The programme provcd
very successful. By 1958,the incidence of malaria drol3ped fro11175 million citses in
1953 to 2 million cases. All aspects of socio-econonlic life showed itnprovcmcnr.
Hence, in 1958 the National Control Programme was convcrled to National Malaria
' Eradication Programme (NMEP). The results were dramatic until 1961 when the
incidence of malaria cases was 0.5 million cases. Near eradication slatus was
achieved in many parts of our country by 1965. After that once again nol la ria cases
had risen very high i.e., 6.45 million cases with 59 deaths in 1976. A Modified Plan
of Operation (NLPO) was introduced in 1977, and the malaria incidence began lo
decline. By 1987 the incidence of malaria came down to 1.7 million cascs. There
was again a slight increase up to 1991 and by 1992 it canlc down to 1.4 million.
During 1994 resurgence of malaria was observed, in some of rhc stiltcs with
epidemics and increase in mortality. During 1994 outbreaks werc re11or;ted from
Rajasthan, Manipur, Nagaland and during 1995 from Assam, Mtharastra and West
Bengal. The year wise and state wise situation of rndaia is given in Trtble 1.1, 1.2
and 1.3 in hdia:

Pf : Plasmodium falcipmrn
API :Annual Parasite incidence
 Role of Nurse in National
Health Programmes

Arunachal Pradesh 4643 '1

Assam , 89601
Bi har . 3683
Chhattisgarh 235434
Go% 16818
Gujarat 82 966
Haryana 936
Jharkhand 126589
Karnataka 132584
Kerala 3360
Madhya Pradesh 108818
Maharashtra 45568
Manipur 1268
Meg halaya 17918
Mizorarn 7859
Nagaland 3945
Orissa 473223
Punjab 250
Rajtjasthan 68627
Tamil Nadu 34523
Tripura 13319
Ilttar Pradesh 90 199
West Bengal 194421
Total 1842019

Epidemiological Factors
We shall studjr the epidemiological factors under Lhree main headings i.c. the agent,
I
the host and the environmental factors.
i) Agent Factors
There a . four distinct species of malaria parasite that causes malasia in man
a) Plasm~~dium Vivax has the wides geographic distribution in the world. Seventy
l
per cent of the malaial cases ill'(? due to P. Vivax.
b) Plasm(odiumFalciparum causes about 25-30 per cent of lhe malarial cases. I
c) Plasmodium Malasia causes about less than 1 per cent: of the cases and is
confirled to tribal areas particularly in Tumkur and Hassan districts of
Karnsitaka. ,
d) Plaslrrodiurn OvJe is very rare and is confined to vopbal Africa and Vietnam.
Malaria piuasite undergoes two cycles of development. The human cycle called
1
asexual cj~cleand the mosquito cycle called sexual cycle. Mosquito is the d e h i t i ~ e
8 host while: man is the intermediate host. .

-
i
_I /
ii) Host Factors National Health
Problems of Indin-I
a) Intermediate Host
: Malaria affects persons of all ages.
Infants have considerable resistance to
infection.
Sex : Males are more frequently exposed to the
risk of acquiring malaria than females in
India due to their nature of work and
dress.
Race : Individuals with sickle-cell trait. (A5
haemoglobin) have a milder illness than
people with nomal haemoglobin.
Social and Economic Factors : Malaria is more prevalent in
underdeveloped areas. I11 ventillated and
badly lighted houses provide ideal indoor
resting places for mosquitoes. The site,
type of construction, nature of walls, etc.,
influence the selection and control
measures.
Movement of Population : People migrate for one reason or other
from one country to another country or
from part of a country to another.
Labourers connected with construction,
industries and agriculture migrate. They
import malaria problem. Tourists also
cause malaria problem.
Habits : Habits of human beings, sleeping out
doors increase man-vector contact.
b) Definite Host
Female Anopheles mosquito is the definite host for malaria. In India, nine
species of Anopheles mosquitoes are reported to be transmitting the malaria.
The habits of each species vary. But in general the environmenral factors
described below regulate the breeding and life span of the mosquitoes and thus
indirectly affect the malaria prevalence.
iii) Environmental actors
Season : Malaria is a seasonal disease, the
lnaximuin prevalence is from July to
October (Rainy Season).
Temperature and Humidity : The mean temperature of 20-30 degree
celcius and relative humidity of 63 per
cent or more is essential for malarial
transmission,
Rainfall : Rain In general provides opportunities for
I the breeding of mosquitoes and may givr:
rise to epidemics of malala.
~eservoirsof Water - : Garden pools, irrigation channels, open
drainage, burrow pels, etc., have led to
the breeding of mosquitoes md increase
in malaria.
Altitude : Generally Anopheles are not found at
high altitude above 2000-2500 metres due '

to unfavourable climatic conditions.

9
Role of Nurse in National Prevention and Control of Malaria
Healtl~ Programmes
You will learn more about these in Unit 4 of this Block. We shall briefly mention the
antimalarial measures for the prevention and control of malaria to be applied by the
individual and the community.
i) Protection against mosquito bites:
- Prevention of manlvector contact - using repellants, protective clothing,
bed nets, screening of houses and site selection for houses.
ii) Anti-adult mosquito measures: , .
- ~estructiohof adult mosquitoes by use of domestic space sprays, residual
'
spraying or space spraying of insecticides.
iii) Anti-larval measures:
- Destruction of mosquito larvae by peridomestic sanitation, intermittent
drying of water containers, using larvicides, both chemical and biological in
stagnant waters.
iv) Source Reduction of mosquitoes:
- Filli'ng small scale drainage, environmental sanitation, water management
and drainage schemes.
v) Control of Human Reservoir:
- Measures against parasites - presumptive treatment; radical treatment,
and mass drug administration - chemoprophylaxis and chemotherapy.
vi) Health Infornlation, Education and Communication:
- To awaken the community for prevention and control of the National
Health Problem of Malaria.
Other Vector Borne Diseases d
i) Filaria
Filariasis is a global probIem. Millions of people are already infected and mdny
millions are at 'risk' of infection in the countries world over -African countries,
Caribbean, Latin American countries, islands of western and South Pacific Ocean,
"
India, China, Indonesia, Malaysia, Korea, Philippines and Vietnam. Of these
countries two-thirds of the estimated world total of infected persons with filariasis
are in China, India and Indonesia.
Filariasis is a major public health problem in India. It is primarily due to the
mismanagement of the environment. Heavily, infected areas are found in Uttar
Pradesh, Bihas, Andhra Pradesh, Orissa, Tamil Nadu, Kerda and Gujarat.
Mostly two types of filarial infection occurs in India i.e. W bczncmj-2iand B.
mnhyi. These are nematode worms transmitted to man by the bites of infective
mosquitoes. These parasites have basically similar life cycles in man-adult worms I
living in lymphatic vessels whilst their offspring, the microfilariae circulate in
peripheral blood and are avaiIable to infect mosquito vectors when they come to
'
feed at night when the human being is asleep. The rnicrofilariae of W bancrofti
and B. malayi occurring in India display a nocturnal periodicily i.e., they appear in
large numbers at night and retreat from the blood streani during day. D i s is a
biological adaptation to the nocturnal biting habits of the vector mosquitoes.
Man is a nabral host. All ages are susceptible to infeclioii. Lymphatic filariasis is
often associated wi'th urbanization, industrialization,migration of people, illiteracy,
poverty, inadequate sewage disposal and poor drainage system. The vector
mosquito; Culex fatigans breeds in soakage pits, septic tanks, open ditches,
stagnant drains when the temperature is between 22-38" celcius with 70 per cent
relative humidity. Even Anopheles and Aedes mosquitoes serve as vectors for
-
lymphatic filariasis. It takes about 8-16 months before the clinical manifestation is
observed after being bitten by an infected vector.