The kiss of death
THE monsoon has struck Assam before schedule, bringing flashfloods, forming mosquito- rearing waterpools, and killing hundreds. An unprecedented toll in April of 240 malarial deaths in 12 districts, has sparked off a debate about the efficacy of the present drug regimen.
The Union government's righteous anti-state government stand stems from the fact that it had provided 100 per cent central assistance for malaria eradication in the 7 hyperendemic northeastern states. The state government says that Central budget cuts are to blame.
Meanwhile, the patients number more than 70,500. A government official points out that instead of the stipulated rate of one Primary Health Centre (PHC) for a population of 30,000 (20,000 in difficult terrain), 1.5 lakh people in Assam have perforce to share a PHC.
Drug resistance is rocketing. According to P N Sehgal, consultant with the Voluntary Health Association of India (VHAI)"Assam, Naogaon and Karbi Anglong have reported drug resistance right from 197i." V P Sharma, director of the Malaria Research Centre, points out that in pockets of the northeast the drug resistance has reached advanced (R-111) levels.
Director general of health services A K Mukherjee recently announced that the government is reviewing the dosage of chloroquine and primaquine, firstline anti-malaria drugs. Mukherjee said that the rules regula-ting the use of the secondline sulphalene and pyrime-thamine are also being relaxed.
Quinine is often used in the treatment of drugresistant cases of falciparum. "More than 20 per cent of cases we see are suspected to be falciparum malaria, which causes lethal complications. Of that a few, maybe 5 per cent, develop symptoms of cerebral malaria," says D C Bhatt, executive secretary of VHAI, Assam.
There is a medical debate about allowing the legal import of mefloquine, a highly potent anti-malarial drug which is now being smuggled in. Says Sanjoy Ghose of Urmul, a Rajasthan-based NGo known for its antimalarial work, "The extensive use of highly potent drugs can hasten the development of drug-resistance even more."