The number of reported cases of chikungunya – a mosquito-borne viral disease – has been increasing in India in recent years, especially during 2016-2017. In this article, Kaushik Bharati discusses why this is so and what can be done about it.
Chikungunya (CHIK) is a mosquito-borne viral disease of great public health concern in India. Chikungunya derives its name from kungunyala, the Swahili word that describes the contorted and stooping posture of those inflicted with the disease. Chikungunya virus (CHIKV)1 causes an acute febrile illness, characterised by fever, rashes, and joint pain. Based on scientific studies (Robinson 1995, Lumsden 1995), CHIKV is believed to have originated in Africa about 200-300 years ago. Chikungunya was first detected in 1952-1953 in the Makonde plateau in Tanganyika, now Tanzania.
Chikungunya affects all age groups but severe manifestations are more often seen in children. Symptoms generally start 4-7 days after the mosquito bite. The acute phase is characterised by joint and muscle pain, high fever, extreme weakness, headache, vomiting, and rashes. In the chronic phase, various neurological syndromes and non-neurological manifestations can occur. Importantly, incapacitating joint pain can persist for months and even up to two years. A major cause for concern is the deaths due to CHIKV infections in recent years.
Chikungunya outbreaks in India
In India, the first outbreak of CHIK was reported in Kolkata in 1963. This was followed by epidemics in Chennai, Puducherry, and Vellore in 1964; Vishakhapatnam, Rajahmundry, Kakinada, and Nagpur in 1965; and Barsi in 1973 (Yergolkar et al. 2006). CHIKV then seemed to have disappeared from the country. The virus re-emerged in 2005 after a gap of 32 years and caused an explosive outbreak affecting 13 states (Lum et al. 2013). The states first affected were Andhra Pradesh, Karnataka, Maharashtra, Madhya Pradesh, Tamil Nadu, Gujarat, and Kerala. All ages and both sexes were affected. The virus isolates belonged to the African genotype, different from the viruses circulating in 1963-1973, which belonged to the Asian genotype (Arankalle et al. 2007).
Since 2007, diagnosis and data assimilation for CHIK in India has been facilitated by the National Vector Borne Disease Control Programme (NVBDCP). The programme has 347 sentinel centres in 35 states and union territories, and 14 apex referral laboratories. Based on NVBDCP data, the number of CHIK cases reported during 2010-2017 is presented in Figure 1.
Figure 1. Chikungunya cases in India, 2010-2017
The number of cases reported is increasing in recent years, particularly during 2016-2017. This could possibly be influenced by the increased efficiency of case detection due to the availability of CHIKV-specific IgM detection kits developed by the National Institute of Virology and made available through NVBDCP.
In 2016 there were 64,057 cases of CHIK. From Figure 2 below, it is evident that the major share of CHIK cases are from Karnataka, accounting for 24.5% of the total number of cases. This is followed by Delhi (19.2%), Maharashtra (11.8%), and Haryana (8.4%). Therefore, these four states together account for nearly 64% of all cases.
Figure 2. Chikungunya cases in 2016
There could be several reasons for the variation in the number of cases across the country. The geography of the area, climatic conditions, vector (mosquito) density, human population density, and rapid unplanned urbanisation are some factors that could account for this variation. Moreover, the burgeoning human population has led to encroachment into sub-urban and rural habitats that had previously been exclusively infested by mosquitoes. Disturbance of this ecological balance could plausibly have led to increased number of CHIK cases.
For 2017, the provisional number of CHIK cases till 17 December 2017 is 61,330 (Figure 3).
Figure 3. Chikungunya cases in 2017
As shown in Figure 3, the highest number of cases are seen in Karnataka, accounting for 50.5% of cases. This is followed by Maharashtra (12.5%), and Gujarat (12.2%). What immediately catches attention is the huge increase in the number of cases in Karnataka. This has essentially doubled, from 24.5% in 2016 to a staggering 50.5% in 2017. In order to figure out the reason for this extreme change, keeping all other factors (mentioned above) constant, I look at rainfall data for Karnataka in 2016 and 2017 provided by the Karnataka State Natural Disaster Monitoring Centre. As of 31 October 2017, the precipitation level in 2017 (over 920 mm) was significantly higher than in 2016 (720 mm). This drastic variation in the rainfall pattern may account for the higher number of CHIK cases in 2017 as higher rainfall translates into increased breeding of mosquitos.
What explains the resurgence of chikungunya in India?
Some of the major reasons for the resurgence of CHIK in India include the following:
- Change in genotype and mutations in the genome: This can increase the virulence and infectivity of the virus.
- Enhanced efficiency of mosquitoes to transmit the virus: This may occur as a result of the increased replication efficacy of the mutated viruses in the mosquitoes.
- Immunologically naïve population: This makes the people more susceptible and vulnerable to infection as they have not been exposed to the virus previously.
- Rapid means of transportation: This can rapidly spread the infected mosquitoes to hitherto unaffected areas.
- Global warming: This facilitates the expansion of the geographical range of the mosquitoes.
- Lack of an efficient public health system: This decreases the rapid response required to tackle the disease, particularly in outbreak situations.
What can be done?
Some of the specific strategies that can be adopted for tackling the problem may include the following:
Proper health facilities: Government hospitals, including those at the district level, should have the capacity and expertise to tackle CHIKV infections, particularly in outbreak situations, where there is a surge of patients flooding these healthcare facilities. In case of absence of proper facilities at the lower rungs of the health system – which is often the case – a prompt referral system should be in place so that patients are not delayed in receiving treatment at the higher levels. The secondary and tertiary healthcare facilities should have proper infrastructure, trained manpower, and rapid diagnostic kits for early detection of CHIK cases, so that treatment can be given without delay.
Robust public health system: There is an urgent need to give more attention to public health services for prevention of the disease. More public awareness needs to be generated about the disease, how it spreads, and how it can be prevented. Local bodies such as Gram Panchayats2 in rural areas and municipal corporations in urban areas should conduct regular checks for mosquito breeding sites at the household level, as well as undertake fogging activities at the community level. The government bodies can impose fines in case of non-compliance – which is now happening. Although there is evidence that the authorities are active in the metros; whether this is true for tier-II cities and more so for the rural areas, is a matter of conjecture.
Adequate and timely financing: Adequate funds should be released in a timely manner so that public health activities can be prioritised and properly planned. This will ensure recruitment and training of staff, prior to the actual occurrence of outbreaks. Sufficient funding will also ensure the procurement of necessary supplies like insecticides, fogging machines, and so on, so that these could be made available to workers on the ground.
Creation of evidence-based policies: As for most diseases in India, the reporting system for CHIK cases is sub-optimal. Disease reporting systems should be strengthened so that the disease burden data can be established and this information properly utilised to chart a course of action. Importantly, all health policies should be formulated based on the evidence generated from ground-level studies and not on assumptions or speculation.
Utilisation of novel strategies for vector control: Some novel methods have emerged from recent research activities, which may be used in conjunction with existing vector control strategies. These are briefly highlighted below:
(a) Bacillus thuringiensis israelensis (Bti), a bacterium that produces a toxin that kills mosquito larvae, has been shown to reduce the number of Aedes aegypti mosquitoes.
(b) Transgenic Aedes aegypti produced by genetic engineering techniques has been shown to exhibit female-specific lethality, thereby preferentially killing female mosquitoes.
(c) The trans-infection of mosquitos with the endosymbiotic bacterium Wolbachia is a promising new biocontrol approach. Wolbachia pipientis can invade and sustain themselves in mosquito populations, reduce adult lifespan, affect mosquito reproduction, and check virus replication. Wolbachia-infected Aedes aegypti mosquitoes have yielded promising results in field trials in Australia.
Mosquitoes have co-existed with us since time immemorial and it will likely remain so for centuries to come. It is next to impossible to entirely eradicate mosquitoes from our ecosystem. Hence, CHIKV is not likely to be eradicated entirely. Moreover, since the virus has an animal reservoir – as is true for most arboviruses – it will still persist in nature even if humans are protected by future vaccination efforts, as and when they are developed. However, the disease burden can be appreciably reduced through well-planned and well-executed public health strategies.
Chikungunya virus (CHIKV) belongs to the genus Alphavirus of the family Togaviridae and is primarily transmitted by Aedes aegypti and to a lesser extent by Aedes albopictus.
Gram Panchayat is the basic unit of village administration (a form of self-governance) in rural India, usually constituted by village elders and headed by a Sarpanch or village head.
Reprinted with permission from Ideas for India
SC Asks Govt for a Scheme for Construction Workers in Six Months
The SC directs all the state governments and union territories to constitute an expert committee and bring out statutory rules within six months.
The Supreme Court on March 19 directed the Narendra Modi-led government to frame a model scheme before September 30 to address the issues of education, health, social security and pension for construction workers, saying they build not just infrastructure, but also the nation.
The top court said that more than Rs 37,400 crore have been collected for the benefit of construction workers, but ostensibly only about Rs. 9,500 crores have been utilized for their benefit.
It questioned as to why millions of construction workers across the country are being denied the benefit of remaining Rs 28,000 crore.
The top court further directed all the state governments and union territories to constitute an expert committee and bring out statutory rules within six months.
A bench of Justices M B Lokur and Deepak Gupta said the directions given by the court from time-to-time to implement the two laws — The Building and Other Construction Workers (Regulation of Employment and Conditions of Service) Act, 1996 (BOCW Act) and the Building and Other Construction Workers’ Welfare Cess Act, 1996, (Cess Act) — have been flouted with impunity.
The top court said that the every state government and Union Territory shall constitute an expert committee and frame statutory rules under provisions of the BOCW Act, if such statutory Rules have not already been framed.
“Setting up an expert committee and framing statutory rules should be in a time-bound manner, with the exercise being completed preferably within six months and in any event by September 30, 2018,” it said.
Empowering India’s daughters
“Societal preference for sons in India is historical and long-standing, and appears inoculated against development.”
The pink-coloured Economic Survey 2017-18 contends that the societal preference for sons in India is historical and long-standing, and appears inoculated against development.
While the preference has its roots in culture, the factors driving it are entwined with economic and practical considerations. In the largely patriarchal Indian society, parents perceive daughters as liabilities who are to be married off on payment of dowry. Given limited household resources, there is little incentive to invest in daughters’ education and (employable) skills, or even health.
This, in turn, causes women to be at a disadvantage as potential entrants to the productive workforce, and in achieving financial independence. Indeed, they end up having no choice but to rely mainly on their husband’s income, with the limited agency regarding their own life and family, let alone to contribute towards their parents’ well-being.
The opposite is true for sons who are viewed as assets that support their families and are, therefore, worthy of investment. As long as these are the beliefs and practices of the majority in the community, it is ‘rational’ for individual families to follow suit, and we are stuck in a ‘bad equilibrium’. This is a vicious cycle that perpetuates son preference.
Even in the case of parents that do not subscribe to this school of thought and are equally invested – financially and otherwise – in the education of both daughters and sons, there may be other constraints to women’s economic participation. Examples include time poverty due to the primary responsibility of the care economy and restricted mobility on account of safety concerns.
The policy push in the form of the Right to Education (RTE) Act, 2009 and programmes such as Beti Bachao, Beti Padhao has led to significant improvement in gender parity in school enrolment. The gender parity index ─ the ratio of the number of females to the number of males that are enrolled at a particular level of education ─ stood at 1.03 and 1.01 respectively for primary and secondary schooling in 2014-15, although disparity persists in higher education (gender parity index of 0.92) (Ministry of Human Resource Development (MoHRD), 2016).
However, more female education does not seem to be translating into more female employment. The Survey reports that female labour force participation rate (FLFPR) has, in fact, declined from 36% in 2005-06 to 24% in 2015-16. Besides, culture may be an explanatory factor for the low levels of FLFPR but not for its decline over time as cultural norms are unlikely to have become more stringent. Other elements seem to be at play.
Understanding and addressing constraints on women’s economic participation
A body of research has emerged in recent years that seeks to understand the alarming trend of stagnant or falling FLFPR in recent decades. (See I4I e-symposium on ‘Women and work’.)
For instance, in an International Growth Centre (IGC) study, Afridi et al. (2016) analyse National Sample Survey (NSS) data to show that the fall in FLFPR is concentrated among rural, married women. They argue that this is because of a lack of job opportunities that are commensurate with women’s enhanced education levels, and their time is better spent at home on child care and domestic work; increased income of husbands enables them to make this choice. Chatterjee, Murgai and Rama (2016) emphasise the need to generate suitable jobs opportunities outside of farming and close to place of residence.
Other recommendations by stakeholders include flexible working conditions, adequate maternity leave (Ahmed 2017), and reliable childcare facilities to enable women to manage their dual responsibilities of work and home; strengthening public services and infrastructure to ease the burden of unpaid domestic tasks; addressing gender discrimination in the job market (Deshpande, Goyal and Khanna 2016); ensuring women’s safety in public spaces to facilitate their mobility (Pande 2014); and encouraging female entrepreneurship via access to finance (Field and Pande 2017, KC and Tiwari 2014), networks, information, and markets (Ghani, Kerr and O’Connell 2012).
Further work is needed on disentangling the various constraints on female economic participation and assigning relative weights to them, so as to get policy priorities right and allocate resources efficiently. Importantly, this would require closing the gender data gap ─ a problem that exists in India and beyond. So although mind-set changes can only take place slowly over a long time horizon, concrete measures can be designed and implemented in the short- to medium-term to change the economic dynamics and address practical constraints at the least.
Promoting women’s education: Beyond enrolment
Education is fundamental to women’s empowerment. In an environment where women are able to engage effectively in productive economic activities, parents are more likely to not just send their daughters to school, but to actually focus on their education and skilling in order to prepare them for the workforce.1 In their research in Bangladesh, Heath and Mobarak (2012) found that the explosive growth of the garment industry had a significant positive influence on girls’ educational attainment, and delayed marriage and childbirth.
They also showed that job growth had a much stronger effect on the demand for education vis-à-vis a large-scale government conditional cash transfer programme to encourage female schooling.
Despite the improved gender parity in school enrolment in India, there is a gender gap of 19.6% (2011) in the adult literacy rate2 (MoHRD, 2016). The Annual Survey of Education Report (2017) tested rural youth (14-18-year-olds) on applying basic foundational skills of reading and arithmetic to real-world situations and found that females almost always perform worse than males. Why is it that despite the increased presence of girls in educational institutions, they still significantly lag behind boys in terms of learning outcomes?
One possibility is that this is a time-use issue. According to ASER (2017), 89.4% of females versus 76.8% of males do household work daily. The differential outcomes may also be a manifestation of boys receiving a lot more support for their education at home as compared to girls. Does such discrimination pervade the classrooms as well? These are important questions for further research.
- Maitra, Pal and Sharma (2016) find a systematic female disadvantage in enrolment in private schools, which are considered as more efficient than government schools by parents.
- The Adult Literacy rate is the percentage of the 15-24-year-old population that can both read and write, and understand a short simple statement on everyday life.
Views expressed are of the author and do not necessarily reflect the views of League of India or of any of its partners.
Reprinted with permission from Ideas for India
India and Japan Hold the First Workshop on Disaster Risk Reduction
The two-day workshop is being jointly organised by the Ministry of Home Affairs, National Disaster Management Authority and Government of Japan.
NITI Aayog Vice-Chairman Dr Rajiv Kumar on Monday inaugurated the First India-Japan Workshop on Disaster Risk Reduction in New Delhi.
The two-day workshop is being jointly organised by the Ministry of Home Affairs, National Disaster Management Authority and Government of Japan.
Speaking on the occasion, the Vice-Chairman of NITI Aayog underlined the synergy between the two ancient Asian civilizations of India and Japan, both of which have frequently witnessed the fury of natural catastrophes and are investing proactively on mainstreaming risk reduction into development.
He said that this workshop “marks the beginning of the formal implementation of the initiatives agreed under the Memorandum of Cooperation signed between the two countries on Disaster Risk Reduction in September 2017”.
While underlining the impact of the disaster on development, Dr Rajiv Kumar stated that uncontrolled development without proper disaster risk assessment has increased the risk of losses from disasters. He added that climate change has further aggravated the disaster risk.
“Therefore, disaster risk management can no longer remain isolated from the overall strategy of sustainable development”, he said.
Recalling commitments made in Sendai on Disaster Risk Reduction, in Paris on Climate Change and in New York on Sustainable Development Goals, Dr Rajiv Kumar emphasized the role of country leadership for implementing the commitments particularly in the field of Disaster Risk Reduction, as returns to investment are not easily visible.
He said that “Disaster Risk Reduction should be seen not as a cost to economic growth, but rather as a valuable asset for the country”.
The Vice Minister for Policy Coordination in the Cabinet Office, Japan, Mamoru Maekawa, thanked the Government of India for hosting this Workshop, which is the first outcome of the Memorandum of Cooperation regarding Disaster Risk Reduction (DRR).
He shared the Japanese experiences of DRR policies, including legal and planning framework, and discussed how Japan is preparing against mega-scale disasters, in collaboration with government, academia, private companies and citizens.
He concluded that Japan and India could collaborate for the implementation of the Sendai Framework so as to contribute to Disaster Risk Reduction globally.
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