The challenges to the Kerala model of health result in part from the re-emergence of communicable diseases, many of which are mosquito-borne. Urbanization has changed the land use pattern across the state and created an environment conducive for mosquitoes to breed. They are typically combated with massive doses of chemicals. The effects on the mosquito population are short-lived, but the side effects last. One of the great achievements of the People’s Campaign was an experiment with environmental mosquito control developed by two creative scientists in Koyilandy Municipality of Kozhikode District.

Koyilandy is a coastal community on Kerala’s Malabar coast, 26 km northwest of Kozhikode (Calicut). In 1990 Koyilandy officially become a municipality after a period of rapid urbanization. In 1991 the population was 57,797 on an area of 21.61 sq. km, a density of 2,675 per sq km. As the density of population increased through the 1980s, problems developed in wastewater drainage, leading to the appearance of stagnant pools that became large-scale mosquito breeding places. It was noted in the project report prepared by the municipality that the inadequately constructed drainage channels combined with the effects of damaged septic tanks connected to individual household toilets led to further mosquito breeding sites.

Koyilandy has a high rate of filaria, a condition caused by a mosquito-borne parasite leading to extreme swelling of the legs. The municipality was thought to be second only to Chertala, an impoverished lowland community on the central coast, in the number of filaria patients in Kerala. According to a 1993 WHO survey 1,400 to 1,500 persons, about 2% of the population of Koyilandy suffer from filaria and another 4%, 2,800 to 3,000 are carriers. Malaria and Japanese encephalitis are also spread by mosquitoes.

 Organizing the Project

The People’s Campaign drew the attention of a husband and wife team who are natives of Koyilandy. Dr. Reena Anil Kumar and her husband Dr.Anil Kumar were doing research on biological mosquito control. Dr. Kumar was working as the head of the Department of Microbiology in St. Pious Xth College in Kanhangad town in nearby Kasargode District while his wife had completed her Ph. D. in Life Sciences at Calicut University on mosquito behavior.

Dr. Reena Kumar suggested this programme for three reasons. The high rate of filaria and the likelihood of other mosquito related problems was the first. Secondly, she was concerned as were many residents, about the possible harmful effects of the chemical Bitex, an organo phosphate that the municipality had been spraying for the past 10 years along with the NFCP, the National Filaria Control Program. The workers who spray the Bitex had been complaining of shortness of breath. Should everyone be exposed over and over to this chemical? But thirdly, she came to believe it would be possible to carry out an environmentally safe mosquito control project because the People’s Campaign had unleashed both energy and created organizations among the local population. In place of chemicals, people’s participation could control mosquitoes. But active and consistent participation requires awareness and as well as appropriate scientific methods. She approached the municipal council chairperson, Advocat Shalini, who got the project approved tentatively by the local council. The council members transmitted the idea of a people’s campaign for mosquito eradication to the fourth round of ward planning assemblies in September 1999. The ward assemblies are the equivalent in the municipalities to the rural grama sabhas.

Reena Kumar and the municipal council decided to introduced the project in wards 24,25, and 26, all beach areas where the major drainage channels are located. The public hospital was also in this area. On August 23, 1999 they set up a committee of eleven persons including Reena, Ba Hassan and S. Ravindran Master, town council members, Dr. T. Ramachandran, superintendant of the hospital, Dr. Ramachandran Pillai, superintendent of the government homeopathic hospital, Bhaskaran, the town health inspector, Jaffer and Balakrishnan, two assistant health inspectors, Ramakrishnan and Sharif, two social workers, and the municipality secretary.

The initial reaction among the participants was cautious. They were used to spraying strong chemicals to kill mosquitoes; why change to an untried method that might also be a lot of work? Furthermore, some community members were reluctant to admit publically that they were afflicted with filarial. Keeping covered with traditional Muslim dress made it possible to hide most of the physical symptoms.

Reena explained the project in detail in the assemblies and then set out with the help of the committee to generate an awareness that would tap into the active mobilization going on the other development issues because of the People’s Campaign. In September 1999 she organized a class at the R. Shankar Memorial SNDP Yogam College, recruiting students who later assisted with a survey. People’s committees were formed in each ward to generate awareness and eventually to implement and monitor the project. A project description in the form of a 4-page newsletter was distributed to all 1,200 households in the project area. The newsletter was called "Arogya Yejnam 2000," or Health Initiative 2000. The newsletter discussed at length the various mosquito control methods, hazards due to overuse of chemicals in mosquito control, the need for people’s participation. Methods to be followed by the people for the control of mosquitoes and details on mosquito-borne communicate diseases.

The front page led with an article by the editor, S. Ravindran Master, a town council member, who argued for the need for better sanitation and drainage, for volunteer work, and for strong action by public institutions. His text surrounded a photo of a grossly distorted, swollen leg of a filarial patient whose face was not visible. Chairperson Shalini provided a piece in which she congratulated Reena Kumar for bringing her science out of the university and to the community. Reena herself had a piece at the bottom explaining the project and emphasizing its non-bureaucratic nature. On the second page, Anil Kumar reinforced the idea with an article on the importance of people’s involvement. Dr. Satish, the Koyilandy branch secretary of the Indian Medical Association described the dangers of excessive use of chemical insecticides, while S. Ravindran Master had a second piece in which he noted that some people were getting 100 to 150 mosquito bites a day. On page 3 were brief statements of support from political leaders including the opposition party leader. On the back page were advertisements from a gold merchant, a home appliances merchant, a jeweler, and a table covering materials store. Those four merchants had donated most of the money to fund the newsletter.

Dr.Reena also taught about 75 classes for college students, neighborhood groups, at ward assemblies and some other public events. Approximately 5,000 people learned about the dangers of the chemical approach and the possible benefits of a biological control project. Following the classes local volunteers and several college students from various branches of Calicut University went door to door to convince additional community members of the possible value of the project. At first the students from the Arts College, Maharaja College, Jawahar College, Muslim Educational Society College, and Bhaghat Singh Memorial College were only fulfilling a social service requirement. But most of them developed a real interest in the project. Their enthusiasm was contagious; community hesitation changed to community action.

The project was unofficially launched on 7 September 1999 with a questionnaire carried to all 1,200 households in the initial three wards to gather information on house construction materials, garbage disposal, personal hygiene, the presence and location of stagnant water pools, house compound area, number and types of latrines, the nature of the flooring in bathrooms and kitchens, whether the household engages in chemical spraying for mosquitoes, and whether they experienced problems from mosquitoes. The survey also asked about the presence of filaria and how long it had been a problem. All 1,200 households identified mosquitoes as an important nuisance in their daily lives. Thirty-two people were found to suffer from filarial. Others complained that they were spending a lot of money on individual mosquito control devices such as mosquito coils, repellent creams, and liquid mosquito-cides, a liquid form of 1.6% allethrin solution, described as a "household insecticide," in a small bottle that is plugged into the electric outlet and heats to send a mosquito-killing vapor throughout the room – here was the first indication of a way to sell the project to the local community. It was found that in 25% of houses the covers of their septic tanks or wastewater pits were broken or had cracks that allowed mosquitoes to enter or come out. But because mosquitoes can range over an area up to 5 km, 25% of the houses can provide mosquitoes for the entire community. The data showed which techniques would result in the most effective mosquito controls.

On 12 November 1999 the project was officially inaugurated, but the anti-mosquito action phase began a few days earlier.

 The Techniques

The project had six components:

1. The control of larvae using bio-larvicides. Both herbal and bacterial larvicides were used. The herbal larvicide is a liquid mixture of the extract of certain medicinal plants, including neem (Azadirachta indica), a tree from which several bioactive elements are produced that repel, suppress appetite, sterilize and/or kill insects but are harmless to humans. The bacterial larvicide was Bacillus thuringiensis – a larvicide that is internationally accepted as environmentally safe and safe to humans. It comes in liquid as well as in powder form and can be sprayed over the drainage channels and other stagnant water pools. Because the biolarvicides degrade quickly, mosquitoes are not likely to develop resistant strains as they do with more long lasting chemical insecticides.
2. Spraying an oviposition repellent mixed with a herbal larvicide to repel female mosquitoes thus preventing them from laying eggs. The oviposition repellent is a combination of herbal oils developed by the Kumars and for which they have applied for a patent;
3. To attract female mosquitoes and trap their eggs with an ovitrap. This is made of shallow pans of plastic or metal – almost any household container can be used – in which one places an organic solution of locally available cow dung, arecanut husks, straw, yeast, and some soil bacteria mixed with water. Mosquitoes lay eggs in this solution. Within six days, before they mature into pupae, they are destroyed by pouring off the water and dumping the pupae onto dry soil where they will die within 15 minutes;
4. Covering the vent pipes of all the septic tanks in the area with mosquito nets;
5. As the survey had found that around 25% of houses had the covers of their septic tanks or wastewater pits broken or had cracks that allowed mosquitoes to enter or come out, an effort was made to motivate the house owners to patch the cracks with cement. In cases where it was not done, the people’s committees in the respective areas took the initiative to make the repairs;
6. Throughout there was a close monitoring and documentation of the project. A control study was conducted to compare the efficacy of the biological larvicide with that of chemical insecticides used in the area.

Monitoring

Both the larvicide and the ovitraps were carefully examined for their effects on the numbers of mosquitoes surviving. A larval count was done both before and after spraying the biolarvicide. The count showed that 75% of larvae were destroyed in the first two months. In wards where chemical insecticides were used, the recommended dose of 5 ml of Bitex in 10 liters of water destroyed only 5% of the larvae. As a consequence, some of the spraying personnel were discovered to be mixing up to 20 times the recommended dose to try to kill more larvae. Overdoses of insecticides always produce insecticide resistance in mosquitoes.

For the ovitraps, a similar larval count was done. The number of larvae destroyed through ovitraps per week per house was recorded and followed up. Random samples were collected every week from September 1999 to July 2001 as shown on Table x.y. Even after reducing the larva population by means of ovitrap, a section of the community still experienced problems with mosquitoes. The organizers found that those households with persisting mosquito problems had the vent pipes or septic tanks not completely covered. The house owners were encouraged to fix the problem and were offered assistance. The septic tanks of the hospital were repaired with community action.

Table 1 shows the results of the ovitrap monitoring. In March/April 2000, the number of mosquito larvae had been reduced to 15% of those counted in September 1999.

Table 1: Mosquito Ovitrap Installation in Houses and Numbers of Larvae Destroyed

Koyilandy Biological Mosquito Control Project, September 1999 to July 2001

The total project cost was Rs 526,250. Counting just the beneficiaries of the first three wards where it was implemented, and assuming 6 members per household, the 85% decline in mosquitoes was achieved for Rs 73 per person. This is about the cost of a one month’s bottle of liquid mosquito repellent, effective in one room of the house. In addition to the official costs, organizers estimate about Rs 400,000 worth of voluntary labor was used, equal to about a 75% addition to the budget.

After the success of the first phase, four additional wards were added to the project. By November 2001 there were 2,100 ovitraps placed at various parts of 7 wards in Koyilandy. Many government offices began to cooperate with the project. Ovitraps were also placed in the hospital, at bus stands, district government offices, the jail, and the railway station. The septic tanks in the jail were properly sealed. The old septic tank in the government taluk (subdistrict) hospital that was a major source of mosquitoes was covered.

A major drawback of the project is that the municipal drainage system has not yet been upgraded. Until this is done, the gains of the project will remain endangered.

In March 2002 the project ended for lack of funds. The Congress ministry elected in May 2001 claimed the state government did not have the funds for decentralized planning and withheld payments for one year. Dr. Reena Kumar is now trying to transfer the project to the Neighborhood Groups (NHGs) that developed in the last two years of the People’s Campaign. The rotating credit associations that the NHGs often start up could provide a basis for local level financing. At a cost of Rs 73 per person per year, it is realistic to think of the project as locally financed. Dr. Kumar hopes to spread the project from the current 7 wards to all 38 wards of the town. She and her husband have established Ram Biologicals, a biological mosquito control consultant service, from which she has offered to provide the organic materials at cost to the NHGs in Koyilandy.

The clear success of the biological control method led nearby communities to request assistance from the Kumars for similar undertakings. Vadakara, Kannur, Cochin, and Kasargode have started projects. Koothuparamba, Kalpetta, and Guruvayoor municipalities have expressed interest. The Cochin project has become one of the largest mosquito control attempts ever in Kerala. As of October 2002 it was in the initial stages of implementation, with emphasis on the ovitraps and on flushing the many stagnant drains alongside the city streets.

The Koyilandy mosquito control project illustrates the potential of a creative combination of innovative science, community dedication, and the active participation of large numbers of citizens. The technical knowledge of the scientists was needed, but also the context of the people’s campaign had to be there to generate the structures of participation that carried the project forward. Dr. Reena Kumar herself acknowledges "the People’s Planning program and democratic decentralization without which this project would not have been implemented."