Context:

According to the World Malaria Report, 2018, India recorded a 24% decrease in malaria cases in 2017 compared to 2016.

Trend in Burden of Malaria

Global

1. An estimated 219 million cases of malaria occurred worldwide in 2017 compared to 217 million cases in 2016.
2. There were 435 000 malaria deaths in 2017.
3. The African region bears the largest burden of malaria morbidity, with 200 million cases (92%) in 2017 followed by the South-East Asia Region (5%) and the Eastern Mediterranean Region (2%)
4. Nigeria accounted for the highest number of malaria cases (25%) followed by the Democratic Republic of the Congo (11%), Mozambique (5%), India (4%) and Uganda (4%)

India

1. The majority of malaria in India is reported from the eastern and central part of the country from the states of Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh, Maharashtra and north-eastern states like Tripura, Meghalaya and Mizoram.
2. In 2017, India accounted for 4% of total malaria cases and 48% of total vivax malaria cases
3. India accounted for 85% of the total malaria cases in WHO South East Region in 2017

Malaria Control in India- A Timeline

• 1953- National Malaria Control programme was launched
• 1971- Urban Malaria Scheme was launched
• 1995- Malaria Action Plan was executed where emphasis was given on revised drug schedule in high risk area
• 2002- Integration of malaria control programme into the National Vector Borne Disease Control Programme (NVBDCP)
• 2005- Global Fund assisted Intensified Malaria Control Project (IMCP)
• 2008- World Bank assisted National Vector Borne Disease Control Support Project was launched
• 2013: National Drug Policy on Malaria- It advocated malaria by either microscopy or Rapid Diagnostic Test (RDT) and advocated proper use of antimalarial drugs including Artesunate Combination therapy (ACT)
• 2015- National Framework for Malaria Elimination in India (2016-2030)

National Framework for Malaria Elimination in India (2016-2030)

Aim: To eliminate malaria nationally and contribute to improved health, quality of life and alleviation of poverty.

The government further drafted National Strategic Plan for malaria elimination (2017-2020) wherein the country has been stratified based on the malaria burden into four categories – category 0 to category 3

Objectives:

Major Interventions

• Early diagnosis and complete treatment
• Case based surveillance and rapid response
• Integrated Vector Management: Indoor Residual Spray (IRS), Long Lasting Insecticidal Nets (LLINs)/ Insecticide-treated Nets (ITNs) and Larval Source Management (LSM)

• Epidemic Preparedness and Early Response
• Behaviour Change Communication (BCC) and Community Mobilization

Challenges in Malaria Control in India

1. Porous borders and migrant movement:

• The North-eastern states share their border with neighbouring countries such as Myanmar and Bangladesh where malaria is still prevalent and there is a persistent threat of influx of malaria cases from these countries.
• Further, there is also threat of the spread of malaria multi-drug resistance including ACT resistance

2. Insecticide Resistance: Due to extensive use of insecticides, particularly DDT, certain vectors of malaria have developed resistance to DDT posing threat to vector control across regions.
3. Antimalarial drug resistance: There are concerns about antimalarial drugs becoming ineffective due to drug resistance. Chloroquine has already become ineffective for treatment of falciparum malaria due to development of resistance by the parasite

• Lack of skilled human resource and infrastructure: Malaria control Programmes in India have been affected by insufficient number of health workers and Entomologists.
• Further poor health infrastructure in many states and UTs impede progress in malaria prevention and control

4. Urban Malaria: Increased population pressure, insufficient capacity of the civic bodies to deal with water supply and sewage and solid waste disposal have led to increased transmission of malaria in urban areas.
5. High endemic malaria pockets in remote areas and in tribal population: Prevention and control of malaria in remote areas and in tribal locations is a significant challenge due to poor transport infrastructure and lack of healthcare facilities.
6. Climate Change: Climate change is expected to worsen the malaria situation in India by encouraging faster rate of development of mosquitoes with rising temperatures.

International efforts towards malaria eradication:

1. WHO’s Global Technical Strategy for Malaria 2016–2030: It advocates global acceleration of malaria elimination efforts
2. The Strategy for Malaria Elimination in the Greater Mekong Sub-region (2015–2030): The goal is to eliminate malaria by 2030 in all Greater Mekong Sub-region countries (Cambodia, the People’s Republic of China, the Lao People’s Democratic Republic, Myanmar, Thailand and VietNam)
3. Asia Pacific Leaders Malaria Alliance (APLMA): It has set a target for malaria elimination in all countries of the Asia Pacific region by 2030 as per its Malaria Elimination Roadmap. India is also a member of APLMA.

Best Practice:

Durgama Anchalare Malaria Nirakaran (DAMaN) – Odisha

• The DAMAN programme envisages mass screening for malaria with treatment of positive cases, robust surveillance, mosquito control measures and regular health awareness activities.
• As a result of its sustained efforts, Odisha recorded 80% decline in malaria cases and deaths in 2017.

Way Forward:

1. It is important to address human resource challenges to effectively implement malaria control programs. Training programmes at the national and sub-national level for entomologists, epidemiologists and physicians should be provided
2. A cross-border malaria strategy with the neighbouring countries is crucial to maintain and achieve the aims of malaria elimination.
3. It is important to have conduct systematic drug resistance studies and monitoring. Antimalarial drug policies should also seeks to address operational issues such as surveillance, diagnosis, compliance, health-seeking behaviour of the malaria affected communities.
4. It is necessary to monitor insect resistance in malaria vectors. Alternative insecticides and approaches for vector control should be introduced.
5. To eradicate malaria it is important to strengthen community participation through information, education and communication (IEC) and Behavioural Change Communication