Malaria is a disease caused by the infectious single-celled microorganisms of the Plasmodium group, which is spread by female Anopheles mosquitoes. Malaria is a leading cause of human morbidity and mortality. Despite huge progress in tackling the disease, there are still 212 million new cases of malaria and 430,000 malaria-related deaths worldwide each year according to the World Health Organisation (WHO). Most cases (80%) and deaths (90%) were in sub-Saharan African.

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India’s efforts to fight Malaria:

• India’s progress in fighting malaria is an outcome of concerted efforts to ensure that its malaria programme is country-owned and country-led, even as it is in alignment with globally accepted strategies.
• Indian government has released a National Strategic Plan (NSP) for malaria elimination for years 2017-2022, targeting eradication by 2030.
• This marked a shift in focus from malaria “control” to “elimination”. The plan provides a roadmap to achieve the target of ending malaria in 571 districts out of India’s 678 districts by 2022.
• India has sustained significant decline in malaria cases, halving numbers to 5.1 million in 2018 from 9.6 million the year before. This followed a 24% decline in 2017, according to the World Malaria Report 2018.
• Since 2000, India has reduced malaria deaths by two-thirds and halved the number of malaria cases.
• Scaling up a diagnostic testing, treatment and surveillance
• Ensuring an uninterrupted drug and diagnostics supply chain
• Training community workers to test all fever cases and provide medicines, and distributing medicated bed-nets for prevention, under its ‘test-treat-track’ in the endemic north-eastern states and Odisha.

Challenges remain:

• Large number of cases treated in the private sector, are not reported to the government
• 80% of malaria cases occurring among 20% of India’s population in 200 high-risk districts
• The Indian record stands in sharp contrast to some of its neighbours — the Maldives was certified malaria-free in 2015, and Sri Lanka followed last year.
• In India, malaria is caused by the parasites Plasmodium falciparum (Pf) and Plasmodium Vivax (Pv). Pf is found more in the forest areas, whereas Pv is more common in the plains.
• Majority of malaria cases in the country occur in its bordering districts, forests and tribal areas.
• The majority of reporting districts are in the country’s eastern and central parts — the largest number of cases are found in Odisha, Chhattisgarh, Jharkhand, Madhya Pradesh and the North-eastern states of Tripura, Mizoram and Meghalaya.
• Drug Resistance:
  • Artemisinin-based combination therapy (ACTs) has been integral to the recent success of global malaria control, and protecting their efficacy for the treatment of malaria is a global health priority.
• Insecticide Resistance:
  • Of the 80 malaria endemic countries that provided data for 2010–2017, resistance to at least one of the four insecticide classes in one malaria vector from collection site was detected in 68 countries.
  • In view of the current situation, resistance monitoring and management plans are essential, in line with the WHO Global plan for insecticide resistance management in malaria vectors.

Way forward:

• Parasite control:
  • Malaria can be eliminated only by stopping indigenous transmission of the infection.
  • In the early1990s, the AMC changed from vector-control (mosquito control) to parasite control strategy to contain infection. From 1999 onwards, cases have steadily declined and by 2008, less than 1,000 cases were being reported per year.
• Health access:
  • A strong public health system, sanitation and roads lowered mosquito breeding and took treatment to people in the remotest of places.
  • Rapid diagnostic tests make it possible for trained health workers to test all cases of fever in makeshift camps and treat everyone with malaria.
  • Prompt treatment by trained health workers with focus on high-risk areas lowered disease and deaths.
• Web-based surveillance:
  • Strong surveillance system requires high levels of access to care and case detection, and complete reporting of health information by all sectors, whether public or private.
  • All fever cases were tested for malaria and each case notified with the Anti ‘Malaria Campaign at the ministry of health.
  • People with a travel history to countries with malaria transmission were closely tracked for symptoms, as were people in the armed forces on peacekeeping missions, immigrants, emigrants, tourists and pilgrims.
• Rationing medicines:
  • Anti-malarial medicines were only available with the AMC, which compelled the private health sector to notify all cases. With malaria cases sharply falling, it soon became unprofitable for the private sector to stock anti-malarial medicines.
• Lessons from Srilanka:
  • Most of these people live in forest-rich districts also affected by the Naxalite problem. By reaching out to marginalised communities living in inaccessible areas and also to Naxal cadres with the help of civil society India can expect to eradicate malaria.
  • Improving public health system and rolling out malaria control interventions in these areas is critical if India wants to eliminate malaria by 2030.
  • Malaria control in border districts in the north and the north-east.
• 24×7 hotline:
  • AMC ran a 24-hour hotline to notify, track and treat the patient in isolation to stop further spread of infection.
• Stakeholder partnerships:
  • Intensive disease surveillance, integrated vector (mosquito) management, rigorous community engagement and research increased social, technical and financial support for eradication.
  • Among states, Odisha’s Durgama Anchalare Malaria Nirakaran (DAMaN) initiative is significant. The initiative aims to deliver services to the most inaccessible and hardest hit people of the State. The initiative has in-built innovative strategies to combat asymptomatic malaria.