Can India be malaria free by 2030?

Dr Richa Sharma, CNS Correspondent, India
Kusum (name changed) shudders at the mere mention of malaria. Last year she was diagnosed with malaria and suffered from weakness, fever, nausea and constant body ache for days. The news of two malaria deaths in the National Capital Region of Delhi is enough to transport her back to the nightmare of enduring it all.

Malaria, a life threatening disease, is transferred through the bite of an infected Anopheles mosquito, which releases Plasmodium parasite into the bloodstream.

After an incubation period of 10-15 days, symptoms like fever, headache, chills, and vomiting occur in the infected individual. Multi organ involvement in adults and severe anaemia, respiratory distress or cerebral malaria in children often occur in later stages. The recent unprecedented victory of Sri Lanka’s long standing battle against malaria serves as a wake-up call to the other countries in the South East Asia region and puts malaria elimination back in the spotlight. Maldives and Singapore are the two other countries in the region that have been declared as malaria free by the World Health Organization so far. There were an estimated 214 million new cases of malaria and 438,000 deaths globally in 2015 (WHO Global Malaria Report 2015).

The highest proportion of cases were from the African region (88%), 10% from South East Asia and 2% from Eastern Mediterranean region. WHO estimates that around 1.3 billon people are at risk of contracting malaria in 10 countries in the South East Asia region. India alone accounts for 70% of the malaria cases and 69% of malaria deaths in this region. Another scary fact is that almost 80% of India’s population resides in malaria transmission high risk areas. The expansive and diverse climate provides an ideal environment for the malaria parasites and its vectors. The diversity influences the distribution of these species and hence malaria parasite takes a number of forms in India: forest/tribal malaria, urban/slum malaria, industrial malaria and plains malaria. States like Odisha, West Bengal, Jharkhand,  Chattisgarh, Madhya Pradesh,  Gujarat , Karnataka and Rajasthan  are the most affected.

India has a long standing history with malaria dating back almost to the pre-independence era. The National Malaria Control Programme(1953) was successful in bringing down annual malaria cases and was also encouraged to be an eradication programme thereafter. However, post 1965, malaria re-emerged, owing to improper surveillance, lack of correct treatment, resistance to DDT and pushed India into deeper realms of the battle.

Currently, the National Vector Borne Disease Control Programme (NVBDCP) is the main nodal department under the Ministry of Health and Family Welfare that aims to address malaria and eradicate it. Training of community health workers ASHAs (accredited social health activists) for rapid diagnostic tests (RDTs) for active detection and administration of anti-malarial medication; distribution of insecticide treated bed nets in high risk regions; constant surveillance; spraying of DDT; evaluation of new insecticides; provision of diagnostic kits; and monitoring resistance to present insecticides are some of the steps undertaken in the programme. WHO has announced ending malaria by 2030 globally and India has also launched a National Framework to Eliminate Malaria.

In congruence with the WHO Global Technical Strategy (GTS) for Malaria 2016-2030 and Asia-Pacific Leaders Malaria Alliance (APLMA), India aims to:
  • Eliminate malaria (zero indigenous cases) throughout the entire country by 2030. 
  • Maintain malaria free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria.

Increase external support while building domestic financing

In a webinar, Dr Tim France, Team Leader for External Communications, Asia Pacific Leaders’ Malaria Alliance (APLMA) and Managing Director, Inis Communication, was on the panel of experts. Dr France elaborated on the importance of funding to fight malaria and also how the regions need to “retain and increase external support while building domestic financing.” Resistance to DDT insecticide and antimicrobial resistance to Choloroquine, the cheapest and most commonly used anti-malarial, and the high treatment failure rates in the North eastern states are some of the major challenges that the country faces in order to upscale its efforts.

A thorough epidemiological study to arrive at the true burden of malaria cases can be done, as there is still gross under reporting, especially when data is not collated from the private sector. New technologies that test antimicrobial resistance and give the extent of it in the population need to be introduced. Behavioural changes with respect to use of insecticide treated bed nets need to be strengthened. People need to be made aware and knowledge increased with respect to the preventive measures and timely diagnosis and treatment of malaria can be stressed upon. Immense efforts are required on the behalf of the Indian government, civil society organizations and the people. India needs to learn from its history of malaria control and then can only a new historical landmark be achieved by freeing the population from the menace of the mosquito-borne diseases.

Dr Richa Sharma, Citizen News Service - CNS
16 September 2016