On the occasion of World Malaria Day last month, Union health minister Mansukh Mandaviya spoke about India’s “remarkable progress” in controlling malaria. The surveillance data backs the assessment as there was a considerable drop in malaria cases and deaths in India while they increased significantly globally in 2020. As many as 241 million malaria cases were reported worldwide in 2020. This marked a six per cent increase compared to 227 million cases in 2019. The malaria-related deaths increased by 12% to 627,000 compared to those reported in 2019.
In Its 2021 world malaria report, the World Health Organisation noted that of the world’s 11 highest-burden countries, only India registered progress against malaria. “The 10 other countries, all in Africa, reported increases in cases and deaths.”
India registered a nearly 50% drop in malaria cases between 2019 and 2020. In 2019, the country reported 3,38,494 cases. They dipped to 1,86,532 in 2020, according to National Vector Borne Disease Control Programme data. There has been a further drop in malaria cases in 2021, as per the government data.
“India has made remarkable progress in reducing malaria incidence and deaths. Our efforts have resulted in an 86.45% decline in malaria cases and 79.16% reduction in malaria-related deaths in 2021 as compared to 2015,” said Mandaviya.
At least 124 districts last year reported zero malaria cases, according to the health ministry even as the Centre needs to validate this reporting by states. “This is a major step towards our goal of elimination of malaria but still more needs to be done to fulfil the dream of malaria-free India. Not only diagnosis and treatment, but swachhta [cleanliness] in our personal and community surroundings and social awareness regarding malaria control and prevention are also equally important in our collective fight against it and for meeting our goal of the elimination of malaria from the country by 2030,” said Mandaviya at an event on the World Malaria Day observed annually on April 25.
Experts have credited concerted efforts of the central and state governments for the improvement in the situation. In 2016, then Union health minister JP Nadda launched the National Framework for Malaria Elimination.
The framework set the target of eliminating malaria from all 26 low and moderate transmission states by 2022. It seeks to reduce the incidence of malaria to less than one case per 1,000 people annually by 2024. The framework has also set the target of interrupting indigenous transmission of malaria throughout the country (making the country malaria-free) by 2027. It aims to prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain national malaria-free status by 2030 and beyond.
States such as Odisha, where Malaria is endemic, have reported significant improvement even though the numbers being reported are still on the higher side, according to the National Centre for Vector Borne Disease Control data. The cases in the state fell from 347,860 in 2017 (41% of national cases) to 255,25 in 2021 (16% of total cases last year). Between 2017 and 2021, the cases in Uttar Pradesh reduced by 66%. In 2019, the state reported 92,732 cases, which reduced sharply to 10,792 in 2021.
Officials credited a multi-pronged strategy as part of the framework that includes quick case detection and treatment and preventive measures for the drop in cases. Malaria elimination is being carried out in a phased manner as different parts of the country differ in their malaria endemicity due to differences in eco-epidemiological settings, socioeconomic conditions, health system development and control accomplishments. Early case detection and prompt treatment remain the main strategy to prevent transmission.
Chloroquine is the main drug for uncomplicated malaria. Alternative drugs have been prescribed to manage chloroquine-resistant malaria. Drug Distribution Centres and Fever Treatment Depots have been established in rural areas for easy access to the drugs.
Vector control is a crucial preventive measure that entails chemical and biological control. Use of indoor residual spray with insecticides, chemical larvicides like abate in potable water, aerosol space spray during the daytime, and malathion fogging during outbreaks have been recommended under the programme.
As part of biological control, the use of larvivorous fish in ornamental tanks, fountains etc, and the use of biocides are recommended. Then there is environmental management wherein emphasis is on source reduction.
The government plans to ensure that frontline healthcare workers, including accredited social health activists and auxiliary nurse midwives, work in tandem for mass awareness about diagnosis, timely and effective treatment, and vector control measures. The private sector is being asked to align malaria case management and reporting with the national programme to achieve the target of the elimination of the disease.
Experts say effective surveillance remains crucial as India enters the elimination phase. “When cases are going down, it is all the more important to detect, treat, and follow up on every case. If surveillance is good, one can detect all outbreaks in time. We cannot afford to be complacent as transmission potential still remains, and malaria is an outbreak prone disease,” said Neeraj Dhingra, a former director of the National Vector Borne Disease Control Programme.Dhingra added the challenge ahead also lies in making effective changes while keeping in mind the elimination phase.
“The programme needs a change now as it enters the elimination phase. Someone who took care of 10,000 cases a month now has one, 10 or at the most 12 cases a month to look after, so what do we do then? Task-shifting has to be done wherein you define the task of people from the centre to right up to the peripheral level based on the needs of the elimination phase. Political advocacy and sustained funding are equally important.”