Numbers Declining, Can India Eliminate Malaria By 2030?

Amid efforts to eliminate malaria by 2030, India has recorded around 66,313 cases and 13 deaths till May 2019, according to the latest data available with the National Vector Borne Disease Control Programme (NVBDCP) under union health ministry. The country remains on course to curtail the number of malaria cases.

As per the NVBDCP data, India recorded 1169261 malaria casesin 2015, 1087285 in 2016, 844558 in 2017 and 429928 cases in 2018. The death count also remained on a decline as 384, 331, 194 and 96 deaths were reported in 2015, 2016, 2017 and 2018, respectively.

The world malaria report released by the World Health Organization (WHO) in November 2018 also stated that India reported 3 million fewer cases in 2017, a 24% decrease compared with 2016. The report also said India is on track for a 20-40% reduction. In spite of being the highest burden country of the region, India showed a 22% decline in reported cases within a year.

According to the union ministry of health and family welfare, nearly 70% of malaria cases in India are contributed by five out of 36 states and Union Territories.

These include Odisha (36%), Chhattisgarh (12%), Jharkhand (9%), Madhya Pradesh (9%) and Maharashtra (5%). Historically, these states and northeastern states such as Meghalaya, Mizoram, Nagaland, which have a wide coverage of forest, hilly, tribal and conflict-affected areas accounted for most number of malaria cases in the country. According to government, India’s declining malaria numbers are largely due to substantial decline in the highly vulnerable state of Odisha which has approximately 40% of all malaria cases in the country. Odisha reported an 80% decline in malaria cases and deaths in 2017.

“After we realized that the disease has to be eliminated and a plan was chalked out, we strengthened our interventions by providing and increasing the outreach of malaria diagnosis by using Rapid Diagnostic Kits, effective anti-malarial medicines like Artemisinine combinations, provision of Long Lasting Insecticidal Nets (LLINs), with special focus on North-eastern states and Chhattisgarh, Odisha and Jharkhand. We changed the medicines where required and focused on the socio economic cause of malaria,” said A.C. Dhariwal, consultant, NVBDCP.

The union health ministry launched the National Framework for Malaria Elimination (NFME) 2016-2030 document in February, 2016. The framework laid out the vision, mission, broad principles and practices to achieve the target of malaria elimination by 2030 synchronising with the Global Technical Strategy (GTS) for Malaria 2016-2030 of WHO.

“Progress is being made in malaria control globally. In the WHO South East Asia Region, between 2000 – 2013, the confirmed malaria cases have decreased from 2.9 million to 1.5 million, six of ten malaria endemic countries reported >75% decrease in the incidence of microscopically confirmed cases, and the reported malaria deaths decreased from 5,500 to 776. India and Myanmar, which together with Indonesia contribute over 90% of malaria cases and deaths in the South-East Asia Region, are also making significant progress in malaria control,” said Poonam Khetrapal Singh, regional director, WHO South-East Asia Region.

The government has also looked at the scientific perceptive for elimination of the disease. The Indian Council of Medical Research (ICMR) in April 2019 launched the Malaria Elimination Research Alliance (MERA)- India. MERA-India is a conglomeration of partners working on malaria control. The principal activity of the Alliance is to prioritize, plan, conduct, scale up and translate relevant research in a coordinated and combinatorial way in order to have a tangible impact of this research on the population at risk for malaria

Despite a progress, challenges remain before the government. According to WHO, keeping track of the malaria burden has proven to be difficult, as private doctors don’t report their cases to the government database. As the number of cases has dropped, so have the funds needed to track down each case and to ensure it is properly treated. Two human malaria parasites, Plasmodim vivax and Plasmodim falciparum are predominant in the country. In most of hilly and tribal high burden areas P. falciparum is predominantly present with limited P. malaria cases.

A study titled –Malaria elimination in India –the way forward– published in latest issue of Journal of Vector Borne Disease done by ICMR, has highlighted that though India is in malaria elimination mode, and set targets for malaria-free status by 2030, diagnosis and treatment of asymptomatic falciparum malaria cases continues to be a challenge for health care providers.

“To overcome these hurdles innovative solutions along with the existing tools and strategies involving vector control, mass drug administration, disease surveillance hold the key to solve this gigantic health problem. Asymptomatic cases carrying falciparum parasites in most endemic areas are potential source of transmission even in non-endemic areas especially among migratory labour force. Malaria infections in pregnant women are the real cause of concern to build confidence in the communities during the elimination process,” the study said.

“A Socio-Economic-Political-Cultural (SEPC) analysis will fasten the malaria elimination initiative. Social acceptance and political commitment on such programme will accelerate the elimination process. Proper financial provisions must be ensured so that there should not be any hurdle during the implementation phase. Additional support from philanthropic organizations, corporate houses, as part of the Corporate Social Responsibility would be an added advantage,” the study said. – Livemint