On September 5th, the World Health Organisation certified island-nation Sri Lanka as malaria-free after a long battle against the life-threatening disease. Whereas, India, almost 50 times in area compared to Sri Lanka, is still grappling with the disease as one to two million malaria cases are reported in the country every year, though numbers are under-reported. Many cases and deaths, especially in remote, tribal locations and disturbed areas do not get reported and in many cases the cause of death is also not clearly assigned.
The story was not always bad like this. In fact, in 1960s, India was pretty close to not only eliminate malaria, but eradicate it. The main weapon to deal with malaria at that time was the DDT spray, a powerful insecticide against the Anopheles mosquito, the main carrier or the host for malaria parasite. But in 1970s, the cases of malaria start increasing. "This happened due to a bit of complacency which led to some laxity in the programme. Plus, by then even DDT resistance may have developed," feels Dr Sowmya Swaminathan, director general of Indian Council of Medical Research (ICMR). But, she sees some improvement in the situation as some states like Punjab are looking poised to get to a stage of eliminating malaria, however, there are still regions where problems exist.
In fact, malaria has become a complex problem today with a rise in number of drug resistance cases and its inter linkages with the patterns of human habitation and health. Malaria cases are surfacing in areas where population is more prone to hunger and undernourishment.
"The most-affected areas in India are in the central belt - Madhya Pradesh, Chhattisgarh, Jharkhand and North East - but today we have good tools. We have good treatment for malaria, we have good diagnosis system and we are looking at vector control through means other than medicines in the form of supply of bed nets," says Dr Neena Valecha, scientist and director, National Institute of Malaria Research of the Indian Council of Medical Research. She feels with good implementation, proper supply chain, quick diagnosis and patients care, the goal to be malaria- free by 2030 should be attained.
So, are we on the track to eliminate the disease? Dr. Valecha says: "we have reached the community-level diagnosis and treatment, which is to be strengthened further. Also, in keeping with the commitment made to eliminate malaria by 2030, the government has prepared a national framework for malaria elimination that was launched in February this year. Along with that each state has been asked to give its plan of action (since it is a state subject though the elimination programme is being driven at the central level)." Further, she said there are other initiatives at work. For instance, she said, "we are also researching on early case management in Odisha (which has a relatively high annual parasite incidence for malaria - number of cases per thousand population in a year)."
She added that even the treatment policy is being revised, something which was successfully done in the North East in 2013 and now government plans to take this to the rest of the country. Talking about the key challenges Dr. Valecha said, "the key is to maintain a good supply chain and implementation of all the vector control strategies." This means a management of whole chain from attending the patient to diagnosis, treatment through rapid diagnostic kits and medicines and reaching them in time and in good supply. This could prove be a challenge in conflict prone regions or places that get cut off during heavy rains or monsoons. For prevention, she advised spraying of insecticide called 'Indoor Residual Spray' and use of bed nets. Experts feel that elimination of malaria is going to be a challenge for India considering the major issues it still has to deal with. But Sri Lanka presents a good example of how to do it. Although Sri Lanka is a small nation in terms of size and in complexity of the disease as compared to India, but what stands out in Sri Lanka's case is that it could achieve the target despite having conflict zones in the country. India can also take a leaf out of its efforts from elimination of polio. But then, polio had a vaccine, which malaria does not have.
(API: Annual parasite incidence: number of cases per thousand population in a year)
SOURCE: NVBDCP (National Vector Borne Disease Control Programme)