The World Malaria Report (WMR) 2020 released by WHO, which gives the estimated cases for malaria across the world, based on mathematical projections, indicates that India has made considerable progress in reducing its malaria burden.

Highlights

    • Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.

    • In 2019, there were an estimated 229 million cases of malaria worldwide compared to 228 million cases in 2018.

    • The estimated number of malaria deaths stood at 409 000 in 2019, compared with 411 000 deaths in 2018.

    • Children aged under 5 years are the most vulnerable group affected by malaria; in 2019, they accounted for 67% (274 000) of all malaria deaths worldwide.

    • The WHO African Region continues to carry a disproportionately high share of the global malaria burden. In 2019, the region was home to 94% of all malaria cases and deaths.

    • In 2019, 6 countries accounted for approximately half of all malaria deaths worldwide: Nigeria (23%), the Democratic Republic of the Congo (11%), United Republic of Tanzania (5%), Burkina Faso (4%), Mozambique (4%) and Niger (4% each).

    • Total funding for malaria control and elimination reached an estimated US$ 3 billion in 2019. Contributions from governments of endemic countries amounted to US$ 900 million, representing 31% of total funding.

    • A period of unprecedented success in malaria control that saw 1.5 billion cases and 7.6 million deaths averted.

Scenario in India

    • India is the only high endemic country which has reported a decline of 17.6% in 2019 as compared to 2018.

    • The Annual Parasitic Incidence (API) reduced by 27.6% in 2018 compared to 2017 and by 18.4% in 2019 as compared to 2018. India has sustained API less than one since year 2012.

    • India has also contributed to the largest drop in cases region-wide, from approximately 20 million to about 6 million. The percentage drop in the malaria cases was 71.8% and deaths was 73.9% between 2000 to 2019.

    • India achieved a reduction of 83.34% in malaria morbidity and 92% in malaria mortality between the year 2000 (20,31,790 cases, 932 deaths) and 2019 (3,38,494 cases, 77 deaths), thereby achieving Goal 6 of the Millennium Development Goals (50-75% decrease in case incidence between 2000 and 2019).

    • The cases and fatalities have declined significantly by 21.27% and 20% in the year 2019 (3,38,494 cases, 77 deaths) as compared to 2018 (4,29,928 cases, 96 deaths).

    • The total number of malaria cases reported in 2020, till October, (1,57,284) has further decreased by 45.02 percent as compared to corresponding period of 2019 (2,86,091).

    • Malaria Elimination efforts were initiated in the country in 2015 and were intensified after the launch of National Framework for Malaria Elimination (NFME) in 2016 by the Ministry of Health and Family Welfare and National Strategic Plan for Malaria Elimination (2017-22) launched in July, 2017.

    • States of Odisha, Chhattisgarh, Jharkhand, Meghalaya and Madhya Pradesh disproportionately accounted for nearly 45.47 percent (1,53,909 cases out of India’s 3,38,494 cases) of malaria cases and 70.54 percent (1,10,708 cases out of India’s 1,56,940 cases) of falciparum Malaria cases in 2019. 63.64% (49 out of 77) of malaria deaths were also reported from these states.

    • Due to the efforts made by the Government of India in provision of microscopes, rapid diagnostics Long Lasting Insecticidal Nets (LLINs) – about 5 crores have been distributed in 7 North-East States, Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha up to 2018-19 and another 2.25 crore LLINs are being supplied/distributed during current financial year.

    • Use of LLINs has been accepted by the community at large and has been one of the main contributors to the drastic malaria decline in the country.

    • WHO has initiated the High Burden to High Impact (HBHI) initiative in 11 high malaria burden countries, including India. Implementation of “High Burden to High Impact (HBHI)” initiative has been started in four states i.e. West Bengal and Jharkhand, Chhattisgarh and Madhya Pradesh in July, 2019. 

    • A key strategy to reignite progress is the “High burden to high impact” (HBHI) response, catalyzed in 2018 by WHO and the RBM Partnership to End Malaria continued to make impressive gains in India, with 18% reductions in cases and 20% reductions in death respectively, over the last 2 years.

About Malaria

    • Malaria is caused by Plasmodium parasites. The parasites are spread to people through the bites of infected female Anopheles mosquitoes, called "malaria vectors." 

    • There are 5 parasite species that cause malaria in humans, and 2 of these species – P. falciparum and P. vivax – pose the greatest threat.

    • In 2018, P. falciparum accounted for 99.7% of estimated malaria cases in the WHO African Region 50% of cases in the WHO South-East Asia Region, 71% of cases in the Eastern Mediterranean and 65% in the Western Pacific.

    • Malaria is an acute febrile illness and in a non-immune individual, symptoms usually appear 10–15 days after the infective mosquito bite.

    • The first symptoms – fever, headache, and chills – may be mild and difficult to recognize as malaria.

    • Children with severe malaria frequently develop one or more of the following symptoms: severe anaemia, respiratory distress in relation to metabolic acidosis, or cerebral malaria. In adults, multi-organ failure is also frequent.

    • Vector control is the main way to prevent and reduce malaria transmission.

    • Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying – are effective in a wide range of circumstances.

    • Antimalarial medicines can also be used to prevent malaria such as sulfadoxine-pyrimethamine.

    • Protecting the efficacy of antimalarial medicines is critical to malaria control and elimination. Regular monitoring of drug efficacy is needed to inform treatment policies in malaria-endemic countries, and to ensure early detection of, and response to, drug resistance.

    • Malaria elimination is defined as the interruption of local transmission of a specified malaria parasite species in a defined geographical area as a result of deliberate activities.

    • Countries that have achieved at least 3 consecutive years of 0 indigenous cases of malaria are eligible to apply for the WHO certification of malaria elimination.

    • The WHO Global technical strategy for malaria 2016-2030 – adopted by the World Health Assembly in May 2015 which includes global targets as:

        ◦ reducing malaria case incidence by at least 90% by 2030;

        ◦ reducing malaria mortality rates by at least 90% by 2030;

        ◦ eliminating malaria in at least 35 countries by 2030;

        ◦ preventing a resurgence of malaria in all countries that are malaria-free.

(The author is a trainer for Civil Services aspirants. The views expressed here are personal.)