India-Malaria Situation in SEAR Countries

Malaria Situation in SEAR Countries

India

Bangladesh

Malaria Situation

Malaria is endemic in India and active transmission has been reported from many areas. The bulk of malaria cases are found in the flood plains of northern India and coastal plains of the east and west coasts. The north-eastern region (population 28.5 million), and the forests and forest fringes on the hill ranges of peninsular India occupied by minority ethnic groups (population 71 million) are highly endemic to malaria. Orisssa, Jharkhand, Chhattisgarh, West Bengal and Madhya Pradesh are contributing more than 60% of reported (confirmed) malaria cases in India. Other highly endemic states include Arunachal Pradesh, Assam, Meghalaya and Tripura.

During pre eradication era, the estimated malaria morbidity and mortality around 75 million and 0.75 million respectively. During eradication era, programme achieved tremendous success till 1965. But after early success, programme began to face difficulties. This resulted in deterioration of the situation with focal outbreaks necessitated reversion of many areas from consolidation phase to attack phase. The ABER who reached its peak of 9.8% in 1964, gradually drooped to 7.65 in 1971 but again climbed up to 9% in 1978. The API rose from 0.21 per thousand in 1965 to 11.25 in 1976. This upward trend true for SPR% for these years also. The number of positive cases increased from 1.0 million to 3.2 million in 1972 to 6.56 million in 1976. Due to technical problems like vector resistance to insecticides and of parasites to drugs, the national malaria eradication programme changed its immediate objective to that of effective control.

After implementation of modified plan of operation in 1977, the ABER maintained above 9%, the number of cases came down to 2 million, SPR at 3.1% in 1984 respectively. Thereafter, except 1995-96, the same trend continued. During 1995-96, the number of reported cases gone up to 3 million and reported deaths at 2803 ( in 1996) due to epidemic (Fig.1). During the 80's the country experienced malaria outbreaks which were promptly contained by insecticide spraying but since the 90's the outbreaks are being

Fig. 1 : Malaria Cases in India, 1971-2010

Fig. 1 : Malaria Cases in India, 1971-2010

Malaria Situation in India, 2010 : At a Glance
Total population	: 1167.4 million
Population in malarious areas	: 1024.6 million
Number of Lab confirmed malaria cases	: 1.60 million
Number of probable malaria cases	: 0
Pf proportion	: %
Number of deaths due to malaria (Reported)	: 1023
# of First Line Treatment Distributed	: 1 599 986
# ACT Courses delivered	: 2.88 million
No of ITNs Distributed	: 0
# of LLINs distributed	: 2.52 million
No. of effective LLINs+ITNs (cumulative) availability	: 4.75 million
Population protected with ITNs /LLINs	: 9.5 million
Population protected with IRS million	: 53.43
Vectors: An. dirus, An. minimus, An. phihppinensis, An.culicifacies, An. stephensi, and An. Annularis Around 80% of malaria cases derived from forest related areas and along the border with Myanmar where malaria is highly endemic. Malaria is a greater problem in border areas with India No major epidemics reported in 2010. Recipient of GFTAM & World Bank support.

witnessed with increasing intensity, like the 1994 epidemic in western Rajasthan and tile 1995 outbreaks along the Indo-Bhutan border, and in Madhya Pradesh and Manipur. In 1996, Haryana and Rajasthan witnessed epidemic. Haryana was the badly affected state causing 1832 malaria deaths. Again, in 1997, Gujrat and Goa and in 1998, Bhandara district of Maharastra and Calcutta district of West Bengal witnessed the malaria out breaks. P. falciparum, which during the 60's had almost touched the zero level, it has reached to 48% of the total malaria cases in 2002 and around 50% in last 2-3 years.

In addition to rural malaria, urban malaria, which was a negligible problem at the time of launching of the programme in 1958, has emerged as an important paradigm, accounting for 14 to 15% of the total malaria cases. Regions, where large-scale irrigation has been developed, have now become regions of endemic malaria, with their mosquito-genic potential being man's contribution. DDT still be in use as cheap insecticide to control malaria. Usage of insecticide treated bednets still very limited.

In 2010, India reported around 1.60 million confirmed cases of malaria which was 21.3% lower than the 2000. But API does not changed much and reached at 1.37 during the said period. However, the reported deaths during the same period has gone up from 924 to 1023, showing an increase of 9%. The ABER is approximately 10% of the population at risk of malaria. Slide positivity rates fell from 2.34% in 2000 to 1.47% in 2010. The percentage of cases due to P.falciparum has increased and reached upto52%. 64% of reported cases derived from five states namely, Orissa, Jharkhand, Chhattisgarh, Maharashtra and West Bengal.

IRS has been the main strategy for vector control, covering about 53.4 million people at risk in 2010. Also, programme delivered 2.52 million ITNs / LLINs making availability of cumulative effective bednets to 4.75 millions covering around 9.50 million population at high risk of malaria (Fig. 2). The bednet coverage has declined significantly due to change of government policy fom ITNs to LLINs alone. sA demographic and household survey carried out in 2005–2006 reflects that 36% of households owned a mosquito net. In 2010, total,1.5 million first-line treatments courses delivered and 2.87 million ACTs were made available for treatment of Pf cases (Fig 3).

Click on the image to enlarge
Fig.2 : Cumulative Availability of Effective LUNs and ITNs in India, 2005-2010	Fig3: Trends of Distribution of ACTs and Malaria Death in India, 2005-2010

The total funding for malaria programmes from all sources has increased from US$ 54 million in 2001 to about US$ 117.05 million in 2010. This increase is primarily due to enhancement in the government funding (US$ 91.55 million or 78% of all malaria expenditure). The contributions from Global Fund and the World Bank were US$ 15.24 million and US$ 10.26 million respectively. The highest amount was spent on insecticides and spraying materials followed by planning / administration, Anti-malarials and LLINS/ITNs respectively.

Control strategy:

ACD and PCD, lab diagnosis and treatment.

Treatment in the periphery through malaria clinic, drug distribution centers.

Selective IRS with DDT and malathion in area with API > 2.0 o/oo, in urban areas: barricading, source reduction and biological control.

ACT adopted for treatment in selected areas.

Insecticide treated bednets are being used but needs to be promotion in big way.

Goals and Targets:

To reduce malaria morbidity and mortality until the disease is no longer a public health problem in the country.

Targets	Baseline data in 2005	2010	Achievement upto 2010
To reduce the morbidity by 50%of the rate in 2000 by the year 2010	2.09 / 1000	1.04/ 1000	1.37/1000
To reduce the mortality by 75%of the rate in 2000 by the year 2010	0.1/ 100000	0.05 100000	0.09/100000
% of fever cases suspected to be malaria are diagnosed either by RDTs or microscopy within 24 hours of the first contact to health services	N.A.	70	35 ( Based on Reports of LQAS Surveys done in project districts of 5 states namely Andhra Pradesh, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa )
% of malaria cases in targeted districts receive prompt and effective treatment as per national drug policy within 24 hours of first contact with the health care provider	N.A.	70	33 ( Based on Reports of LQAS Surveys done in project districts of 2 states namely Jharkhand and Orissa )
% of people sleep under effective ITNs/LLINs in target areas	N.A.	30	25 ( Based on Reports of LQAS Surveys done in project districts of 2 states namely Orissa and Chhattisgarh )
% coverage of households in targeted high risk areas with spray of effective insecticides	N.A.	80	77.16

Achievements and Initiatives

Incidence of malaria has been brought down below 2 million cases annually since 2002 and sustained near 1.5 million in recent years

12 million fever cases tested for malaria with RDT

Pf cases are treated with ACT

Procurement of LLINs initiated in the country & 2.52 million LLINs distributed in 2010

170,000 ASHAs (Community based services providers) trained on malaria diagnosis & treatment

1-2 Sentinel sites identified for assessing the burden of severe malaria and case fatality

Improved surveillance and supervision by providing additional 3500 MPWs and 300 MTS respectively

Issues and challenges:

The constraints impending the progress include insecticide resistance in A. culicifacies and A. stephensi, the major rural and urban vectors obtaining in the country, and exophily and exophagy in A. dirus, A. minimum and A. fluviatilis in the wet climatic zones.

The drug resistance of P. falciparum to chloroquine is widespread. However for SP, low to moderate level resistance is observed in north-east states, in kolar district in Karnataka, . and one district each in Madhya Pradesh and West Bengal respectively. Quinine resistance is limited to few places of North-East states only.

Problem of urban malaria is one of major hurdle for malaria control programme.

Scarcity of funds, man made malariogenic condition by various development projects, transmigration are other main problems in malaria control programme.

Difficulty in regular malaria surveillance activities due to difficult terrain conditions like hills and forests poses many problems.

Vacancy of key positions of programme in the states

Frequent shifting of various programme officers at states, zonal and country level.

Inadequacy of transports affecting supervision of operational activities.

Partners and donors

Global fund

World Bank

WHO

Other related links:

Country profile – World Malaria report 2011 [PDF 558 KB]

Malaria Situation in India, 2010 [PDF 1.7 MB]

Country profile – World Malaria report 2009