Come summer and the rains, the terror unleashed by mosquitoes gets into full gear. Most disease-carrying mosquitoes breed in stagnant fresh water, and so it is important that preventive action such as anti-larval measures need to be undertaken regularly during the rainy season inorder to check the onslaught of mosquito-borne diseases, particularly the dreaded malaria – a dangerous and often difficult to manage disease caused by tiny parasite called ‘Plasmodium’. The disease can be caused by five different species of Plasmodium, the most deadly being Plasmodium Falciparum. The other three species are: P. Vivax, P. Malariae and P. Ovale that generally do not cause life-threatening disease. A fifth species, P. Knowlesi, causes malaria in monkeys but also infect humans. Malaria infects around 700 million people and killing more than a million each year worldwide, mainly in the wet tropical regions of the world such as Asia, Africa, Central and South America, where the disease is mostly endemic as people are brutally exposed to compromised health conditions. 

It was in August 1867, that Dr Ronald Ross (Nobel prize winner for Physiology or Medicine in the year 1902) a renowned British army surgeon, began dissecting mosquitoes that fed on malarious patients. On August 20, while dissecting a mosquito, he found many cells on the stomach wall of the bug and concluded that these were the malaria parasite stages in the mosquito. This research was quite significant because until then, no one had any idea of how parasites in the blood of malarious patients were transmitted via mosquitoes. Hence, August 20, is designated as the ‘World Mosquito Day’.

India, with the highest malaria burden outside Africa, needs an investment of US$ billion to achieve its 2030 deadline to eliminate the disease, say an estimate drawn up by the Union Health Ministry (UHM) along with the World Health Organization (WHO) funders, and malaria advocacy groups that had met in Chennai in December last year to consider strategies to shrink the global malaria map and took stock of India’s anti-malaria efforts. The need for more finance had arisen due to severe malaria outbreaks in India, aggravated by poor sanitation and inadequate drainage system, underlining an urgent and growing need for financial commitment to deal with a menace estimated to inflict nearly US$ 2 billion or Rs 13,520 crore in socio-economic losses annually. It was pointed out at the meet that the scale of the challenge can be judged by the fact that India accounts for over 70 per cent of malaria cases in WHO – classified Southeast Asia region, which includes countries like Bangladesh, Nepal, Indonesia, Sri Lanka and Thailand among others. 

The World Malaria report 2016, however, revealed that India contributed 89 per cent of the incidence of malaria in the Southeast Asia region. As per the provisional epidemiological report 2016, there were over one lakh positive cases in India’s 36 states and UTs, which caused 331 deaths. The Indian record stands in sharp contrast to some of its neighbours – the Maldives was certified malaria-free in 2015, and Sri Lanka followed last year. The Union Health Ministry has now announced its vision for riding the country of malaria by 2027, and of eliminating the disease by 2030. The ambitious National Strategic Plan for Malaria Elimination (2017-22) – a year-wise roadmap launched in mid-July this year, is based on last year’s National Framework for Malaria Elimination, which was, in turn, spurred by WHO’s Global Technical Strategy for Malaria, 2016-2030. To be declared malaria-free, a country has to report zero incidence for at least three years.

The National Strategic Plan for Malaria Elimination (NSPME) divides the country into four categories, from 0 to 3. Zero, the first category, has 75 districts that have not reported any cases of malaria for the last three years. Category 1 has 448 districts, in which the annual parasite incidence (API or the number of positive slides for the parasite in a year) is less than one per 1000 population. In Category 2, which has 48 districts, the API is one and above, but less than two per 1000 population. Category 3 has 107 districts, reporting an API of two and above per 1000 population. 

The plan is to eliminate malaria (zero indigenous cases) by 2022 in all Category 1 and 2 districts. The remaining districts are to be brought under a pre-elimination and elimination programme. The NSPME also aims to maintain a malaria-free status for areas where transmission has been interrupted. It seeks to achieve universal case detection and treatment services in endemic districts to ensure 100 per cent diagnosis of all suspected cases, and full treatment of all confirmed cases.

The plan has four components, based on WHO recommendations: diagnosis and case management; surveillance and epidemic response; prevention – integrated vector management; ‘cross-cutting’ interventions, which include advocacy, communication, research and development, and other initiatives. There are 660 reporting districts, which, along with another 18 reporting units, make up a total of 678 reporting units. The NSPME is a detailed strategy with operational guidelines for Programme Officers of all States and UTs towards set targets. Besides, it has given a detailed breakdown of annual budgetary requirements over five years (2017-22).

One of the biggest challenges the NSPME is likely to face, is the shortage of manpower. According to the Union Health Ministry, there are only about 40,000 multipurpose Health Workers (MPHWs) against the approximately 80000 sanctioned posts in the 1,50,000 sub centers in the country. Other problems include access to conflict-affected tribal areas, and to areas with a high malaria endemicity and insecticide resistance. High endemicity states include those in the NE, which share borders with neighboring countries like Bangla and Mayanmar, where the prevalence of malaria is considerably high.

(The writer is a freelance journalist).