Strong partnerships and funds have resulted in the progress against malaria in the past 15 years. In India, tremendous success has been achieved under the Millennium Development Goals. Malaria cases and deaths have gone down by 60% in India as well in other parts of the world. The idea now is to sustain this reduction and move towards complete elimination of malaria, just like smallpox or polio.

India had 1,102,205 confirmed malaria cases in 2014 as against 8,81,730 in 2013 despite efforts at war footing. The reported deaths have gone down from 754 in 2011 to 561 in 2014.

Malaria is a major health public problem especially in South-East Asian and African countries. Malaria is caused by a type of microscopic parasite known as Plasmodium that is transmitted by a specific species of mosquitoes. Four Plasmodium species cause malaria in humans. These include Plasmodium falciparum, P. vivax, P. ovale, P. malariae.

The Plasmodium parasite is spread by the bite of an infected female Anopheles mosquito. Malaria symptoms include fever along with chills and sweating, severe fatigue, vomiting and headaches. The most common antimalarial drugs include artemisinin combination therapy, chloroquine, quinine sulfate, hydroxychloroquine, mefloquine.

Statistics and Facts About Malaria

• Every year around 300-500 million cases of malaria are reported globally and more than 1 million people die annually; a majority of them are young children.
• According to 2015 statistics, around 214 million cases are diagnosed globally and 438,000 malaria deaths were reported.
• From this, about 90% of deaths occurred in Sub-Saharan Africa region (majority of them were children under the age five).
• In India, in 2014, 1.1 million cases of malaria were detected of which, 0.72 million cases were of the deadly P. Falciparum. 561 deaths were reported due to malaria and many went unreported.
• Malaria is dangerous for pregnant women as the parasite can pass into the mother's womb and infect the fetus as well.
• Although malaria can be a deadly illness, malaria deaths can usually be prevented.

Government Approaches in Control of Malaria and its Spread in India

The Health Minister launched the National Framework for Malaria Elimination (NFME) 2016-2030, which outlines India's strategy to eliminate malaria by 2030. This program defines key strategic approaches such as:

• Program phasing owing to the varying endemicity in the country
• Classification of States/UTs based on API (Annual Parasite Incidence. API = (confirmed cases during 1 year/population under surveillance) x 1000) as primary criterion
• District as the unit of planning and implementation
• Focus on high endemicity areas
• Special strategy for Plasmodium vivax elimination

The Objectives of the NFME are to

• Eliminate the mosquito-borne disease from all low and moderate endemic states/UTs (26) by 2022
• Reduce incidence of malaria to less than 1/1000 population in all States/UTs and the districts and malaria elimination in 31 states/UTs by 2024
• Interrupt indigenous malaria transmission in all States/ UTs (Category 3) by 2027
• Prevent re-establishment of local malaria transmission in areas where it is already eliminated and to achieve a malaria-free status of the country by 2030

By the end of this year, all states will have the Malaria Elimination Planning Framework implemented. By the end of 2017, all states should have cut down the API to under 1 per 1000 population. It is expected that by 2020, 15 states that are under the Category 1 of the malaria elimination program will have zero cases and malaria deaths. India is to achieve an API>1 at state as well as district level by the end of 2017.

Latest Research Update on Malaria Vaccine

Under clinical trials, over 20 subunit vaccine constructs are currently being evaluated or are already in the advanced preclinical development phase. One of them is:

The malaria vaccine candidate RTS,S/AS01 is the foremost vaccine candidate against the deadly Plasmodium falciparum parasite. A Phase III trial began in May 2009 with enrollment in 2011 of 15,460 children in the 7 countries in sub-Saharan Africa. The final results were published last year in April.

Health Tips for Prevention of Malaria

For prevention of malaria, following steps should be taken:

• Take appropriate anti-malarial medicines. The choice of anti-malarial drugs will be based on your past medical history, age and other current medications.
• Avert mosquito bites by sleeping under insecticide-treated or simple mosquito nets.
• Always be covered to avoid mosquito bites - wear socks, long pants, long-sleeved shirts and blouses.
• Spray mosquito repellents and apply repellent lotions on exposed skin.
• Ensure doors and windows are shut tight and screened with gauze or mesh to prevent mosquitoes from entering.
• Pregnant women and small children must avoid traveling to malaria-endemic areas.
• It is necessary to check with your family doctor or a travel clinic for anti-malarial medicines for the country you are traveling to. Malaria treatment is challenging as malaria parasites have grown increasingly drug-resistant.

References:

1. P Melmane, S Shetty, D Gulati. A study of drug resistance in malaria. JIACM 2014; 15(1): 9-12
2. Promoting Rational Use of Drugs and Correct Case Management in Basic Health Services Published by UNICEF's Programme Division in cooperation with the World Health Organization.
3. Press Information Bureau Government of India Ministry of Health and Family Welfare 11-February-2016 15:47 IST
4. Fact sheet: The RTS,S malaria vaccine candidate (MosquirixTM). GSK, July 2015
5. http://www.worldmalariaday.org/about/key-facts

Source: Medindia