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. 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).
Figure 1: Epidemiological trends of Malaria in India (2000-2019) Pv; Plasmodium Vivax & pf; Plasmodium Falciparum
Decrease in incidence of Malaria cases is also exhibited in the year-on-year tally. 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. National Strategic Plan for Malaria Elimination (2017-22) was launched by the Health Ministry in July, 2017 which laid down strategies for the next five years.
Figure 2: Epidemiological situation of Malaria in India (2015 – 2019)
The first two years saw a 27.7% decline in cases and 49.5% reduction in fatalities; 11,69,261 cases and 385 deaths in 2015to 8,44,558 cases and 194 deaths in 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 to high burden areas leading to reduction in endemicity in these otherwise very high endemic states. Additional procurement of 2.52 crore LLINs is initiated.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.
Decline of API in HBHI (High Burden High Impact) Regions of India (2016-2019)
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.
Malaria has been made notifiable in 31 states/UTs (Andhra Pradesh, Arunachal Pradesh, Assam, Chhattisgarh, Goa, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Manipur, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, , Sikkim, Tamil Nadu, Telangana, Tripura Uttar Pradesh, Uttarakhand, West Bengal, Pudducherry Chandigarh, Daman & Diu, D&N Haveli and Lakshadweep) and decline has been observed in the hitherto high endemic states. Percentage of decline in the year 2019 as compared to 2018 is as follows: Odisha – 40.35%, Meghalaya- 59.10%, Jharkhand – 34.96%, Madhya Pradesh –36.50% and Chhattisgarh –23.20%.
The figures and trends between last two decades clearly show the drastic decline in malaria. The malaria elimination target of 2030 looks achievable building on the Union Government’s strategic interventions in this regard.