India unlikely to cut malaria by half in 2020: WHO

India unlikely to cut malaria by half in 2020: WHO

Context

Article talks about World Health Organization’s World Malaria Report 2017

Malaria

It is transmitted by the infective bite of Anopheles mosquito

• Incubation period: The disease has an incubation period of 10-15 days which means a person may develop symptoms after a fortnight of being bitten by an infected mosquito.
• The Plasmodium parasite that causes malaria is neither a virus nor a bacterium – it is a single-celled parasite that multiplies in red blood cells of humans as well as in the mosquito intestine. Infection by P falciparum is believed to be the most deadly
• When the female mosquito feeds on an infected person, male and female forms of the parasite are ingested along with human blood. The male and female forms of the parasite meet and mate in the mosquito’s gut, and the infective forms are passed onto another human when the mosquito feeds again

Observations

• India accounted for 6% of global malaria cases and 7% of deaths caused by it in 2016
• India is unlikely to reduce its case burden beyond 40% by 2020. In contrast, Maldives, Sri Lanka and Kyrgyzstan achieved malaria-free status in 2015 and 2016 respectively
• There were an estimated 445,000 deaths from malaria globally in 2016, compared with 446,000 estimated deaths in 2015. About 80% of the deaths were accounted for by 15 countries, namely, India and 14 countries in Sub-Saharan Africa
• Weak surveillance system: A key impediment to eliminating malaria is a weak surveillance system. India and Nigeria, two major contributors to the global burden of malaria, were able to detect only 8% and 16% of cases, respectively, via the system. Despite this, India accounts for 6 per cent of all malaria cases reported globally
• More plasmodium vivax cases: 51% of plasmodium vivax cases were traced in India. This could at least be partially explained by resistance to chloroquine, the first line treatment to p. vivax infections that has been detected in pockets of the country earlier this decade. For a long time, p falciparum dominated India’s case burden and, though its share has decreased, there is a slight increase in malaria cases by other parasites
• Reversal of decline:In 2016, 91 countries reported a total of 216 million cases of malaria, an increase of 5 million cases over the previous year. The global tally of malaria deaths reached 445 000 deaths, about the same number reported in 2015
• Investment needed:A minimum investment of $6.5 billion will be required annually by 2020 in order to meet the 2030 targets of the WHO global malaria strategy. The $2.7 billion invested in 2016 represents less than half of that amount. Of particular concern is that, since 2014, investments in malaria control have, on average, declined in many high-burden countries
• Lesser reduction in India: India — due to low funding per person at risk and resistance to certain frontline insecticides — is only expected to achieve a 20%-40% reduction

Malaria parasites

Following are the malaria parasites,

1. falciparum: It is found worldwide in tropical and subtropical areas, and especially in Africa where this species predominates. P. falciparumcan cause severe malaria because it multiples rapidly in the blood, and can thus cause severe blood loss (anemia). In addition, the infected parasites can clog small blood vessels. When this occurs in the brain, cerebral malaria results, a complication that can be fatal
2. vivax: It is found mostly in Asia, Latin America, and in some parts of Africa. Because of the population densities especially in Asia it is probably the most prevalent human malaria parasite. P. vivax(as well as P. ovale) has dormant liver stages (“hypnozoites”) that can activate and invade the blood (“relapse”) several months or years after the infecting mosquito bite
3. ovale: It is found mostly in Africa (especially West Africa) and the islands of the western Pacific. It is biologically and morphologically very similar to P. vivax. However, differently from P. vivax, it can infect individuals who are negative for the Duffy blood group, which is the case for many residents of sub-Saharan Africa. This explains the greater prevalence of P. ovale(rather than P. vivax ) in most of Africa.
4. malariae: Found worldwide, is the only human malaria parasite species that has a three-day cycle. (The three other species have a two-day cycle.) If untreated, P. malariaecauses a long-lasting, chronic infection that in some cases can last a lifetime. In some chronically infected patients P. malariae can cause serious complications such as the nephrotic syndrome
5. knowlesi: It is found throughout Southeast Asia as a natural pathogen of long-tailed and pig-tailed macaques. It has recently been shown to be a significant cause of zoonotic malaria in that region, particularly in Malaysia. P. knowlesihas a 24-hour replication cycle and so can rapidly progress from an uncomplicated to a severe infection; fatal cases have been reported.

Note:

• There are 4 species of the Plasmodiumparasite that can cause malaria in humans:  falciparum, P. vivax, P. ovale, and P. malariae.The first 2 types are the most commonAmong those infected, P. falciparum is the most common species identified (~75%) followed by P. vivax (~20%)
• Malaria can also be transmitted from mother to fetus during pregnancy

Annual Parasite Incidence (API)

API = (confirmed cases during 1 year/population under surveillance) x 1000

Malaria elimination target

As per the targets under the 12th Five Year Plan, the country is to achieve API<1 at state and district level by 2017 and pave way to malaria elimination in subsequent years

Government interventions against malaria

National Vector Borne Disease Control Programme (NVBDCP)

• It was launched in 2003-04 by merging National anti -malaria control programme,National Filaria Control Programme and Kala Azar Control programmes
• Japanese B Encephalitis, Dengue/DHF& Chikungunya have also been included in this Program
• Directorate of NAMP is the nodal agency for prevention and control of major Vector Borne Diseases

National Framework for Malaria Elimination (NFME)

India launched the National Framework for MalariaElimination (NFME) 2016-2030 in 2016, which outlines India’s strategy for elimination of the disease by 2030. This framework has been developed with a vision to eliminate malaria from the country and contribute to improved health and quality of life and alleviation of poverty

Objectives

The Framework has four objectives:

• Eliminate malaria from all 26 low (Category 1) and moderate (Category 2) transmissionstates/union territories (UTs) by 2022
• Reduce the incidence of malaria to less than 1 case per 1000 population per year in allstates and UTs and their districts by 2024
• Interrupt indigenous transmission of malaria throughout the entire country, includingall high transmission states and union territories (UTs) (Category 3) by 2027
• Prevent the re-establishment of local transmission of malaria in areas where it has beeneliminated and maintain national malaria-free status by 2030 and beyond

API: Primary criteria

API has been kept as the primary criteria for classifying states/UTs under the framework

Classification of States/UTs based on API as primary criteria

Other features of NFME

• District has been kept as the unit of planning and implementation
• Focus will be on high endemic areas
• Special strategy for P. vivax elimination

Targets under NFME

• By end of 2016, all states/UTs are expected to include malaria elimination in their broader health policies and planning framework
• By end of 2017, all states are expected to bring down API to less than 1 per thousand population
• Lastly, by the end of 2020, 15 states/UTs under category 1 (elimination phase) are expected to interrupt transmission of malaria and achieve zero indigenous cases and deaths due to malaria

National Strategic Plan for Malaria Elimination (2017-22) 

Union Minister of Health and Family Welfare launched the National Strategic Plan for Malaria Elimination (2017-22) in 2017. It gives year wise elimination targets in various parts of the country depending upon the endemicity of malaria in the next 5 years

• Strategy under NSP: The strategies involve
  • Strengthening malaria surveillance
  • Establishing a mechanism for early detection and prevention of outbreaks of malaria
  • Promoting the prevention of malaria by the use of Long Lasting Impregnated Nets (LLINs)
  • Effective indoor residual spray
  • Augmenting the manpower and capacities for effective implementation for the next five years