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Friday, June 18, 2010

Come back (?) of Malaria in India

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I remember a government slogan popular in my early school days that was often seen on the walls of even mud houses of rural Uttar Pradesh where my childhood was growing, many -many years ago. The slogan in Hindi was – “Machchhar rahenge Malaria nahin” and it meant in English – “Mosquitoes will live but not malaria”. Since then, as I am in the middle of my age I remember that both mosquitoes as well as malaria have been well in existence through all these years.

It appears that we somehow manage to boast of success of our programmes but in real sense we do not get success in cracking the nut properly. Certainly, the cases and recurrences have been reduced considerably in most of the health campaigns run by us - the small pox, tuberculosis, leprosy and malaria. Projects for the eradication of some more deadly diseases are still going on. In fact, the biology and biochemistry of vectors and patients reveal that these diseases are hard to be overpowered in the ever-changing environment which is largely controlled by human beings.

Various researches published from time to time indicate a heavy and more dangerous come back of diseases declared earlier as eradicated by   governments. As for malaria, there have been certain obstacles in the way of its eradication and some of these obstacles are – insecticide resistance, changes in the behavior of vectors, drug resistance in the pathogen and lack of adequate resources to fight the disease. These obstacles have been reported to be responsible for the recurrence of malaria in India. It has also been reported that casual approaches at various levels of programme execution and monitoring and lack of serious researches have been two among various other causes of this experience.

The National Malaria Eradication Programme was launched in 1958 when about 75 million cases of malaria and eight lakh deaths due to this disease were recorded. After the launch of the programme deaths due to malaria were reduced to zero while cases of the disease dropped down to just one lakh by 1965-66.

Malaria is transmitted through mosquito-injections of a single celled protozoa often called as Plasmodium falciparum into the body of a healthy person. The P.falciparum is reportedly responsible for much of the severe cases of malaria and deaths from this disease. The World Health Organization (WHO) is of the opinion that infection by P.falciparum is among the leading causes of deaths from a single infectious agent across the world.

Image: 1 Malaria is transmitted through mosquito-injections of a single celled protozoa often called as Plasmodium falciparum into the body of a healthy person.

The Union Government of India’s National Vector Borne Disease Control Programme reports that there were over 1.5 million cases of malaria out of which more than half cases were due to infection by P.falciparum causing deaths up to 1,068 in 2009. Scientists working in the field observed in 2007 that the reported incidence of malaria at the national level on the basis of surveillance carried out in primary health system at best reflected (only) a trend and not the true burden of the disease. Studies conducted through this period showed deficiencies in coverage, collection and testing of blood samples and in the reporting system. The studies indicated that the number of cases of malaria was more than recorded. It was also suspected by researchers and surveyors that deaths due to malaria were likely to be higher than reported.

The WHO estimate in 2008 reported that there had been 10.6 million cases of malaria and 15,000 deaths from this disease during 2006. Now a map based approach to estimate the global burden of P.falciparum malaria is being used by scientists from the “Malaria Atlas Project”. According to the report by scientists concerned with the approach the extent of disease caused by P.falciparum in India has been about 102 million in 2007. The Hindu in its June 17 issue reports that – in India P.falciparum infections are particularly high in forested areas inhabited by ethnic tribes in the Indian states of Orissa, Jharkhand, Madhya Pradesh and Chhattisgarh. There is also malaria caused by Plasmodium vivax which is usually less deadly than P. falciparum. Almost half of he cases of malaria in the country account for P.vivax. Scientists are of the opinion that it is essential to obtain a true picture of the burden of malaria in India as it would enable to set up priorities in planning and resource allocation for its control and gradual eradication.

Image:2 Blood smear of P. falciparum

Image:3  P. vivax

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