Yesterday, Sri Lanka was officially declared Malaria free by WHO. It is a great achievement for our Island neighbor, being only the second country in the tropics to achieve this distinction. Maldives was declared Malaria free some time ago.
Sri Lanka has been working with WHO for a while, implementing the recommendations, for the last 10 years. They have been no known cases of local transmission of malaria for the last three and a half years. In Sri Lanka’s case the campaign targeted not only the mosquitoes (Females species of the anopheles) but also the malarial parasite, belonging to Plasmodium genum.
There are 100 species of Plasmodium that cause diseases in man, birds, animals and reptiles, but only 5 of them are known to infect man. These are Plasmodium Vivax, Plasmodium Falciparum, Plasmodium Ovale, Plasmodium Malariae and Plasmodium Knowlesi.
According to the WHO “Sri Lanka’s achievement is truly remarkable. The change in strategy was unorthodox, but highly effective. Mobile malaria clinics in high-transmission areas meant that prompt and effective treatment could reduce the parasite reservoir and the possibility of further transmission.” (Source: WHO)
While I congratulate our neighbors I am curious as to where are we on malaria eradication. As I researched the topic, I came across the NATIONAL FRAMEWORK FOR MALARIA ELIMINATION IN INDIA (2016–2030). This is a document drawn up along with WHO and three government bodies in India, DIRECTORATE OF NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP), DIRECTORATE GENERAL OF HEALTH SERVICES (DGHS) and MINISTRY OF HEALTH & FAMILY WELFARE GOVERNMENT OF INDIA.
The key elements of this framework include
Eliminate malaria nationally and contribute to improved health, quality of life and alleviation of poverty.
In line with the WHO Global Technical Strategy for Malaria 2016–2030 (GTS) and the Asia Pacific Leaders Malaria Alliance Malaria Elimination Roadmap, the goals of the National Framework for Malaria Elimination in India 2016–2030 are:.
• Eliminate malaria (zero indigenous cases) throughout the entire country by 2030; and
• Maintain malaria–free status in areas where malaria transmission has been interrupted and prevent re-introduction of malaria.
The Framework has four objectives:
• Eliminate malaria from all 26 low (Category 1) and moderate (Category 2) transmission states/union territories (UTs) by 2022;
• Reduce the incidence of malaria to less than 1 case per 1000 population per year in all states and UTs and their districts by 2024;
• Interrupt indigenous transmission of malaria throughout the entire country, including all high transmission states and union territories (UTs) (Category 3) by 2027; and
• Prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain national malaria-free status by 2030 and beyond.
So clearly there is going to be no quick win in this aspect, and though we have been battling malaria since the 1950’s through policy, the real progress has been made in the last 20 years. Since 2000, we have more than halved the number of malaria cases, down from 2 million to 882 000 in 2013. The worst hit areas in India is the North-East which is home to 20 % of India’s population but is responsible for more than 80 % of the cases. Lack of awareness, poor medical facilities, regional conflict, poor nutrition and lack of access are the key reasons for these poor numbers. So tackling malaria is more of handling the North-East socio-economically. While Dengue and Chikungunia continue to torment the national capital, it is malaria that makes us look really bad as a nation.
According to Dr A C Dhariwal, Director of India’s National Vector Borne Disease Control Programme. “Through rapid diagnostic tests, artemisinin-based combination therapy, long lasting insecticidal nets and indoor residual spraying, we’ve been able to bring down the rates of malaria and reduce the number of deaths.” (Source: WHO)
Malaria eradication has four phases- control, pre-elimination, elimination and prevention of reintroduction. India is moving from control to pre-elimination. Almost 74% of the 650 districts in India re moving towards an annual parasite incidence (API) of less than 1 per 1000. India to its credit has been working on the WHO plans. They have introduced more than 900,000 accredited social health activists, in villages of population of more than 1000. These activists are working with the local communities, raising awareness and ensuring that there is rapid identification and diagnosis of cases.
Having said all this, Sri Lanka has a population of 20 Million, slightly more than Bangalore and its suburbs. So thought they deserve credit for this, to replicate this model in India would be slightly complicated. Also while most of the resources are being consumed by the Hindi heartland, and the south and the west of the country set them selves to compete with the western world, is there anyone who cares enough for the north east to help them battle, control and eliminate malaria ? I dont think so, but we would know by 2030 it we met those goals.
Do write back to me with perspectives and thoughts on this topic ?