Drug Resistance: Malaria

Anti-malarial drug resistance is a major public health problem which hinders the control of malaria. In India resistance of Plasmodium falciparum to chloroquine, the cheapest and the most used drug was first reported in the year 1973 from Diphu of Karbi-Anglong district in Assam state. The Dte. of National Vector Borne Diseases Control Programme has been monitoring the response of antimalarial drug in Pf malaria parasite in the country since 1978 through 13 monitoring teams located in 11 Regional Office for Health & Family Welfares with the following objectives:

  • To assess the therapeutic response of P.falciparum to currently used anti-malarials in order to establish and generate information on sensitivity of local strains for formulation of National Drug Policy and recommend needful changes in the control strategy including treatment policy to contain resistant P.falciparum foci.
Tools for monitoring

Till 2002 drug sensitivity status in the country was assessed following conventional WHO In-vivo protocol. From 2002-03 onward, new WHO protocol on "Therapeutic efficacy of anti-malarial drugs in uncomplicated P.falciparum malaria" is being followed to assess the efficacy of antimalarial drugs. The classification of response according to new protocol is interpreted into three categories as per the WHO criteria i.e Adequate Clinical and Parasitological Response (ACPR), Early Treatment Failure (ETF) and Late Treatment Failure (LTF).

Criteria for change of drug policy

Drug policy is changed for the area/Block PHC reporting 10% or more total treatment failure (ETF+LTF) to the tested drug i.e the currently used antimalarials in a sample of minimum 30 P.falciparum test cases. To combat the drug resistant in malaria, the National Drug Policy on Malaria recommends the use of combination therapy i.e Artesunate plus Sulfadoxine Pyrimethamine for treatment of P.falcipuram cases in chloroquine resistant areas, surrounding cluster of Blocks and 117 high endemic districts of 7 North Eastern States and state of Andhra Pradesh, Chhatisgarh, Jharkhand, Madhya Pradesh & Orissa.

Status of drug resistance in India

List of areas showing high treatment failure to chloroquine is given in Annexure-1 and depicted in Map below. At present ACT (AS+SP) combination is being implemented in 117 districts (i.e 50 high endemic districts of States namely Andhra Pradesh, Chhatisgarh, Jharkhand, Madhya Pradesh & Orissa + 67 in North Eastern States), in addition to 253 PHCs of 46 districts included on the basis of chloroquine resistance status and its surrounding cluster of Blocks. List of areas identified for use of ACT combination as per drug policy enclosed at Annexure-2.

Chloroquine Resistant Areas (1978-2008 updated to August)

National Vector Borne Disease Control Programme, 22, Shamnath Marg, Delhi - 110054.