MALARIA
 
MAGNITUDE OF THE PROBLEM

Malaria is a public health problem in several parts of the country. About 95% population in the country resides in malaria endemic areas and 80% of malaria reported in the country is confined to areas consisting 20% of population residing in tribal, hilly, difficult and inaccessible areas. Directorate of National Vector Borne Disease Control Programme (NVBDCP) has framed technical guidelines/ policies and provides most of the resources for the programme. Indicators have been developed at national level for monitoring of the programme and there is uniformity in collection, compilation and onward submissions of data. Passive surveillance of malaria is carried out by PHCs, Malaria Clinics, CHCs and other secondary and tertiary level health institutions that patients visit for treatment. Apart from that, ASHA- a village volunteer is involved in the programme to provide diagnostic and treatment services at the village level as a part of introduction of intervention like Rapid Diagnostic Tests and use of Artemisinin Combination Therapy (ACT) for the treatment of Pf cases.

The countrywide malaria situation as reflected in surveillance data from 1995-2014 is given in the following Table: 1.

Table 1: Countrywide Epidemiological Situation (1995 2014*)

Year Population (in ‘000) Total Malaria Cases (million) P.falciparum cases (million) Pf % API Deaths due to malaria
1995 888143 2.93 1.14 38.84 3.29 1151
1996 872906 3.04 1.18 38.86 3.48 1010
1997 884719 2.66 1.01 37.87 3.01 879
1998 910884 2.22 1.03 46.35 2.44 664
1999 948656 2.28 1.14 49.96 2.41 1048
2000 970275 2.03 1.05 51.54 2.09 932
2001 984579 2.09 1.01 48.20 2.12 1005
2002 1013942 1.84 0.90 48.74 1.82 973
2003 1027157 1.87 0.86 45.85 1.82 1006
2004 1040939 1.92 0.89 46.47 1.84 949
2005 1082882 1.82 0.81 44.32 1.68 963
2006 1072713 1.79 0.84 47.08 1.66 1707
2007 1087582 1.51 0.74 49.11 1.39 1311
2008 1119624 1.53 0.77 50.81 1.36 1055
2009 1150113 1.56 0.84 53.72 1.36 1144
2010 1167360 1.60 0.83 52.12 1.37 1018
2011 1194901 1.31 0.67 50.74 1.10 754
2012 1211580 1.06 0.53 49.98 0.88 519
2013 1221640 0.88 0.46 52.61 0.72 440
2014* 1234995 1.10 0.72 65.55 0.89 561
* Provisional
The case load, though steady around 2 million cases annually in the late nineties, has shown a declining trend since 2002. When interpreting API, it is important to evaluate the level of surveillance activity indicated by the annual blood examination rate. At low levels of surveillance, the Slide Positivity Rate (SPR) may be a better indicator. The SPR (not shown in table) has also shown gradual decline from 3.50 in 1995 to 0.89 in 2014. The reported Pf cases declined from 1.14 million in 1995 to 0.72 million cases in 2014. However, the Pf % has gradually increased from 39% in 1995 to 65% in 2014.

Number of reported deaths has been levelling around 1000 per year. The mortality peak in 2006 was related to severe malaria epidemics affecting Assam caused by population movements.


Country Scenario of Epidemiological Indicators for Malaria

The data in following Table 2 shows that Annual Parasite Incidence (API) rate has consistently come down from 2.12 per thousand in 2001 to 0.89 per thousand in 2014 but confirmed deaths due to malaria have been fluctuating during this period between 1707 and 561. The table below shows the information on indicators by which malaria prevention/ control activity in India are monitored and evaluated. Slide Positivity Rate (SPR) and Slide falciparum Rate (SfR) have reduced over the years 2001-2014. It is also observed that ABER has remained within 9.95% to 8.69 % during the period 2001 to 2013 and reached 10.05 in 2014.

Table 2: Epidemiological Indicators for Malaria in India (2001-14*)

Year Population in thousand Blood Smear Examined Positive cases Pf Cases ABER API SPR SFR Deaths
2001 984579 90,389,019 2,085,484 1,005,236 9.18 2.12 2.31 1.11 1005
2002 1013942 91,617,725 1,841,229 897,446 9.04 1.82 2.01 0.98 973
2003 1027157 99,136,143 1,869,403 857,101 9.65 1.82 1.89 0.86 1006
2004 1040939 97,111,526 1,915,363 890,152 9.33 1.84 1.97 0.92 949
2005 1082882 104,143,806 1,816,569 805,077 9.62 1.68 1.74 0.77 963
2006 1072713 106,725,851 1,785,129 840,360 9.95 1.66 1.67 0.79 1707
2007 1087582 94,928,090 1,508,927 741,076 8.73 1.39 1.59 0.78 1311
2008 1119624 97,316,158 1,526,210 775,523 8.69 1.36 1.57 0.80 1055
2009 1150113 103396076 1563,574 839,877 8.99 1.36 1.51 0.81 1144
2010 1167360 106040223 1495817 779549 9.21 1.37 1.41 0.74 1018
2011 1194901 109313294 1310656 665004 9.12 1.10 1.20 0.61 754
2012 1211580 109048884 1067824 533695 9.00 0.88 0.98 0.49 519
2013 1221640 113445106 881730 463846 9.26 0.72 0.78 0.41 440
2014* 1234995 124066331 1102205 722546 10.05 0.89 0.89 0.58 561
BSE : Blood Smear Examined *Prov.
ABER : Annual Blood Smear Examination Rate (percentage of blood smears examined in a year of total population)

Fig 1: Trend of Malaria Cases And Deaths 2001-2014*
malaria cases trend
Fig 1 shows that the cases have consistently declined from 2.08 million to 1.10 million during 2001 to 2014. Similarly Pf cases have declined from 1.0 to 0.72 million cases during the same period. Less than 2000 deaths were reported during all the years within this period with a peak in 2006 when an epidemic was reported in NE States. The country SPR has declined from 2.31 to 0.89 and SFR has declined from 1.11 in 2001 to 0.58 in 2014. This indicates declining overall endemicity of malaria in the country.