London: India ranked fourth in the global incidence of the deadly mosquito-borne disease malaria in 2017, with four per cent of the cases worldwide reported in the country, according to a report published in The Lancet journal. Of the 219 million cases of malaria reported globally in 2017, nearly 10 million were from India, making it the fourth most affected by the disease – only behind the African countries Nigeria, Democratic Republic of Congo, and Mozambique, the report said.
The report was compiled by more than 40 experts including malariologists, biomedical scientists, economists, and health policy experts, assimilating existing evidence with new epidemiological and financial analyses.
The authors used new modelling techniques and estimated how prevalent and intense malaria could be in 2030 and 2050. Their analyses indicated that socioeconomic and environmental trends, together with improved coverage of current malaria interventions, will “lead to low levels of malaria that persist in pockets across roughly ten countries in equatorial Africa in 2050.”
However, according to the report, India, eastern Indonesia, and Papua New Guinea would struggle to eliminate malaria by 2030 based on current trajectories. The study noted that regional support, such as peer country technical assistance, should be increasingly focused on these countries. The authors of the study noted a peculiar case of malaria in India where in 2017, 71 per cent of the cases in the state of Tamil Nadu occurred in the capital city, Chennai with a population of seven million people.
The reason for high urban incidence in India is due to the main malaria vector being Anopheles stephensi which is particularly suited for Indian urban environments, the report noted. These urban landscapes provide ideal breeding habitats with water storage containers, wells, gutters, and construction sites, the report said.
The authors emphasise the need for unique strategies and interventions beyond those typically deployed in rural settings for eliminating malaria transmission in urban settings. Improving municipal water supply infrastructure and reducing the need for rooftop water storage are priority interventions needed in India, according to the report.
As the world becomes more urban, with more than 50 per cent of some countries expected to become urban by 2050, the potential also exists for urban malaria to increase depending on the Anopheles vectors present in the regions, and their ability to survive in changing urban environments.
One of the hurdles for India, according to the report, is the lack of assistance for health expenditure, forcing people to spend money out of their pockets – costs that are not reimbursed by the government or other agencies.
“In some countries, such as India, this source (out-of-pocket spending) represents 60 per cent or more of all healthcare financing. Out-of-pocket spending on this scale is undesirable, forcing families to forego necessary care and causing medical impoverishment,” the report noted.
According to a 2017 report by the World Health Organization (WHO), out-of-pocket spending should not be more than 20 per cent of total health expenditure. The report recommends driving down out-of-pocket spending, and reallocating these funds to prepaid social health insurance schemes – which is a major goal for universal health coverage (UHC) in all countries.
The Lancet report also cautions that for successful elimination of Malaria in India, there should be “oversight and stewardship of both formal and informal private health-care providers.”
According to the authors of the study, poor oversight of private health-care providers causes a substantial proportion of malaria cases to be “poorly diagnosed, inappropriately treated, and unreported.”