New Delhi: April 25 is globally recognised as World Malaria Day, an international observance commemorated every year for the global efforts to control cases of Malaria. This year’s theme, “Time to Deliver Zero Malaria: Invest, Innovate, Implement,” calls for raising awareness about the need to implement the available tools and strategies to control and eventually eradicate the disease.
In 2021, an estimated 619,000 people globally died of Malaria, compared to 625,000 in 2020, according to the World Health Organization (WHO). There were an estimated 245 million new cases of Malaria in 2020, compared to 247 million in 2019.
According to WHO Regional Director for South-East Asia, Dr. Poonam Khetrapal Singh, the South-East Asia Region was the only WHO region to achieve a 40 per cent reduction in Malaria case incidence and mortality by the end of 2020 as compared to 2015.
To know about India’s status in preventing and treating the chronic disease, the NDTV-Dettol Banega Swasth India team spoke to Dr. Neeraj Dhingra, Former Director, National Vector Borne Disease Control Programme (NVBDCP), and Member, WHO Strategic and Technical Advisory Group on Neglected Tropical Diseases (NTDs).
Dr. Dhingra said that India has made tremendous progress in mitigating malaria in the last decade, ever since the WHO gave a clarion call for the disease’s elimination in 2015. He said that India was one of the few countries to initiate action after the WHO’s direction. The country developed the National Framework for Malaria Elimination (NFME) in 2016, through an extensive consultative process. Its framework was implemented by the Directorate of the National Vector Borne Disease. Control Programme (NVBDCP) of the Ministry of Health and Family Welfare on February 11, 2016.
India immediately drafted the broad policies by means of launching a national framework for Malaria elimination, which gave India long-term goals for eradicating the disease. This was immediately followed by a strategic plan that ; district wise actions that needed to be taken. The best part about India is that the country worked on differential approaches based on Malaria endemicity in various parts of the country. This was crucial as some parts of the country were at higher risk compared to others, so every district and area required a different approach.
Dr. Dhingra said that India has reported a in Malaria deaths as of 2020.
Talking about the kinds of strategies that have helped India contain the disease, Dr. Dhingra said that they have varied from testing to treatment.
The first thing is early detection and treatment. So if the person has a fever, they must be tested immediately, and the test is a rapid diagnostic or microscopic. If found positive, the patient is provided with treatment based on the parasite he/she has been infected with.
There are four kinds of malaria parasites infecting humans: Plasmodium falciparum, P. vivax, P. ovale, and P. malariae. Two of them, Plasmodium falciparum, P. vivax, are more prevalent in India. In the case of falciparum, the treatment is for three days. For vivax, the treatment is needed for 14 days, Dr. Dhingra said.
Another strategy looks at the control of the vectors. Dr. Dhingra explained,
When we say vectors, we mean the mosquitoes that are transmitting malaria and need to be taken care of. These are controlled by conventional means, such as indoor residual spray (IRS). As its name implies, IRS involves coating the walls and other surfaces of a house with a residual insecticide. For several months, the insecticide will kill mosquitoes and other insects that come in contact with these surfaces.
In recent years, India has also introduced long-lasting insecticide nets (LLINs), which are given free of charge by the government and must also be used. Dr. Dhingra said,
These nets contain a WHO recommended insecticide, and the insecticide effect lasts longer, and the nets can be used for up to three years or 20 washes. When the mosquito comes into contact with them, it immediately dies. These nets were given to the people living in the high-risk areas.
Other strategies include surveillance, and the main purpose of surveillance is to detect changes in trends or distribution in malaria in order to initiate investigative or control measures.
Dr. Dhingra also highlighted the importance of the toolkit provided under the government’s ‘Swachh Bharat Abhiyan’, to safely manage greywater and achieve reductions in the breeding of mosquitoes and exposure to other water-borne and water-washed diseases.
Speaking about the parts of the body that are affected due to malaria, Dr. Paparao Nadakuduru, Sr. Consultant Physician & HOD – Internal Medicine, Citizens Specialty Hospital, Hyderabad, said,
Malaria leads to widespread organ damage due to impaired microcirculation and anaemia among others. In falciparum malaria, the red cells containing schizonts adhere to the lining of the small microcirculation of the brain, kidneys, gut, liver and other organs. This causes the mechanical obstruction of the small vessels causing obstruction to blood circulation and multiple organ damage. At the same time, the schizonts rupture and release toxins and stimulate cytokine release that also damages the organ. Anaemia can be caused because the malarial parasite goes into the red blood cells and ruptures the cells, causing hemolysis. It also affects the bone marrows, production of red blood cells and much more.
Dr. Nadakuduru also detailed the treatments available for malaria. He said that the treatments are provided according to the severity of the diseases. In non endemic areas, where uncomplicated falciparum and vivas malaria occurs, a patient can be treated with Chloroquine. This medication is primarily used to prevent and treat malaria in areas where malaria remains sensitive to its effects. This should be followed by a radical treatment for two to three weeks of complete eradication of the disease, he added. Adding to this, Dr. Dhingra said that the treatment for falcipuram is primarily for three days, where for vivax the treatment needs to continue to about 14 days.
For higher endemic areas, Dr. Nadakuduru said that the patient can be provided with Primaquine. It is a medication used to treat and prevent malaria and to treat Pneumocystis pneumonia. The dosage of the medicine is varies according to different age groups.
These are the two medicines primarily given for the treatment of malaria, coupled with early detetction of the symptoms and continuing the treatment as per the severity.
Dr. Dhingra pointed out the role of climatic conditions in the spread of Malaria and the challenges they pose.
The influence of climate on Malaria transmission depends on daily temperature variation. In India, malaria is not reported in the high regions. The cases are primarily reported from the peninsular regions or Northeastern states. Change in the temperatures, especially in the peninsular areas, can possibly lead to a rise in Malaria cases. The increase in temperature leads to the reduction of the winter season, which further gives rise to the transmission of the disease.
Detailing the prevent measures individuals can take to avoid contracting Malaria, Dr. Nadakuduru suggested the use of bed and window nets and insecticides for the walls of the house and other surfaces. This will help kill mosquitoes. Using mosquito repellents when outdoors can also be a huge help, he added.
We need to understand that the repellents do not protect a person from the disease but helps the plausibility of contracting it and other diseases.
Dr. Nadakuduru said that wearing clothes that cover most of the body can also help in the preventing the disease, especially in higher endemic areas. He advised people to consult a specialist as soon as one notices he or she is developing high fever, chills, nausea and weakness.
Dr. Dhingra also underlined the significance of hygiene and sanitation in building a Malaria-free India.
Hygiene and sanitation conditions are associated with the risk of Malaria among children under five years and pregnant women. Several studies have stated hygiene and sanitation as the most frequently mentioned methods for preventing Malaria. Hence, it becomes all the more important to focus on these two aspects.
Given hygiene and sanitation has been the main areas of focus for Reckitt, the company announced a new ‘Mission Zero Malaria’ initiative on World Malaria Day. Reckitt’s well-known household insecticide brand, Mortein launched ‘Mission Zero Malaria’ with support from the Government of Uttar Pradesh in Bareilly. Aligned with the India’s goal to eliminate Malaria by 2030, Mission Zero Malaria has been launched with Malaria No More, as an implementation partner and aims to enhance health awareness and inspire adoption of desired behavior change within the community, health system, and government bodies of the region.
Talking about the initiative, Ravi Bhatnagar, Director-External Affairs and Partnerships, Reckitt- South Asia said,
We are more than thrilled to take steps towards achieving ambitious goal of eliminating Malaria through our partnership with Malaria No More. This partnership will focus on targeted interventions by using advanced data management and analytics to better understand the distribution and prevalence of the diseases. This information would be used to inform targeted interventions in areas that are most affected by the disease. This partnership will support India’s journey towards holistic health and well being while leveraging advanced technologies to curb centuries old menace of Malaria towards health
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.