Malaria in India

India has been historically endemic for both Plasmodium vivax and Plasmodium falciparum malaria and has history of successes and resurgences. India makes up over 75% of the total number of malaria cases in . In 2016 over half of India's population (698 million) was at risk of contracting malaria according to the World Malaria Report, which also reported India accounting for 6% of the world's malaria cases, 6% of deaths caused by the disease, and 51% of the global Plasmodium vivax malaria cases. In 2017, India was placed 46th with a malaria death rate of 1.97 per 100,000 individuals.

Vectors 

Nine Anopheline vectors are able to transmit malaria in a range of geo-ecological areas throughout the country. Three Plasmodial species are involved: Plasmodium falciparum, P. vivax, and P. malariae. The main vector of malaria in rural areas, Anopheles culicifacies, is distributed widely. The primary urban vector is Anopheles stephensi, while Anopheles fluviatilis is a vector throughout the hills and foothills. Anopheles minimus, Anopheles nivipes, Anopheles philippinensis, and Anopheles dirus are vectors throughout northeast areas. Anopheles sundaicus is only found in the Car Nicobar and Andaman islands. Anopheles annularis and Anopheles varuna are widely distributed secondary vectors.

Epidemiology 

Malaria has been controlled throughout many areas of the country. The epidemiology of the disease in India is a complex problem resulting from the geo-ecological diversity of the country, the multi-ethnicity of the population, and widely distributed transmitting vectors. 
The high endemic areas make up to 80% of cases of the disease in the country. Around 95% of the country's population live are areas where malaria is endemic, 80% of malaria occurs among 20% of those classified as ‘high-risk populations’, who reside in Andhra Pradesh, Chhatisgarh, Gujarat, Jharkhand, Madhya Pradesh, Maharashtra, Orissa, and Rajasthan – the seven north-eastern states – and Sikkim. The state of Orissa, although constituing only 4% of India's population, produces the proportion of malaria cases at 22%; 43% of total Plasmodium falciparum cases and around 50% of deaths attributed to malaria in the country. At a national level, about two million cases of the disease resulting in around 1,000 deaths occur each year, although estimates by the South East Asia Regional Office of the World Health Organisation put the figures at 15 million cases causing 20,000 deaths. India contributes over 75% of the total malaria cases throughout South East Asia. When India became independent in 1947, 75 million malaria cases were estimated in a population of 330 million. A great achievement would be witnessed during the late 1950s and early 1960s, as a result of eradication efforts reducing malaria cases to just 100,000 in 1964. A reversal would be experienced and by 1976, malaria cases reached the 6.4 million mark. A further rise in Plasmodium falciparum was reported, and has slowly risen to nearly 50% in recent years.

Healthcare and control programs 

State governments implemented a number of control and eradication programs following a set of national policies. Technical and operational guidelines are provided by the National Vector Borne Disease Control Program (NVBDCP) to the state governments and shared half of the costs of the programs. Analyses show that for every Indian rupee invested by in National Malaria Control Program pays a dividend of 19.7 rupees in savings.

In April 1953, the Government of India commenced the National Malaria Control Program, which proved highly successful and significantly reduced the total number of malaria cases to around 2 million by 1958. An even larger National Malaria Eradication Program commenced operating in 1958. In 1961 a total 49,151 cases were reported, with no deaths. However, a malaria resurgence was experienced in the 1960s and 1970s. Malaria cases in urban areas increases in the late 1960s, and a widespread upsurge of the disease rose. In 1976, 6.45 million incidences were documented by the National Malaria Eradication Program), the highest since resurgence. In 1971-72 an urban malaria scheme (UMS) was commenced and a modified plan of operation (MPO) followed in 1977, improving the malaria situation for 5-6 years, providing easy availability of drugs, reducing morbidity and preventing deaths. A reduction to about 2 million cases was achieved. The impact was mainly on Plasmodium vivax malaria. In 1977 the Plasmodium falciparum containment program (PfCP) launched  helping reduce falciparum malaria. However, the general spread of this parasite was not reduced. P. falciparum incidences slowly increased through the 1970s and thereafter. 
The Enhanced Malaria Control Project (EMCP) was launched in April 1997 and implemented in 181 districts across India, with the financial assistance of the World Bank. It consisted in five components: early diagnosis and prompt treatment, selective vector control, insecticide-treated bed nets, epidemic response and inter-sectoral collaboration, and institutional strengthening. This program directly benefited the tribal population of eight peninsular states covering 100 districts and 19 urban areas, as well as the population living in other malaria endemic areas. In 2003, it expanded to cover 200 tribal blocks, and added two states, Karnataka and West Bengal. India reported 3 million fewer cases in 2017 compared with 2016, a 24% decrease, being a unique case reporting progress in reducing its malaria cases in the period. As compared to 2017, India reported 2.6 million fewer cases in 2018.

See also 

 Malaria and the Caribbean

References 

Category:Disease-related deaths in India
Category:Malaria
Category:Diseases and disorders in India