Malaria Site: Malaria In India

Malaria has been a problem in India for centuries. Details of this disease can be found even in the ancient Indian medical literature like the 'Charaka Samhita'. In the 30's there was no aspect of life in the country that was not affected by malaria. The economic loss due to the loss of man-days due to malaria was estimated to be at Rs. 10,000 million per year in 1935. The annual incidence of malaria was estimated at around 75 million cases in 1953 with about 8 lakhs deaths annually. To combat this menace, the Govt. of India launched the National Malaria Control Programme in April 1953. The programme proved highly successful and within five years the incidence dropped to 2 million. Encouraged by this, the programme was changed to a more ambitious National Malaria Eradication Programme in 1958.By 1961 the incidence dropped to a mere 50,00 cases a year. But since then the programme suffered repeated set-backs due to technical, operational and administrative reasons and the cases started rising again. Malaria has now staged a dramatic comeback in India after its near eradication in the early and mid sixties.

The estimated economic loss due to malaria in India from 1990-1993 is $506.82 million to $630.82 million (Sharma, 1996c). India has spent up to 25% of its health budget on malaria control from 1977-1997, and starting in 1997, India planned to spend $40 million on malaria control, a 60% increase from the previous year. This expenditure is part of a five year program aimed to target 100 districts where 80% of all P. falciparum cases occur (Jayaraman, 1997). 70-80% of the malaria control money in India is spent on insecticides (Dhingra et al., 1998).

See http://www.brown.edu/Research/EnvStudies_Theses/full9900/creid/malaria_in_india.htm

Year	Total cases	P. falciparum	Deaths
1947	75 million	?	8,00,000
1961	49151	?	--
1965	99667	?	--
1976	6.47 million	0.75 million	59
1984	2.18 million	0.65 million	247
1985	1.86 million	0.54 million	213
1986	1.79 million	0.64 million	323
1987	1.66 million	0.62 million	188
1988	1.85 million	0.68 million	209
1989	2.05 million	0.76 million	268
1990	2.02 million	0.75 million	353
1991	2.12 million	0.92 million	421
1992	2.13 million	0.88 million	422
1993	2.21 million	0.85 million	354
1994	2.51 million	0.99 million	1122
1995	2.93 million	1.14 million	1151
1996	3.04 million	1.18 million	1010
1997	2.57 million	0.99 million	874
1998	2.09 million	0.91 million	648
2002	1.84 million	0.87 million	973
2003	1.86 million	0.85 million	1006
2004	1.91 million	0.89 million	949
2005	1.81 million	0.80 million	963
2006	1.78 million	0.84 million	1707
2007	1.5 million	0.74 million	1311
2008	1.52 million	0.75 million	935
2009 (April)	0.27 million	0.16 million	130
See NVBDCP Data

Early set backs in malaria eradication coincided with DDT shortages. Later in the 1960s and 1970s malaria resurgence was the result of technical, financial and operational problems. In the late 1960s malaria cases in urban areas started to multiply, and upsurge of malaria was widespread. As a result in 1976, 6.45 million cases were recorded by the National Malaria Eradication Programme (NMEP), highest since resurgence. The implementation of urban malaria scheme (UMS) in 1971-72 and the modified plan of operation (MPO) in 1977 improved the malaria situation for 5-6 years. Malaria cases were reduced to about 2 million. The impact was mainly on vivax malaria. Easy availability of drugs under the MPO prevented deaths due to malaria and reduced morbidity, a peculiar feature of malaria during the resurgence. The Plasmodium falciparum containment programme (PfCP) launched in 1977 to contain the spread of falciparum malaria reduced falciparum malaria in the areas where the containment programme was operated but its general spread could not be contained. P. falciparum showed a steady upward trend during the 1970s and thereafter. Rising trend of malaria was facilitated by developments in various sectors to improve the national economy under successive 5 year plans. Malaria at one time a rural disease, diversified under the pressure of developments into various ecotypes. These ecotypes have been identified as forest malaria, urban malaria, rural malaria, industrial malaria, border malaria and migration malaria; the latter cutting across boundaries of various epidemiological types. Further, malaria in the 1990s has returned with new features not witnessed during the pre-eradication days. These are the vector resistance to insecticide(s); pronounced exophilic vector behaviour; extensive vector breeding grounds created principally by the water resource development projects, urbanization and industrialization; change in parasite formula in favour of P. falciparum; resistance in P. falciparum to chloroquine and other anti-malarial drugs; and human resistance to chemical control of vectors. Malaria control has become a complex enterprise, and its management requires decentralization and approaches based on local transmission involving multi-sectoral action and community participation.
(Re-emergence of malaria in India. Sharma VP; Indian J Med Res 1996 Jan 103 26-45).

Realising the difficulties in controlling/eradicating malaria, the National Malaria Eradication Programme has been now renamed as National Anti Malaria Programme. (See National Vector Borne Disease Control Programme Website)

During this period of resurgence of malaria, certain states of the Union of India like Uttar Pradesh, Bihar, Karnataka, Orissa, Rajasthan, Madhya Pradesh and Pondichery are found to be worst affected, particularly with increasing incidence of P. falciparum infection. The statistics from the state of Karnataka, to which my city Mangalore belongs, are given below:

It has been observed that the incidence of malaria increases with the onset of the monsoon (June to October), when the water logging helps mosquito breeding and thus transmission of the disease.

Annual Distribution of Malaria Incidence in Karnataka and Dakshina Kannada for the year 1998

1998	Jan	Feb	Mar	Apr	May	Jun	Jul	Aug	Sep	Oct	Nov	Dec
Karnataka	8112	7360	8915	8495	9775	10077	10684	11067	13395	12296	11056	7456
Dakshina Kannada	772	587	569	434	493	658	874	1081	974	898	851	643

Malaria in Dakshina Kannada District:Dakshina Kannada district is located on the western coast of Karnataka State. It was relatively free from malaria until early 1990 with only sporadic case reports. But since 1990, with a sudden spurt in industrialisation and construction activities, malaria has made a dramatic comeback here. The table below gives the details of the incidence as per the data available with the District Malaria Officer. The data is based on the study of only peripheral smears examined at the district laboratory and the primary health centres and it is generally a gross understatement. (QBC Technique is not accepted by the National Malaria Eradication Programme for diagnosis of malaria and hence data from private labs is not included).

Year	Population	Slides examined	Total Positive	P. vivax	P. falciparum
1991	2582500	287171	340	334	6
1992	2638100	298658	992	968	24
1993	2690600	325512	4588	4584	24
1994	2746700	315493	4744	4723	21
1995	2772800	358312	9221	7527	1694
1996	2792600	418110	12481	10732	1749
1997	2834500	369120	10057	9068	989
1998*	1675300	255506	8834	8149	685
1999	1716982	214487	4438	4143	295
2000		221479	2653	2531	122
2001		266661	4441	3992	449
2002		282905	5069	4195	874
2003		325690	6344	5274	1070
2004		290947	11691	8661	3030
2005		328862	16154	11327	4827

* In 1998 the district was bifurcated into Dakshina Kannada and Udupi districts, hence the numbers

Most of these cases in Dakshina Kannada have occurred in the city of Mangalore, its head quarters.