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India ranked 4th globally in malaria - Lancet report

·       Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable. 


     According to the States Lancet Journal report published on September 9, 2019, India ranked 4th in the global incidence of the deadly mosquito-borne diseases malaria in 2017.

     219 million cases of malaria reported globally in 2017, nearly 10 million were from India, making the fourth most affected by the disease – only behind the African countries Nigeria, Democratic Republic of Congo, and Mozambique.

    According to the team of 40 experts including malariologist biomedical scientists, economists, and health policy experts, found existing evidence with epidemiological and financial analyses.

     Over 100 countries had already eliminated malaria. However, the risk of resurgence and reestablishment run high in many of them. Of the factors could be the exponential growth in the international movement of people.

    The fact that India has the fourth-highest number of malaria cases could also become a cause of worry to some of these countries precisely because of this reason. The exponential growth in the international, movement of people including from endemic countries such as India and Indonesia to countries that have eliminated the disease such as Sri Lanka and Malaysia, creates a situation of unique jeopardy.

    According to the report, many low-income countries that achieved elimination with support from non-profit The Global Fund to Fight AIDS, TB and Malaria were unlikely to be able to sustain the surveillance and response system necessary to prevent re-establishment without external assistance.

     In 2017 report by the World Health Organization (WHO), out-of-pocket spending should not be more than 20 percent 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.

     Why India has high cases than in other countries?

    According to the authors of the study noted a peculiar case of malaria in India wherein 2017, 71% 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 India. Urban environment. These urban landscaped provide ideal breeding habitats with water storage containers, wells, gutters, and construction sites.

    One of the hurdles for India 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 many countries, such as India, this sources (out of pocket spending) represent 60% or more of all health care financing out of pocket spending in this scale is undesirable, forcing families to forego necessary care and causing medical impoverishment, the report stated.

The estimated number of malaria deaths stood at 435 000 in 2017.

·       The WHO African Region carries a disproportionately high share of the global malaria burden. In 2017, the region was home to 92% of malaria cases and 93% of malaria deaths.
·       Total funding for malaria control and elimination reached an estimated US$ 3.1 billion in 2017. Contributions from governments of endemic countries amounted to US$ 900 million, representing 28% of total funding.
Source- WHO


The World Health Organization (WHO) states that, in 2016, there were an estimated 216 million cases of Malaria in 91 countries.  And killed 445,000 of them. Most malaria deaths killed babies and young children.

In the U.S, the centers for disease control and Prevention (CDC) report 1,700 cases of malaria annually. Most cases of malaria develop in people who travel to countries where malaria is more common.
It is evident that Malaria is a life-threatening disease.

What is Malaria?

Malaria is a disease caused by a parasite, transmitted by the bite of infected mosquitoes. 

It’s typically transmitted through the bite of an infected Anopheles mosquito. Infected mosquitoes carry the Plasmodium parasite. When this mosquito bites, the parasite is released into the bloodstream.
Once the parasites are inside the body, they travel to the liver, where they mature. After several days, the mature parasites enter the bloodstream and begin infecting red blood cells.
Within 48 to 72 hours, the parasites inside the red blood cells multiply causing to burst open.

Symptoms of Malaria

The parasites continue to infect red blood cells, resulting in symptoms that occur in cycles that last two to three days at a time.
Malaria infection is generally characterized by recurrent attacks with the following signs and symptoms:
1.       Moderate to severe shaking chills
2.      High fever
3.      Sweating
Other signs and symptoms may include:
1.       Headache
2.      Vomiting
3.      Diarrhea

Where does Malaria Spread?

Malaria is typically found in tropical and subtropical climates where the parasites can live.  The six highest-burden countries in the WHO African region (in order of estimated number of cases) are Nigeria, the Democratic Republic of the Congo, United Republic of Tanzania, Uganda, Mozambique, and Cote d'Ivoire. These six countries account for an estimated 103 million (or 47%) of malaria cases.

Types of malaria mosquitos

There are four kinds of malaria parasites that can infect humans:
1. Plasmodium vivax
2. p. ovale
3. p. malariae
4. p. falciparum

Note – p falciparum causes a more severe form of the disease and those who contact this form of malaria have been a higher risk of death. An infected mother can also pass the disease to her baby at birth. This is known as congenital malaria.
Malaria can also be transmitted through:
- An organ transplants
- A transfusion
- Use of shared needles or syringes.

First Vaccination to Treat Malaria

The World Health Organization has announced in April 2019 that 360,000 children in a year in three African countries will receive the world's first malaria vaccine as part of a large-scale pilot project.
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Malawi has started vaccinating children under 2 years of age on 23rd April 2019. The country is the first of three in Africa in which the vaccine, known as RTS, S will be made available to children up to 2 years of age; Ghana and Kenya will introduce the vaccine.
The vaccine offers partial protection from the disease, with clinical trials finding that it prevented approximately 4 in 10 malaria cases according to WHO.
It is a World Health Organization-coordinated three-country pilot program where the risk of malaria is high.

 It’s to vaccinate 360,000 children and give them partial protection against disease. children will be vaccinated on time with 4 required doses.

The money for funding the vaccination

The program is financed by the collaboration of three key global health funding bodies; Gavi (a public-private partnership Global vaccine alliance, Global Fund to fight AIDS, Tuberculosis and Malaria, and United (global health initiative that works with partners to end world's tuberculosis, HIV/AIDS, malaria and hepatitis C epidemics) Also, WHO, PATH and GSK will provide in-kind contribution.

The vaccine, RTS, S, also known as Mosquirix - It was created by a scientist at the British Drugmaker GlaxoSmithKline (GSK) in partnership with the Path malaria vaccine.

Has Malaria increased?

According to WHO, there was a 62% reduction in malaria deaths and 41% reduction in the number of cases, from 2000 to 2015, However, more recent data suggests that malaria is making a comeback, with 219 million in 2017, compared with 217 million in 2016.
It's a difficult disease to deal with.

The tools we have are modestly effective, but drugs and insecticides wear out; after 10, 20 years, mosquitoes become resistant.

There's a real concern that in 2020s cases are going to jump back up again - said by a professor of human genetics Adrian hill.

What step India has Taken to Eradicate Malaria

The Indian Council of Medical Research launched Malaria Elimination Research Alliance (MERA), With the aim of eliminating Malaria from India by 2030. it is a collective group of partners working on malaria control. It was launched on occasion of World Malaria Day 2019.

MERA India

It seeks to facilitate trans-institutional coordination and collaboration around a shared research agenda, which response to programmatic challenges, addresses gaps in available tools, and proactively contributes to targeted research.

It complements and not duplicates international efforts to eliminate Malaria on a national scale and simultaneously contributing to broader global agenda. It aims to prioritize, plan and scale up coordinated research to have an impact on population facing malaria risk and to eliminate malaria from India by 2030.
It holds importance for the Ministry of Health and Family Welfare because of operational research.

India and Malaria

Declining Trend: Malaria burden has declined in India by over 80% from 2.03 million cases in 2000 to 0.39 million in 2018, and Deaths caused by malaria also declined by over 90% from 932 deaths in 2000 to 85 in 2018.

This success of India in malaria control cases provided the foundation for leadership commitment towards eliminating malaria from India by 2030.

The WHO report also appreciated India's research for the decline in malaria. India's 'The National Vector Borne Diseases Control Program (NVBDCP), developed a comprehensive framework to achieve the overarching vision of "Malaria free India by 2030". NVBDCP's National Strategic plan recognized the critical role of research to support and guide malaria elimination efforts.

Malaria detection test kit by IIT researchers

IIT Guwahati researchers had developed a simple detection method that an instrument when in the lab or a piece of chromatographic paper when in the field.

The kit can be used to detect - Plasmodium parasite, which causes malaria and also specifically detect plasmodium falciparum, a notorious species.

How exactly the instrument works?
By using an ordinary syringe fitted with a small magnet, magnetic needs and few chemicals inside, the researchers were able to specifically capture the antigen released by the parasites in the blood of malaria patients.

working process
As the blood has many interfering agents, they used magnetic bead-ththered aptamers (two small DNA molecules), Which capture only the specific antigens and separate these from the blood serum to perform the reaction. The magnetic beads help in the holding aptamers.

When the captured antigens interact with specific substrates inside the syringe, the blue dye turns pink. The dye is then absorbed over a modified chromatographic paper. 

The formation of pink color on the paper is a direct indication of the presence of parasites in blood serum. The intensity of the color increase when the concentration of antigen is high.

This kit also has stability in hot and humid conditions. When mass-produced, the kit can be cheaper than the existing rapid detection test kit available in the market.

Genetic Engineering experiments to wipe out the malaria

London Reuter's scientists have succeeded in wiping out a population of caged mosquitoes in laboratory experiments using a type of genetic engineering known as a Gene Drive, which spread a modification blocking female reproduction.
A report published in the journal nature biotechnology, says scientists managed to eliminate the population in less than 11 generations, the technique in future could be used to control the spread of malaria, a parasitic disease carried by Anopheles gambiae mosquitoes.
The results mark the first time this technology has been able to completely suppress a population. The hope is that in future, mosquitoes carrying a gene drive could be released spreading female infertility within local malaria-carrying mosquito population and causing them to collapse.

Gene Drive Technology

Gene drive technologies alter DNA and drive self-sustaining genetic changes through multiple generations by overriding normal biological processes.

The technologies can be very powerful, but they are also controversial since such genetically engineered organisms released into the environment could have an unknown and irreversible impact on the ecosystem.

The technology used in this study was designed to target the specific mosquito species Anopheles gambiae that is responsible for malaria transmission in sub-Saharan Africa.
The World Health Organization has warned that global progress against malaria is stalling and could be reversed if momentum in the fight to wipe out was lost.

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Scientists stated the results showed the gene drive solution can work, offering hope in the fight against a disease that has plagued mankind for centuries., however, there is still more work to be done in both terms of testing the technology in larger lab-based and working for affected countries.

     What can be the solutions to eliminate malaria from India?

    Experts say there is a need for unique strategies and interventions beyond those typically deployed in rural settings for eliminating malaria transmission in an urban setting.
     Improving municipal water supply infrastructure, and reducing the need for rooftop water storage and priority interventions needed in India.
    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. As the poor oversight of private health care providers causes a substantial proportion of malaria cases to be poorly diagnosed, inappropriately treated, and unreported


Malaria is one the most dangerous life-threating infection, therefore to solve the malaria crises scientists should focus on the least risky and most effective solutions, not experiment with ecosystems with little regard for the potentially new environmental and health consequences.

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