Two malaria deaths were confirmed in Delhi on September 5, the day the World Health Organization (WHO) certified neighbouring Sri Lanka free of the mosquito-borne disease. Sri Lanka is the second country in the region after Maldives to be free of the parasitic virus, which has infected 471,083 people and killed 119 till July-end in India.
The states of Odisha, Chhattisgarh and Jharkhand account for close to half of the cases of malaria, transmitted to humans through the bite of infected female anopheles mosquitoes. Symptoms include fever, headache, chills and vomiting, which may cause severe disease and death if left untreated. It’s not that India hasn’t tried to fight malaria. In February, India launched the National Framework for Malaria Eradication with a target to stop transmission by 2027 and certified “malaria free” in 2030 by the WHO.
Going by the infection trends and India’s old-school strategies aimed at destroying adult mosquitoes and larvae, the target seems unachievable. Though malaria cases in India almost halved from 2.03 million in 2001 to 1.13 million in 2015, and confirmed deaths fell from 1,005 in 2001 to 287 in the same period, cases have been hovering around one million over the past five years (see box).
What India needs to do is think out-of the-box like Sri Lanka, which used live web-based surveillance to track, test and treat all suspected cases. In the early 1990s, a major shift was the change from vector control (mosquito control) to parasite control strategy to contain infection.
“Using mobile malaria clinics in high transmission areas gave prompt and effective treatment that reduced the parasite reservoir and the possibility of further transmission,” said Dr Poonam Khetrapal Singh, regional director, WHO South East Asia Region.
What’s equally worrying is the ever widening spread of other mosquito-borne diseases like dengue and chikungunya. Till the end of August, India confirmed more than 12,000 chikungunya cases and close to 28,000 dengue cases and 60 deaths.
An outbreak in K ar nat aka led to as pike inc hi kunguny ac as e sin 2015 after a steady decline since 2010, but what’ s changed is its widening geographical spread. A decade ago, few people in north India had heard of dengue and chi kun gun ya, which mostly caused infections in southern and eastern states. Over the past decade, both infections have crossed several state boundaries to sicken hundredsof people. Chikunguniya cases, for example, rose from 6 in 2012 to 560 till September 3 this year.
Apart from fever and bone-breaking pain, what both these diseases have in common is that they are all under-reported across states. Close to one lakh dengue cases were reported in India in 2015, just a fraction of the actual number of infections, reported scientists from the Johns Hopkins Bloomberg School of Public Health.
Blood samples taken from more than one thousand people across 50 Chennai neighbourhoods revealed that nearly everyone tested had been exposed to dengue virus and 44% to chikungunya.
Yet, almost no one reported having been infected, either because they had very mild disease that could have been dismissed as seasonal flu or because they did not get a diagnostic test done. “Where India fails is in providing consistent and quality public healthcare delivery system across states. Low visibility of primary healthcare services needs to their neglect by politicians as well as medical professionals,” said DR Srinath Reddy, president, Public Health Foundation of India.
Missed diagnosis is the biggest concern about Zika, the newest mosquito-borne threat at India’s doorstep. With infections being reported in Singapore, Thailand, Philippines and Malaysia, where it has been confirmed in a pregnant woman, India’s ports are on high alert for travellers with infection.
Spread by the same mosquito that spreads dengue and chikungunya, Zika doesn’t cause symptoms in 80% people and causes mild fever, rash, conjunctivitis, fatigue and joint pain for two days to a week in others.
Pregnant women with the infection, however, risk having babies with microcephaly, a condition in which babies are born with abnormally small heads and brains.
“With 26 million babies born in India every year and most infected people not developing symptoms, the potential of disability is great for lakhs of unborn babies. This makes it vital for all pregnant women to be screened for Zika in countries with local transmission,” said Khetrapal Singh.
Complicating containment in India is a blame-game played out by the Centre, state governments, health department and civic authorities during each outbreak; public accusations of mismanagement is followed by cleanliness drives to destroy the breeding grounds of mosquitoes, but all work stops when infection ends during the cold and dry winter months that bring down mosquito breeding.
“Health responses have to be integrated and backed with an efficient public health delivery system and evidence based strategies to prevent and control diseases and improve people’s quality of lives,” added Khetrapal Singh.