Zakir and his three-year-old daughter, residents of Bibipur, a village with 500 odd households in Nuh, were ill for most of last summer. Both had severely high fever due to malaria. This year, his 10-month-old son contracted the life-threatening disease a second time. According to Zakir, his son first got malaria when he was around five months old. Bibipur is less than a kilometre away from Ujina village that suffers from nearly half of Haryana’s malaria burden every year. In 2018, of 3,149 cases of malaria reported in the state, 1,968 cases were from Nuh district and 1,187 cases were reported in Ujina itself. In 2017, 5,696 cases of malaria were reported in Haryana, with 3,643 cases in Nuh district, of which Ujina alone reported 2,468. Most of these cases are reported in children below the age of 13, according to officials. This year, 65 cases have been reported in Nuh — well before the rains have arrived — and 55 of them were reported in Ujina. “Almost every family in this village and adjacent ones has had at least one person infected by the malaria mosquito in the last three to four years,” said Farrukh, Zakir’s brother, adding that his two daughters — three- and five-years-old — recently fell prey to the disease, but recovered fully. Malaria is considered closely linked to climatic phenomena like rainfall, temperature and humidity. In many places, transmission is seasonal, with the peaks during and just after the rainy season. The female anopheles mosquitoes lay their eggs in water, which hatch into larvae, eventually emerging as adult mosquitoes. Female anopheles mosquitoes pick up the parasite from infected people when they bite to obtain blood needed to nurture their eggs. The mosquitoes breed in small, shallow collections of still water, such as puddles, open drains and waterlogged areas — all abundant during the monsoon.However, in Ujina, malaria isn’t spurred only by the rainy season, but remains prevalent throughout the year, said health workers.The Ujina drain, a major conduit which flows from Faridabad to Punhana in Nuh, is a prime reason for the high incidence of malaria in the region. Around 22 villages in the area, including Ujina and Bibipur, are situated adjacent to the drain which is squalid throughout the year, and perpetually contaminated with faeces. According to Dayanand Kumar, health inspector at the primary healthcare centre (PHC) in Ujina, the region’s soil has a high clay content and low permeability, which leads to heavy waterlogging. “Water from the drains and nearby ponds overflows, creating puddles of stagnant water where adult mosquitoes deposit their eggs,” Kumar said. Zakir lives with his family of five in a dimly lit house that can be traversed in barely 10 footsteps. Piped water supply in the village is a rarity, so Zakir and his brother’s family, who live next door, store water in buckets and drums in their small courtyard. Such uncovered containers of stored water and dim spaces in houses are the perfect habitat for mosquitoes to breeding. “Only around 50 houses in the village get piped water. The rest of us are forced to store water from tankers. The service costs ₹500 for 15 days of water,” Farrukh said.The cluster of villages near Ujina has a large number of man-made ponds used for fish farming, and most households in the vicinity of the village are less than 200 metres from these ponds. The water from these ponds also overflows and swamps the road throughout the year. Several studies have found a high prevalence of malaria in communities that live close to the banks of fish farms. A 2015 study conducted in the Brazilian Amazon, published in the scientific journal PlosOne, found that “vegetation floating in the water and located in the surroundings create favourable conditions for the appearance and development of anopheles mosquitoes, which lay their eggs in uncontaminated water, in the shade and in vegetation on the banks.” It said the results are valid anywhere that has a tropical climate with fish farming. The Haryana government has, in the last three years, rolled out incentives and subsidies for farmers to shift to fish rearing. According to the state fisheries department, more than 80% of village ponds in the state are under fish culture. The state had 18,975 hectares of water area under fish farming in 2017, and according to agriculture and fisheries minister Om Prakash Dhankar, fish production rose to 10,000 kilograms per hectare per year in 2017-18. In May this year, three teams of health workers — of six people each — started a new round of house-to-house surveys to identify people with malaria. Those with high fever are being tested through rapid diagnostic tests (RDTs), and those found positive are given treatment, the workers said. The treatment continues till the malaria parasite is eliminated from the body, they added. At the same time, insecticides are sprayed by another set of workers on the inside walls of houses, schools and community areas. Mosquitoes are killed or repelled by the spray, preventing the disease’s transmission.However, many residents flat-out refuse the spray treatment. “People often refuse to get their houses sprayed, saying there are no mosquitoes inside. They say the smell of the insecticide makes them sick, or it leads to rashes, and even that their newly painted walls will have stains,” health inspector Kumar said, blaming the lack of awareness in the region about the disease for the refusals.The health department in the area too is plagued by staff and equipment shortage, an impediment to malaria eradication, officials said. Dr Vimlesh Tiwari, district epidemiologist, said posts for 94 workers are sanctioned in the region; however, till July last year, they had a workforce of five. “With 45 workers currently, we are only able to focus on areas with high prevalence,” he said. While health officials said the number of cases will shoot up after the first monsoon rain, expected later this month, the number is expected to be much lower than last year’s (1,187). “Last year, by June, we had seen many more cases than the 55 this year. We have, so far, managed to keep the number of cases low due to active surveillance,” Tiwari said. However, he added, till the time people lack awareness of the disease and refuse treatment and prevention measures, cases will remain high. Dr Usha Gupta, the state health department’s director of vector-borne diseases said a lot of initiatives were taken to improve the situation in the area in 2018. “Before 2018, Nuh district had no microscopes — used to diagnose malaria. At least 19 were provided last year. The number of fogging machines with the health department was also increased by at least a dozen last year,” she said. Gupta added that insecticide-treated nets — bed-nets designed to block mosquitoes, were distributed in high-risk areas like Ujina and Bibipur. “The number of cases of malaria in the state in 2018 reduced by close to 55%. We have taken all the steps to ensure the number falls this year too. However, we will find out how effective the measures are only after the rains,” Gupta added. Nuh was the most backward district in the country, according to a 2018 Niti Aayog list, and experts and activists working in the region said the high prevalence of diseases such as malaria increase the level of poverty and social backwardness. Babita, a resident of Ujina, said when she fell sick with malaria last year, she couldn’t work for days. “All the household work was getting neglected. I couldn’t cook or clean for my family,” she said. Siddique Ahmad, historian and patron of the Mewat Vikas Sabha, said the burden of malaria extends to a family’s ability to earn. “People can’t work for days when they fall sick frequently. It leads to increased costs of food, medicines and travel to the hospital,” he said, adding that as the disease is eradicated, the region’s level of economic growth will get better by an extent.