In terms of antiquity, malaria is as old as the hills just like some other classic killers, e.g. TB and typhoid. But the lack of a glamorous tag around this so-called poor man’s disease is standing in the way of proper diagnosis and treatment for the teeming masses in a country where showbiz cum glamour TRPs rule the roost even in basic elements of healthcare in five star hotels that hog the limelight for all the wrong reasons.
At the East Asia Summit in 2015, the Prime Minister of India committed our country to eliminating malaria by 2030. However, India faces formidable challenges in the fight against malaria. In 2017, there was an 18 per cent increase in malaria cases in Tamil Nadu, a State that has otherwise been a leader in fighting the disease. These malaria upsurges could jeopardise the successful elimination that neighbouring Sri Lanka has sustained, particularly given the frequent travel between south India and the island nation.
The true numbers of malaria cases and deaths are not known. Estimates range from 1 million to 18 million cases and from 400 to 48,000 deaths per year. Malaria exists in all States in India, and 95 per cent of Indians are at risk. Most cases are reported from Chhattisgarh, Jharkhand, Madhya Pradesh and Odisha. Arunachal Pradesh, Meghalaya, Mizoram and Tripura also have high transmission. However, the scale and distribution of this devastating disease is not well documented.
The majority of malaria in India is diagnosed and treated (or commonly misdiagnosed and mistreated) in the private sector. Private doctors and clinics have no obligation to follow government guidelines, use recommended drugs, or report malaria cases to State authorities. Malaria treatment by the private sector is especially problematic. In 2015, 86 million malaria treatments were procured in the private sector, compared to just 2 million in the public sector. In the private sector, all types of drugs are used, including those that are either ineffective or harmful.
India must declare a campaign and a determination to get the job done. National initiatives must promote innovative strategies, incentivise the appropriate use of diagnostics, drugs and insecticides, and ensure that all malaria cases are reported. The most affected States must aggressively bring their malaria down using effective vector-control and case management practices, combined with robust surveillance systems. This fight against malaria will require partnership between communities, civil society, private sector, and public health agencies.
States will have to tailor their programmes to achieve elimination, especially in tribal areas where the burden of malaria is often the highest. A single approach to malaria elimination will not work in any large country, especially in India where the biology, entomology and epidemiology of the disease vary considerably.
India has been central to the fight against malaria since the beginning of the battle. The breakthrough discovery that malaria is transmitted by mosquitoes was made 120 years ago in Secunderabad, India. Since then, half of the world’s countries have banished malaria. Now is the time for India to do the same. (adapted from The Hindu BusinessLine 16 February 2018)
Views are personal.
