1. MALARIA SITUATION IN INDIA
Dr. Neeraj Dhingra
Additional Director & Head Malaria Division, NVBDCP
DGHS
MOHFW
India

2. LIFE CYCLE OF MALARIA PARASITE
TYPES OF MALARIA PARASITE
Plasmodium vivax (Pv)- may lead to chronicity
Plasmodium falciparum (Pf) – leads to complication death
In India, above 2 are common
Others rarely
Plasmodium malariae
Plasmodium ovale

3. 2016 NSP 1995 National Anti-Malaria Programme (NAMP)
WHO 24m
WHO 29m
WHO 21m
WHO 13m
2005 Intensified Malaria Control Project
Supported by the Global fund and the National Vector Borne Disease Control project
1958
Natiional Malaria Eradication Programme
1965
Zero Malaria Deaths reported
1971 UMS
1977 Modified plan of Operation(MPO)
1982
First national anti-malaria drug policy
1995
National Anti-Malaria Programme (NAMP)
1997 Enhanced Malaria control Project
2016
NSP

4. REGIONAL DISTRIBUTION OF MALARIA

5. FALCIPARUM RATE

6. Decrease in total malaria cases from 354250 to 132216 (62.68%)
MALARIA DECLINE CONTINUES IN 2018
June2017 vs June2018
Decrease in total malaria cases from to (62.68%)
Decrease in Pf cases from to (71.14%)
The Pf % has been decreased to 53.77% from 69.54%.
The surveillance has decreased (1.10%) from tests (malaria parasite) to tests (test include slides examination and RDTs).
Eleven deaths have been reported in as compared to corresponding period of (till June) were 31deaths in reported.
There is decrease in SPR from 0.65 to 0.25
No. of malaria cases declined by 28 percent in last 3 years
62 percent decline in malaria cases in 2018 as compared to corresponding period in 2017
No. of deaths declined due to malaria by 49.5 percent in last 3 years

7. STATES CONTRIBUTING MAXIMUM BURDEN OF MALARIA IN INDIA (2017)
Name of the State
Total Malaria Cases
PERCENTAGE CONTRIBUTION TO TOTAL MALARIA
Deaths
ODISHA
3,52,140 42 25
CHHATTISGARH
1,41,310 17 81
JHARKHAND
92,770 11 1
MADHYA PRADESH
46,176 5 3
MEGHALAYA
16,433 2 12
TOTAL OF ABOVE STATES
6,48,829
77.2
122
ALL INDIA 2017
8,40,838
194
ALL INDIA 2016
10,90,677
331

10. CATEGORISATION OF STATES BASED ON MALARIA BURDEN (API)
Chandigarh, Daman & Diu, Delhi, Goa, Haryana, Himachal Pradesh, J & K, Kerala, Lakshwadeep, Manipur, Puducherry, Punjab, Rajasthan, Sikkim, Uttarakhand
Category 1
(15 States)
-State/Districts reporting an API of less than 1 case per population
Andhra Pradesh, Assam, Bihar, Gujarat, Karnataka, Maharashtra, Nagaland, Tamil Nadu, Telangana, Uttar Pradesh, West Bengal
Category 2
(11 States)
- State < 1 API but some districts report API of 1 case per population
A & N Islands, Arunachal Pradesh, Chhatisgarh, Dadra & Nagar Haveli, Jharkhand, Madhya Pradesh, Meghalaya, Mizoram, Odisha, Tripura
Category 3
(10)
- States with API of 1 or more per population

11. CATEGORISATION OF DISTRICTS/REPORTING UNITS (API based)
Category of districts
Definition
(%)
Prevention of re-establishment phase
No local transmission and reporting no case for last 3 years.
(11.0)
Elimination phase
Districts/units having API less than 1 per 1000 population
(66.1)
Pre-elimination phase
Districts/units having API 1 and above, but less than 2 per 1000 population. 46
(6.8)
Intensified control phase
Districts/units having API 2 and above per 1000 population.
109
(16.1)

12. Milestones and Targets for Malaria Elimination
By 2020
Eliminate malaria from all 15 low transmission states and UTs (Category 1) and 3 additional progressive states and UTs of Category 2
By 2022
Eliminate malaria from all 8 moderate transmission states and UTs (Category 2)
By 2024
Reduce the incidence of malaria to less than 1 case per 1000 population in all states and UTs and their districts
By 2030 and beyond
Prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain national malaria-free status

13. Malaria elimination in phases in India- Stratification
Year
Category 0
Category 1
Category 2
Category 3
Total
2015 75
448 46
109
678
2017
106
470 68 34
2019
305
233 33
107
2020
523 48 15 92
2022
571 30 62
Technical Strategies will need to adapt to this bring this change and maintain it:
HIGH ENDEMIC AREAS CASE DETECTION, TREATMENT, FOLLOW UP, EFFECTIVE VECTOR CONTROL
MODERATE AREAS INTENSIFY MALARIA REPORTING AND SURVEILLANCE –
early detect, contain and prevent outbreaks
LOW ENDEMIC AREAS CASE BASED SURVEILLANCE AND FOLLOW UP
IN INDIA- WE WILL NEED TO IMPLEMENT THE ABOVE DIFFERENT REGIONS AT SAME TIME

14. National Strategies for Malaria Elimination
Early diagnosis and complete treatment
Case based surveillance and rapid response
Integrated Vector Management
Indoor Residual Spray (IRS)
Long Lasting Insecticidal Nets (LLINs)/ Insecticide- treated Nets (ITNs)
Larval Source Management (LSM)
Epidemic Preparedness and Early Response
Monitoring & Evaluation
Advocacy, Coordination and Partnerships
Behavior Change Communication (BCC) and Community Mobilization
Programme Planning and Management

15. Progress on Malaria Elimination Activities
Launch of National Framework for Malaria Elimination (NFME) in February, 2016
Dissemination of NFME to all States and UTs with instructions to initiate key actions
Launch of Operational Manual for Malaria Elimination on April, 2016
Launch of National Strategic Plan ( ) for Malaria Elimination document on July,2017
Formation of a National Malaria Task Force under the Union Health Secretary (July2016) and a Technical Working Group under the DGHS for oversight of all malaria elimination activities in the country.
First National Task Force Meeting under Health Secretary held in Feb2018.
14 States have made malaria a notifiable disease
Update this slide with addition of Strategic meeting with the states

16. Progress on Malaria Elimination Activities (contd)
40 million LLINs distributed/being distributed million proposed for the year 2018
Fourteen states successfully launched their respective plans for malaria elimination, other states/ UTs are in process of finalizing their action plans for elimination.
Involvement of private medical sector through trainings, publication of special issue on VBD, regular SMS to 2.5 lakh medical practitioners under the aegis of Indian Medical Association (IMA)
Quality Assurance mechanisms for Rapid diagnostics and malaria microscopy started.
Rapid Diagnostic Tests: Started in 2009
Malaria microscopy – up gradation as per international standards initiated in November2016

17. Trend of Malaria in 7 NE states 2012-17*
Total malaria cases declined in 2017 by 72.24% compared to 2015 & by 56.24% compared to 2012.
Total Pf cases declined in 2017 by 72.14% compared to 2015 & by 51.34% compared to 2012.
Total malaria deaths declined in 2017 by % compared to 2015 % by 83.19% compared to 2012.

18. Odisha - Monthly Burden of Cases & Deaths (2016 vs 2017)
After July in 2017, there is sharp decline 4%
44%
56%
62%
80%
80%
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Cases-2016
26251
19498
21741
22883
22908
36940
75550
65115
42434
34275
40584
36663
Cases-2017
23970
20841
26954
35471
40050
48644
72546
36446
18878
12911
8182
7247 
Deaths-2016 2 1 3 6 7 27 12 5 4
Deaths-2017 13 0 

19. National Drug Policy
All fever cases should preferably be investigated for malaria by microscopy or RDT
P. falciparum: ACT first line antimalarial
AS+SP all over India except NE states; AL in NE states
PQ single dose
MiP: ACT 2nd/3rd trimester; quinine in 1st trimester
P. vivax: CQ 25mg/kg over 3 days + PQ 0.25 mg/kg x 14 days
Primaquine in Pv: test G6PD if facilities available
If no facilities; look for symptoms of hemolysis
Prevention of MiP: Personal protection measures
Chemoprophylaxis for travellers, migrant labourers and military personnel
<6 weeks: Doxycycline; >6 weeks: Mefloquine

20. Challenges to Malaria Elimination
Financial sustainability
Uninterrupted supply of materials – procurement and supply uncertainity
Highly trained and skilled manpower at all levels – hiring and continuation
Developmental activities creating more malariogenic potential – identification and prevention
Engagement of private sector
Drug resistance
Insecticide resistance
Research for newer drugs, insecticides
Real Time reporting from remote and inaccessible areas

21. THANKS