The history of malaria and its control

History of malaria in India dates back to centuries and it has been a major public health problem from time immemorial. Malaria has been a formidable deterrent to the cultural and socio-economic progress of people in India and other parts of the world where it is prevalent such as the tropical, sub-tropical and monsoon prone zones of the world.

According to recent estimates, globally, about 300-500 million clinical cases and 1.5-2.7 million deaths occur annually due to malaria and the majority of deaths occur in tropical Africa (about 90%). In the SE Asia region, India contributes to the majority of the reported cases and deaths. We present to you more on malaria, the history of malaria and its control in India.

Malaria in India

• The four species of human malaria parasites are plasmodium vivax, falciparum, malariae and ovale. In India 60 to 65 % of the infections are caused due to P. vivax and the rest by P. falciparum (35 to 40%).
• Malaria is prevalent in all parts of India except in places which are more than 5000 feet above sea level. The states where malaria is very prevalent (that is highly endemic states) and which contribute about 90% of the total malaria cases in the country are Orissa, U.P., Gujarat, West Bengal, Maharashtra, Madhya Pradesh, Rajasthan, Karnataka, and Andhra Pradesh.

History of Malaria in India

Malaria has been a major public health problem in India. Malaria epidemics have been reported for centuries and according to history one malaria epidemic in 1852 wiped out the entire village of Ula and then spread across the Bhagirathi River to Hooghly and the epidemic continued for many years in Burdwan.

The spread of malaria intensified with the development of Indian railways under the British administration. The construction of railway embankments provided a number of breeding sites for the malaria vectors, and movement of labourers from different parts of the country probably introduced different strains of the parasite to the areas in which they worked. Major epidemics occurred in the city of Bombay during construction of railroads, bridges, Alexander Dock and Hughes Dry Dock in the early 1800s (1821 and 1841).

High morbidity and mortality were reported in Punjab and Bengal during the malaria epidemics in the 1920s. In the early 1920s, a severe malaria epidemic occurred in Bengal which caused over 730,000 deaths in 1921 alone after which the number of deaths slowly decreased to about 300,000 to 400,000 per year. During the Second World War, rise in malaria deaths was observed. In 1943 over 680000 deaths and in 1944 about 763220 deaths due to the disease were recorded in Bengal.

According to the first Director of the Malaria Institute of India, in 1935 about 100 million people suffered from malaria in India and approximately one million deaths occurred annually in endemic areas. After independence, about 75 million people suffered from the disease every year and 0.8 million people died as direct result of the disease.

Even today malaria continues to be endemic in many parts of the country. Although the number of cases and deaths from malaria has reduced significantly –malaria still continues to be a major public health problem in India.

Malaria control program in India

Malaria control program was started after independence in India in April 1953.The aim of this program (the National Malaria Control Programme or NMCP) was to bring down malaria transmission to a level at which it would cease to be a major public health problem. The strategy to achieve this aim was vector control by DDT spraying.

The program was intensified in 1958 with the aim to eradicate malaria. The National Malaria Eradication Programme (NMEP) was started in 1958. The program was successful and the annual malaria incidence decreased from 75 million cases to an all-time low of 0.1 million cases in 1965. But there were setbacks from 1968 and 6.47 million cases of malaria were recorded in 1976.

Attempts at malaria eradication were stopped in 1977 and Modified Plan of Operation (MPO) was started. The aims of this program were as follows:

• Preventing deaths due to malaria.
• Reducing complications and morbidity.
• Maintenance of industrial and green revolution due to freedom from malaria and retention of achievements gained so far.

Strategies used to achieve these objectives were:

• Blood smear collection and examination from fever cases, and treatment with antimalarial drugs.
• Involvement of primary health care for laboratory services and treatment.
• Vector control by appropriate insecticidal spray during the transmission period in rural areas.
• Recording Annual Parasite Incidence (API) 2 or above and in urban areas, through recurrent anti larval operations.
• Health education and community participation.

After the implementation of MPO, the situation of malaria in India has improved definitely and a gradual downward trend in incidence has been recorded. However, the situation since 1984 has remained more or less static and increase in malaria incidence has been noted from 1994 due to focal outbreaks. The number of P. falciparum cases have also increased and reached up to 40%, which is a major programme concern.  Several new approaches have been adopted in view of renewed demand for malaria control but malaria continues to be major public health problem in India and much has to be done to control malaria effectively.

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