World Malaria Report 2024

World Malaria Report 2024

India's remarkable progress in reducing malaria cases and deaths has been highlighted in the World Malaria Report 2024 by the World Health Organization (WHO). The report shows that between 2017 and 2023, India made significant strides in malaria control, with the aim of achieving a malaria-free status by 2030 and eliminating all indigenous cases by 2027.

What is Malaria?

• Cause: Malaria is a life-threatening vector-borne disease caused by Plasmodium parasites, transmitted through the bites of infected female Anopheles mosquitoes.

• Key Species: There are five species of Plasmodium, but P. falciparum and P. vivax are the most dangerous and widespread.

• Geographic Distribution: Malaria is most common in tropical and subtropical regions, including parts of Africa, South America, and Asia.

• Transmission: The malaria parasite enters the bloodstream when an infected mosquito bites a person. The parasites travel to the liver, mature, and then infect red blood cells.

• Symptoms: Malaria symptoms include fever, chills, headaches, muscle aches, and fatigue. It is preventable and curable with appropriate treatment.

Findings of the Report

Global Findings:

• Disease Burden:

  • 263 million malaria cases occurred globally in 2023, up by 11 million from 2022.

  • Malaria-related deaths reached 597,000, a decrease from 622,000 in 2020.

• Geographic Distribution:

  • The WHO African Region accounted for 94% of global malaria cases and 95% of malaria deaths.

  • Five countries — Nigeria (26%), Democratic Republic of Congo (13%), Uganda (5%), Ethiopia (4%), and Mozambique (4%) — together contributed nearly 52% of global malaria cases.

• Malaria-Free Certification:

  • Since 2015, nine countries, including Egypt in 2024, have been certified as malaria-free.

• Vaccine Uptake:

  • The rollout of RTS,S and R21 malaria vaccines has increased vaccine coverage in endemic areas.

India-Specific Findings:

• Historical Context:

  • At independence, India faced a massive malaria burden with 75 million cases annually and around 800,000 deaths.

  • Over the decades, efforts have drastically reduced the malaria burden.

• Recent Achievements (2017-2024):

  • From 2015 to 2023, malaria cases in India fell from 1,169,261 to 227,564, and deaths decreased from 384 to 83, reflecting an 80% reduction.

  • The Annual Blood Examination Rate (ABER) increased from 9.58% in 2015 to 11.62% in 2023, which supports early detection and effective intervention.

• Exit from WHO's High Burden to High Impact (HBHI) Group:

  • In 2024, India exited the HBHI group, a key milestone marking substantial progress in malaria control.

• State-Level Progress:

  • High-Burden States: Reduced from 10 to 2 (Mizoram & Tripura).

  • States like Odisha, Chhattisgarh, Jharkhand, and Meghalaya transitioned to medium-burden status.

  • Regions such as Andaman & Nicobar Islands, Madhya Pradesh, Arunachal Pradesh, and Dadra and Nagar Haveli achieved low-burden status.

  • Ladakh, Lakshadweep, and Puducherry achieved Zero malaria status and are eligible for subnational malaria elimination verification.

Government Initiatives to Curb Malaria

1. National Framework for Malaria Elimination 2016-2030:
   This framework provides the strategic vision for malaria elimination by 2030.

2. National Vector-Borne Disease Control Programme:
   This programme addresses multiple vector-borne diseases, including malaria, through prevention, control, and surveillance.

3. National Malaria Control Programme (NMCP):
   Launched in 1953, this programme focuses on malaria prevention through activities such as:

   • Insecticidal Residual Spraying (IRS) using DDT.

   • Case monitoring and surveillance.

   • Effective patient treatment.

4. High Burden to High Impact (HBHI) Initiative:
   Launched in 2019 in states like West Bengal, Jharkhand, Chhattisgarh, and Madhya Pradesh, this initiative works towards malaria reduction through measures such as distribution of insecticide-treated nets.

Malaria Elimination Research Alliance-India (MERA-India):
Established by the Indian Council of Medical Research (ICMR), MERA-India collaborates with domestic and international partners to conduct research on malaria control and elimination.

Malaria: An Overview

Malaria is a life-threatening disease caused by Plasmodium parasites, which are transmitted to humans through the bites of infected female Anopheles mosquitoes. It is one of the most prevalent vector-borne diseases, particularly in tropical and subtropical regions of the world. While malaria is preventable and treatable, it remains a major global health issue.

Malaria Parasites and Transmission

• Plasmodium Parasites:
  There are five species of Plasmodium that cause malaria in humans:

  1. Plasmodium falciparum – the deadliest species, responsible for the majority of severe cases.

  2. Plasmodium vivax – the most widespread species.

  3. Plasmodium ovale – relatively uncommon but can cause relapses.

  4. Plasmodium malariae – less common but can persist for years.

  5. Plasmodium knowlesi – a species primarily found in Southeast Asia, known to infect both humans and monkeys.

• Transmission Cycle:

  1. Infection in Mosquitoes: When a mosquito bites an infected person, it ingests the parasite (in its immature form).

  2. Human Infection: The parasite develops in the mosquito's stomach and migrates to the salivary glands. The mosquito then bites another person, injecting the parasite into their bloodstream.

  3. Liver Stage: The parasite travels to the liver, where it matures and multiplies.

  4. Blood Stage: The parasite infects red blood cells, causing them to rupture and release more parasites into the bloodstream, which leads to symptoms of malaria.

Symptoms of Malaria

Malaria symptoms usually appear 10-15 days after being bitten by an infected mosquito. Common symptoms include:

• Fever and chills

• Headache

• Muscle aches

• Fatigue

• Sweats (following fever spikes)

• Nausea and vomiting

• Anemia (due to the destruction of red blood cells)

• Jaundice (yellowing of the skin, especially in severe cases)

In severe cases, Plasmodium falciparum can lead to cerebral malaria, organ failure, and death.

Diagnosis of Malaria

• Blood Smear: The most common method of diagnosing malaria involves examining a drop of blood under a microscope for the presence of Plasmodium parasites.

• Rapid Diagnostic Tests (RDTs): These are used in areas with limited access to microscopy and can detect specific proteins produced by the parasite.

• PCR (Polymerase Chain Reaction): A more precise method, often used in research, for detecting low levels of parasites.

Treatment of Malaria

Malaria is treatable with antimalarial medications, but the type of medication depends on the Plasmodium species and the severity of the disease. Common treatments include:

1. Artemisinin-based Combination Therapies (ACTs) – The most effective treatment for Plasmodium falciparum malaria.

2. Chloroquine – Effective for Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale.

3. Primaquine – Used for Plasmodium vivax and Plasmodium ovale to prevent relapses.

4. Quinine – Used in more severe cases of malaria, often in combination with other drugs.

Resistance to antimalarial drugs, particularly artemisinin, has been reported in certain areas, leading to the need for newer drugs and strategies.

Prevention of Malaria

• Insecticide-Treated Nets (ITNs):
  Sleeping under a bed net treated with insecticide is one of the most effective ways to prevent malaria, especially in endemic regions.

• Indoor Residual Spraying (IRS):
  Spraying insecticides on walls and other surfaces can kill mosquitoes that come in contact with them.

• Antimalarial Medications:
  In malaria-endemic areas, travelers or residents may take prophylactic antimalarial medications (such as doxycycline or mefloquine) to prevent infection.

• Elimination of Mosquito Breeding Grounds:
  Reducing standing water (where mosquitoes breed) through sanitation efforts can help control mosquito populations.

• Vaccine Development:
  The RTS,S/AS01 (RTS,S) malaria vaccine has shown effectiveness in preventing malaria caused by Plasmodium falciparum in young children. A newer vaccine, R21/Matrix-M, has also demonstrated high efficacy in trials.

Global Malaria Burden and Efforts

• Global Statistics (2023):

  • 263 million malaria cases worldwide.

  • 597,000 deaths globally, a reduction from previous years.

  • WHO African Region: Accounts for 94% of cases and 95% of deaths.

• Malaria-Free Certification:
  Some countries, including Egypt and Sri Lanka, have achieved malaria-free status by implementing aggressive control and elimination strategies.

India and Malaria

• Historical Burden:
  At the time of independence, India had a massive malaria burden, with 7.5 crore cases and 800,000 deaths annually. However, over the years, the country has made significant strides in reducing malaria cases.

• Recent Progress (2017-2023):

  • India has reduced malaria cases by over 97% since independence.

  • The number of malaria deaths has also dropped significantly to just 83 deaths in 2023.

  • States like Mizoram and Tripura are now in the low-burden category, with areas like Ladakh and Lakshadweep achieving zero malaria status.

• Government Programs:

  • National Framework for Malaria Elimination (2016-2030): India aims to eliminate malaria by 2030, with a target of zero indigenous cases by 2027.

  • National Vector-Borne Disease Control Programme and other initiatives are working toward malaria elimination.

Challenges in Malaria Control

• Drug Resistance:
  Resistance to antimalarial drugs, particularly artemisinin, is emerging, especially in Southeast Asia.

• Insecticide Resistance:
  Mosquitoes are developing resistance to commonly used insecticides, which complicates control efforts.

• Environmental and Social Factors:
  Changes in climate, migration, urbanization, and access to healthcare can all impact malaria transmission and control efforts.

• Global Health Burden:
  Despite progress, malaria remains a major health burden in many parts of the world, particularly in sub-Saharan Africa and parts of Asia.

Conclusion

Malaria remains a global health challenge, but significant progress has been made in its prevention, treatment, and elimination. Continued efforts, including the expansion of mosquito control programs, better access to treatment, vaccine development, and addressing drug resistance, will be crucial to eradicating malaria and achieving a malaria-free world. In India, the goal is to eliminate malaria by 2030, with zero indigenous cases by 2027, marking a critical step in global malaria control.