Model Answer
0 min readIntroduction
Malaria, a life-threatening disease caused by Plasmodium parasites transmitted through infected Anopheles mosquitoes, has historically been a significant public health challenge in India. To combat this, India launched the National Framework for Malaria Elimination (NFME) 2016-2030, aligning with the WHO Global Technical Strategy for Malaria 2016-2030. This comprehensive framework provides a strategic roadmap for a phased elimination of malaria, demonstrating India's commitment to achieving a malaria-free status. The framework categorizes states and Union Territories (UTs) based on their epidemiological situation, allowing for tailored interventions and surveillance strategies to effectively tackle the diverse malaria burden across the country. India has made remarkable progress, with malaria cases and deaths significantly declining, and the country exiting the WHO's High Burden to High Impact (HBHI) group in 2024.
Targets under the National Framework for Malaria Elimination in India
The National Framework for Malaria Elimination (NFME) in India (2016-2030) sets ambitious milestones and targets to achieve malaria elimination. These targets are:
- By 2027: Interrupt indigenous transmission of malaria throughout the entire country, including all high transmission states and Union Territories (UTs) (Category 3), thereby achieving zero indigenous malaria cases across all States and UTs.
- By 2030: Prevent the re-establishment of local transmission of malaria in areas where it has been eliminated and maintain national malaria-free status. This also involves initiating the process for WHO certification of malaria elimination.
Key Interventions for States and UTs in Category 3 (Intensified Control Phase)
States and UTs falling under Category 3 are those with an Annual Parasite Incidence (API) of 1 case per 1000 population at risk or above, indicating high transmission areas. These regions require intensified control measures to significantly reduce the malaria burden and move towards elimination. The key interventions recommended for Category 3 areas include:
- Universal Access to Diagnosis and Treatment:
- Ensuring widespread availability of Rapid Diagnostic Tests (RDTs) and microscopy facilities at all peripheral health centers.
- Prompt and effective case management using appropriate antimalarials, such as Artemisinin-based Combination Therapy (ACT) for Plasmodium falciparum and Chloroquine for Plasmodium vivax where suitable.
- Active case detection through fever surveillance, focal screening, and robust follow-up of all confirmed cases.
- Integrated Vector Management (IVM):
- Mass distribution and promotion of Long-Lasting Insecticidal Nets (LLINs) in endemic communities.
- Targeted Indoor Residual Spraying (IRS) with appropriate insecticides in high-risk areas.
- Environmental management and larval source reduction through community participation (e.g., filling breeding sites, proper water management).
- Use of biological (e.g., larvivorous fish) or chemical larvicides in breeding hotspots.
- Strengthened Surveillance and Response:
- Case-based surveillance with immediate notification and reporting of all malaria cases.
- Prompt investigation of all reported cases to identify local transmission sources and potential outbreaks.
- Rapid outbreak investigation and implementation of targeted containment measures.
- Implementation of the '1-3-7' strategy for case notification, diagnosis, treatment, and follow-up within specific timeframes.
- Community Engagement and Behavioural Change Communication (BCC):
- Mobilizing communities for consistent use of mosquito nets, early health-seeking behavior for fever, and participation in environmental sanitation activities.
- Involvement of local self-help groups, community health workers (ASHAs), and other stakeholders in malaria control efforts.
- Health System Strengthening:
- Ensuring robust logistics and supply chains for diagnostics, antimalarials, and vector control tools.
- Capacity building through regular training of health professionals at all levels.
- Strengthening laboratory infrastructure for accurate diagnosis and drug efficacy monitoring.
- Establishing effective referral networks for severe malaria cases.
- Intersectoral Collaboration:
- Collaboration with departments like rural development, education, and water and sanitation to address social and environmental determinants of malaria.
Parameters Employed for Maintaining Epidemiological Surveillance Over Malaria
Epidemiological surveillance is crucial for monitoring the malaria situation, assessing the impact of interventions, and guiding further actions. The key parameters employed for surveillance include:
| Parameter | Description and Significance |
|---|---|
| Annual Parasite Incidence (API) | Number of confirmed malaria cases per 1,000 population per year. It is a primary indicator of malaria incidence and disease burden. API < 1 per 1000 population is a target for pre-elimination. |
| Annual Blood Examination Rate (ABER) | Percentage of the population whose blood smears are examined for malaria parasites annually. It reflects the operational efficiency and coverage of the surveillance program. A minimum of 10% is typically desired. |
| Slide Positivity Rate (SPR) | Percentage of blood slides examined that are found positive for malaria parasites. It indicates the prevalence of infection among those tested and helps identify areas with ongoing transmission. |
| Slide Falciparum Rate (SFR) | Percentage of blood slides examined that are found positive specifically for Plasmodium falciparum. This is crucial for monitoring the more severe form of malaria. |
| Annual Falciparum Incidence (AFI) | Number of confirmed Plasmodium falciparum cases per 1,000 population per year. This is a key indicator for severe malaria burden. |
| Proportion of P. falciparum cases | The ratio of P. falciparum cases to total malaria cases. Changes in this proportion can indicate shifts in species dominance and potential changes in severity of the disease burden. |
| Malaria Mortality Rate | Number of deaths due to malaria per unit population. This is a critical outcome indicator reflecting the severity of the disease and the effectiveness of case management. |
| Treatment Adherence and Cure Rates | Monitoring the completion of prescribed antimalarial treatment regimens and the subsequent cure rates to assess the effectiveness of treatment protocols and drug resistance. |
| Drug Efficacy Monitoring and Molecular Surveillance for Resistance | Regular assessment of the efficacy of antimalarial drugs and monitoring for the emergence and spread of drug-resistant parasite strains. |
| Vector Susceptibility to Insecticides | Testing local mosquito populations for susceptibility to insecticides used in vector control (LLINs, IRS) to guide appropriate intervention strategies. |
| Geographic Mapping of Cases and Hotspots | Utilizing GIS technology to map the spatial distribution of malaria cases and identify persistent transmission foci for targeted interventions. |
| Coverage Indicators for LLINs and IRS | Monitoring the distribution and effective coverage of Long-Lasting Insecticidal Nets and Indoor Residual Spraying in endemic areas. |
| Timeliness of Reporting and Response | Assessing the speed with which cases are reported, investigated, and responded to, which is vital for preventing onward transmission. |
Conclusion
India's National Framework for Malaria Elimination reflects a robust and systematic approach to eradicating malaria by 2030, with an intermediate goal of achieving zero indigenous cases by 2027. This ambitious vision is underpinned by tailored interventions, particularly for high-burden Category 3 states, focusing on universal diagnosis and treatment, integrated vector management, and strengthened surveillance. Continuous and comprehensive epidemiological surveillance using parameters like API, ABER, and SPR is indispensable for tracking progress, identifying challenges, and adapting strategies. The significant reduction in malaria cases and deaths in recent years, leading to India's exit from the WHO's High Burden to High Impact group, demonstrates the effectiveness of these efforts, positioning India as a global leader in public health transformation. Sustained political will, community engagement, and scientific advancements will be crucial for achieving the ultimate goal of a malaria-free nation.
Answer Length
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