1. G.P. CHATTERJEE MEMORIAL AWARD LECTURE Malaria Control in India by Dr. V.P. Sharma 91st Session of the The Indian Science Congress Session Chandigarh 4th January 2004

2. Burden of Malaria in the World
million malaria cases in the world
1.5 to 2.7 million deaths due to malaria
90% disease burden in Africa, South of Sahara

3. Estimated Burden of Disease in Disability Adjusted Life Years (DALYs) (WHO Report 2001)
Total DALYs
Region %
World
40,213,000 -
Africa
35,748,000
88.89
The Americas
111,000
2.76
1,945,000
4.83
Eastern Mediterranean
Europe
21,000
0.052
Western Pacific
5,16,000
1.28
South East Asia
1,874,000
4.66
India
1,311,800
(70% of SEAR DALYs)

5. SITUATION ANALYSIS OF MALARIA IN INDIA
1 BILLION POPULATION AT RISK OF MALARIA
10 MILLION POPULATION UNDER SP TREATMENT
2 MILLION CASES REPORTED BY NAMP
MALARIA DEATHS REPORTED BY NAMP
6 MAJOR VECTORS-RESISTANT, EXOPHILIC AND OR ENDOPHILIC BEHAVIOR
NEW MALARIA ECOTYPES IDENTIFIED
SPRAYING PRODUCES TRANSIENT CONTROL
WIDESPREAD MONO-DRUG RESISTANCE, MULTI-DRUG RESISTANCE IN P. falciparum
INADEQUATE RESOURCES
1 BILLION US DOLLARS LOSS DUE TO MALARIA

6. HUMAN MALARIA PARASITES
Plasmodium vivax
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale

7. Chronology of drug resistance in SEA Region
CHLOROQUINE
1962 Thailand 1969 Myanmar 1970 Bangladesh 1973 India Indonesia 1981 East Timor 1984 Nepal Sri Lanka 1985 Bhutan
SULFADOXINE-PYRIMETHAMINE
1979 India Indonesia 1980 Myanmar Thailand 1985 Bangladesh 1997 Nepal
QUININE
1983 Thailand 1986 India
MEFLOQUINE
1989 Thailand

9. Total Deaths in Severe Malaria Cases 61/431 (14.15%) 236/996 (23.69%)
DEATHS DUE TO ARF/ARF COMPLICATIONS IN SEVERE MALARIA IN ISPAT GENERAL HOSPITAL, ROURKELA, ORISSA
Total Deaths in Severe Malaria Cases
61/431 (14.15%) 236/996 (23.69%)
Deaths Due to ARF/ARF Complications
14/62 (22.58%) 117/265 (44.15%)
Deaths Due to Complications without ARF
47/369 (12.74%) 119/731 (16.28%)

10. MALARIA TREATMENT COST OF AN ADULT IN INDIA
Drugs Cost (Rs.)
 Chloroquine
Chloroquine injection + fluids
Sulfadoxine Pyrimethamine
Mefloquine
Artemether injections
Arteether injections
Artesunate injections
Quinine tables + Tetracycline
Quinine injections+IV fluid+Tetracycline  
Rs per treatment
I/V fluid may be required during Artemisinin treatment

11. MALARIA INCIDENCE AND DRUG CONSUMPTION IN INDIA
6.5 m +s
CQ 61 mt
CQ 400 mt
2m +s
140 mt SP

12. Malaria in Pregnancy
Pregnant women attract twice the number of mosquitoes than non-pregnant women
There is a greater susceptibility to P. falciparum than P. vivax during pregnancy
Low birth weight babies in malarious areas are 2 to 4 times more likely to experience failure in school.

13. Endless Vicious Cycle of Malaria
Malaria is the leading cause of anemia
Malaria affects cognitive development and learning abilities of children
Malaria is a risk factor of neuro-sensory and behavioral development in children
Malaria-one clinical febrile episode of malaria consumes 5,000 k Cal.

17. Role of Vectors in Malaria Transmission in India
Malaria Vectors
Disease Potential
Total malaria cases (%)
Pf cases (%)
Rural & Urban Vector
An. culicifacies + 65 55
An. stephensi ++ 12 5
Regional Vector
An. fluviatilis 15 30
An. minimus
+++
An. dirus 3
Coastal Vector
An. sundaicus
0.4
0.001
Broad categorization based on 1996 NAMP data Low Medium High

19. Status of Insecticide Resistance Status of Insecticide Resistance
in An. culicifacies
Status of Insecticide Resistance
in An. culicifacies

20. Distribution of An. culicifacies species A,B,C,D and An
Distribution of An. culicifacies species A,B,C,D and An. fluviatilis Species S,T, and U

21. An. culicifacies Sibling Species
Biological Variations Among members of An. culicifacies Sibling Species Complex
Biological Behaviour
An. culicifacies Sibling Species A B C D E
Anthropophilic index (%)*
0-4
0-1
0-3
0-1 80
Biting Activity
All night
All night
All night
Till mid-night -
10-11 pm
10-11 pm
6-9 pm
6-9 pm -
Peak Biting Time
Vector Potential
Vector
Non-vector
Vector
Vector
Vector
Sporozoite Rate
0.51
0.04
0.3
0.4 20
Resistance to DDT
Slow
Fast
Fast - -
Fast
Fast
Fast - -
Resistance to HCH
Resistance to Malathion
Slow
(9-10 yrs.)
Medium
(6-7 yrs)
Fast
(4-5 yrs.) - -

22. MAJOR MALARIA ECOTYPES FOUND IN INDIA
RURAL MALARIA
URBAN MALARIA
FOREST MALARIA
IRRIGATION MALARIA
PROJECT MALARIA
MIGRATION MALARIA
BORDER MALARIA

23. Time taken in days (approx) for 50 per cent of the human population to become infected at different reproduction rates with an initial parasite rate of 0.1 per cent
100 65
120 80 50
160
110 20
220
155 10
Over 300
215 5
falciparum rate
vivax
Reproduction rate

24. Resistance in vectors and parasites Global warming
FACTORS THAT WILL INCREASE MALARIA
Irrigation
Urbanization
Industrialization
Migration
Natural disasters
Resistance in vectors and parasites
Global warming
Malaria control costs
Political instability/war

25. “Everything about malaria is so molded by local conditions that it becomes a thousand epidemiological puzzles. Like chess, it is played with a few pieces but is capable of an infinite variety of situations.”
- L.W. Hackett (1937)

26. PERSISTENT ORGANIC POLLUTANTS
Eight Pesticides
Aldrin, chlordane, DDT, dieldrin, endrin, heptachlor, mirex and toxaphene
Two Industrial Chemicals
PCBs and hexachlorobenzene
Two unwanted by-products of combustion and Industrial Processes
Dioxins and furans

27. TIMES OF INDIA 24 November 1944 (On the introduction of DDT on December 2, 1944)
“It should be stressed that it is a re-enforcement and not a substitute for existing well tried systems of malaria control, which should on no account be relaxed. But we believe that DDT is going to have a big future in the fight against malaria and dysentery in post-war India”

29. IRRIGATION IN INDIA
Million Hectares

30. An.culicifacies Breeding Sites on the Margins of Bargi Dam, M.P.

31. Malaria Outbreak in Bargi Dam area in Narayanganj PHC, M.P.
Dam impounded
Dam
Dam completed

32. SSP Command area in Gujarat

33. Stagnant Water in Canals of the Sardar Sarovar Project