India
Malaria Facts
Close to 1.3 billion people are at high risk of being infected with malaria in India. [1] India carries 2% of the global malaria case burden and 2% of global malaria deaths (52% of all malaria deaths outside of sub-Saharan Africa). [2] India also bears 85.2% of the malaria burden in South East Asia.[2] Of importance is that India carries 47% of the global P. vivax malaria burden,[2] making the country strategically important for global malaria elimination, particularly in the South-East Asian region.
The country has made significant gains towards malaria control and eradication. In 2019, there were 6.8 million fewer cases than in 2016, and the number of cases per 1000 of the at risk population fell from 10 to 4.3. Over the same period, deaths also fell from 0.018 to 0.006 per 1000 of the population at risk. [2]
Malaria has a significant economic impact on Indian families with household malaria-associated direct out-of-pocket costs ranging from US$ 0.34– 7.66 (average of about US$ 2.67) and resulting in lost productivity to the tune of about 2-4 days. [3] The national malaria burden has been pegged at approximately US$1940 million per year.[4]
Geographical distribution of malaria in India
Just seven out of 36 states in the country accounted for 90% of the estimated cases in 2018. [5] These states, together with other states in the north eastern part of India, have some parts of it being either forest-like, hilly, tribal or conflict-affected and have historically had a large burden of malaria. Even in states with low levels of malaria transmission, most of the malaria cases are confined to areas that have the above-mentioned geographical or socio-political profiles. [5]
Intervention: prompt, complete and effective treatment – (non-severe and severe malaria)
Treating all confirmed Plasmodium falciparum cases with a full course of artemisinin-based combination therapy (ACT) and low dose primaquine; and treating all confirmed P. vivax cases with a 3-day course of chloroquine and a 14-day course of primaquine.[6]
Severe malaria policy and practice
| Recommendation | Treatment |
|---|---|
| Strong | Injectable artesunate (IV or IM) |
| Alternative | Intramuscular artemether |
| Alternative | Injectable quinine |
*Since artesunate and artemether are often not available, injectable quinine continues to be the most commonly used treatment for severe malaria nationwide.
| Recommendation | Pre-Referral |
| Alternative | Rectal artesunate |
| Alternative | Intramuscular artesunate |
| Alternative | Intramuscular artemether |
| Alternative | Intramuscular quinine |
