India

Fardeau du paludism

Photo: Jaya Banerji/MMV

Malaria burden

Close to 1.264 million people are at high risk of being infected with malaria in India. India carries 3% of the global malaria case burden and 2% of global malaria deaths (52% of all malaria deaths outside of sub-Saharan Africa). 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.

Progress against malaria

The country has made significant gains towards malaria control and eradication. In 2018, India reported the largest absolute reductions in malaria cases: with 2.6 million fewer cases in 2018 than in 2017.1 The World Malaria Report 2018 also noted cases dropped by 45% from 9.7 to 5.3 per 1000 of the population at risk. Deaths also fell by 39% from 0.0012 to 0.00074 for that same period.1 Malaria has a significant economic impact on Indian families with household malaria-associated direct out-of-pocket malaria 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. The national malaria burden has been pegged at approximately US$1940 million per year.

Geographical distribution of malaria in India

Just seven out of 36 states in the country accounted for 90% of the estimated cases in 2018. 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.

 

Intervention: prompt, complete and effective treatment – (non-severe and severe malaria)

Treating all confirmed P. falciparum cases with a full course of ACT and 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

National treatment guidelines
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