In its Eliminating Malaria report released on April 25, the World Health Organisation has set a malaria-free goal for 35 countries by 2030, but at the same time highlighted the challenge of handling Plasmodium vivax (P.vivax), a dominant strain of malaria parasite.
The WHO notes that P.vivax infections are more difficult to detect as the number of parasites circulating in the blood is typically low. The parasite can remain hidden and dormant in a patient’s liver, and can cause multiple episodes of malaria months, or even years, later.
Dr Neena Valecha, director of National Institute of Malaria Research, said: “In the case of P.vivax malaria, the patient is cured for that particular episode, but the infection can recur after three or six months, or one year, without a mosquito biting the person.” She said India has effective tools now — technological advances to detect P. vivax malaria, a good implementation plan, and also compliance of treatment — that would help it achieve the 2030 target. She also said drug resistance too was being monitored.
However, experts mapping Mumbai’s malaria situation said that while setting an elimination goal was needed, there are basic concerns that need to be addressed, primary among them being better sanitation. Also, while a standardised procedure to treat P.vivax malaria is there on paper, not all doctors follow it, experts said.
Dr JP Jadwani, critical care consultant and cardiologist with Lilavati Hospital, said, “In our city, drug resistance has been there for the past 10 to 15 years. Chloroquine doesn’t work any more. We have been monitoring P.vivax for the past 10 years and how the virus has changed its nature.” He said that while P.vivax malaria was once considered mild to moderate, now all kinds of complications can be seen, and it needs to be treated more seriously.
He pointed out that follow up treatment was not correct in most cases. “The dose of the drug primaquine has to be adjusted as per body weight. The duration too has to be fixed. But not everybody is following standardised dose. Even in cases of falciparum malaria, primaquine should be given as it will stop transmitting of the infection from human to mosquitoes,” Dr Jadwani said.
Experts in the field of healthcare said that while deaths in Mumbai due to malaria have come down, there was a need to ensure all fevers are treated as malaria until proven otherwise to ensure both early diagnosis and early treatment.
The WHO noted in its report that in many areas where P. vivax predominates, mosquitoes bite outdoors and early in the evening. “As a result, conventional malaria control tools that work well against indoor-feeding and night-biting mosquitoes, such as indoor residual spraying and insecticide-treated nets, may be less effective against P.vivax,” the WHO said.
Healthcare providers note that in a city like Mumbai, containing malaria in general remains a concern as they routinely see cases that are linked to water stagnating in their surroundings.
Dr Om Srivastava, infectious diseases specialist with Jaslok Hospital, said, “Countries that have eliminated malaria have stringent health checks of migrants, and have their public health problems under control.” He said that India’s tackling of malaria cannot be gauged on the parameters of other countries. “So long as our waste disposal does not improve, the risk (of malaria) is always going to be there.”
The WHO has also highlighted the challenge of P.vivax, a dominant strain
