The Health Department has called for the early diagnosis and prompt and complete treatment of malaria and sustained vector control measures to help Kerala achieve the target of eliminating malaria by 2020.
Kerala had been the first State in the country to achieve the eradication of malaria in 1965. However, this was short-lived. Slackening of vector-control activities and the importation of malaria from other States re-introduced the disease in Kerala in 1965 and from 1975 onwards malaria became a regular disease in the State.
However, the health-care system has been fighting back and the State is now closer to eliminating malaria than ever before. Since 2013, both malaria cases and deaths have been steadily decreasing and 95% of the cases today in Kerala are those imported or introduced from other States.
Four districts
Of the 10 districts that have been reporting indigenous malaria cases (locally occurring infection) since 2008, four districts (Pathanamthitta, Kottayam, Alappuzha, and Ernakulam) have not reported any indigenous case since 2008. Reporting of indigenous cases have declined in other districts too but Kozhikode and Kasaragod remain the two vulnerable districts.
“Malaria cases have declined to such low levels today that the disease now seems to be totally escaping the index of suspicion in clinical practice. As a result, it has now come to our notice that there is a delay of at least seven to 10 days in the diagnosis and treatment of malaria. Early diagnosis and prompt and complete treatment is important not just to prevent the complications of malaria but also to prevent the transmission of the disease,” said V. Meenakshy, Additional DHS (Public Health).
Early diagnosis
“As Kerala is now in the disease elimination mode, apart from vector control, we are now focussing on early diagnosis through better and enhanced laboratory skills. Malaria testing facilities, including rapid diagnostic kits, are now available in all PHCs. Since last year, our technicians are being put through a WHO-model skill training programme as accuracy in doing peripheral blood smear tests can affect the results. The Health department has also given directives that all blood samples of fever patients be tested for malaria, even if the doctors’ prescription does not specify the test. In 2018, we thus detected eight new malaria cases,” Dr. Meenakshy added.
Apart from hurdles in sustaining vector-control measures, the lack of reporting of malaria from private hospitals in the State could affect disease surveillance and containment measures. Though Kerala declared malaria as a notifiable disease in 2016, lack of reporting from private sector continues to be a major problem.
Migrant screening
Screening of the migrant population is an important strategy that the State intends to promote as part of malaria elimination. Malaria carrier status amongst the migrants could lead to potential local outbreaks as the incriminating vector — Anopheles Stephensi — is rampant across the State.
The Health Department has now decided to launch an integrated approach so that special medical camps for migrants be conducted to screen them for all diseases now declared in elimination mode — tuberculosis, human immunodeficiency virus (HIV), leprosy, malaria, filariasis, and Kala Azar — Dr. Meenakshy added.
