Reducing the Burden of Malaria in India - Essay Example

Malaria in India Student’s name: Institution: Instructor: Subject: Malaria in India The history of malaria traces back millennia where it caused illness and deaths throughout the tropical and temperate world which included India (Covell, 1955). Global efforts have been made to control, eliminate and to totally eradicate malaria as much as possible. Recent years have however seen periods of renewed investment in the anti-malaria efforts. There have been favorable environments that have emerged for global health and malaria. Malaria is a disease that is caused by infection with a single-celled parasite which is of the genus plasmodium. The Anopheles mosquitoes are responsible for the transmission of this parasite from one person to another through biting. Malaria is characterized by some periodic bouts of severe chills and high fever. The serious causes of malaria may result to death if it is left untreated. In India, Malaria is a disease of antiquity that has proved to be formidable deterrent to the socio-economic progress and cultural progress of man. History has repeated with instances of devastation which are caused by this deadly disease (Glang, 1971). The wide distribution and its intensity of transmission in India are some of the important factors that slow down the scientific, economic and the industrial progress of this country. Malaria is still one of the major public health problems in India and other developing country. Recent reports indicate that between three hundred and five hundred million clinical cases and between1.5 to 2.7 million deaths are caused by malaria. Malaria is a complex disease and many factors that are influential to the human activities and the natural calamities like drought, flood excessive rainfall among others have great influence in the conditions that favor conditions that leads to increased potential for malaria to transmit. Like other diseases, the natural transmission of malaria does depend on the relationship between and the presence of the three basic epidemiological factors which are the agent, the environment and the host. Through the female anopheles mosquito, the Mosquito is the single major agent of infection (Dash,et al 2007). There are four major species malaria parasites that related to human infection. Plasmodium vivax, malariae, falciparum and ovale. In the country of India about 60 % of the malaria infection is caused by P. vivax and about 35% are due to falciparum. Very few cases that are reported to Orissa and Karnataka are caused by malariae. The life cycle of malaria parasite consists of endogenous asexual phase commonly known as schizogony, and the exogenous sexual phase commonly called the sporogony. The minimum time of the appearance of parasite in RBC from the time of biting by the mosquito is termed as pre-patent period. The incubation period depends on the species. Incubation period is the time interval from the time of infection to the appearance of the clinical symptoms, that is, when the parasitaemia reaches the sufficient density (Green & Gass, 1990). This is usually two days longer than the pre-patent period. The incubation period ranges from 8 to 21 days which depends on the climatic conditions, immunity and the species (Brithr, 1963). The asexual life cycle of the parasite is completed in the human host. For all the other species of malaria parasite the process is essentially the same except that the life cycle of p.malariae and p. falciparum do not have the persistent tissue phase called the Hypnozoite stage. Schizogony is repeated till the increasing chemotherapy and immunity inhibits the parasitaemia. Schizogony periodicity is the characteristic for each of the species. Basically, at least two cycles of schizigony must elapse in the blood before the sexual forms appear in human malaria parasites with the exception of P.falciparum in which the gametocytes appear after the tenth day in the peripheral circulation. (Nanda, Das & Adak, 2004). The recrudescence is then renewed which is the manifestation of the infection due to the survival of erthrocytic forms. The renewal of relapse is the manifestation of the infection that arises from the survival of hypnozoites. This happens in either a short interval of time or over long periods. In human malaria relapses are normally confined to P. vivax and P. ovale (Sukowati, 1999). The sexual cycles, otherwise known as exogenous sexual phase of the parasite is normally completed in female anopheles. This cycle completes in 7 to 15 days depending on the species. The antigenic diversity is normally present among different malaria parasite species and also within a species either between or within a geographical area. In India malaria prevails in all parts of the country except in areas of the country which are above 5000 feet above sea level. In India malaria is transmitted by nine vector species of which six are of primary importance (Singh, 2002).. These are An stephensi which is mostly found in the urban areas, An. Fluviatilis which is mostly found in hills and foot hills, An. Sundaicus and An. Dirus that are found in north eastern states and An. sundaicus found in Andaman and Nicobar island. Of all these, An. Culicifacies is the one responsible for the transmission of 60 to 70% and An. Fluviatilis is responsible for 15% of new cases of malaria. Vector control is an important component of controlling malaria in India though it has become less effective in the recent years mainly due to poor use of the control tools. Vector control involves the intervention measures that restrict the transmission of malaria through controlling the vector population. Among the most effective vector control strategies are based on four facets viz. incrimination of the vector species, the knowledge and understanding of the vector biology and ecology, public education, surveillance and the implementation of control measure that are effective. A malaria vector is one that has to be susceptible to malaria, have enough longevity and be anthropophagic so that it becomes infective to human. Anopheline are the vectors for malaria. In India, there are over 58 Anopheles of which six have been implicated to be the main malaria vectors. With the knowledge of vectors and through studies on the bionomic role of malaria transmission and distribution, biological insecticides are made that can be able to kill these mosquitoes. Vector control programs in India rely mainly on the usage of the natural and synthetic chemical molecules that have the potential to kill the target insects (Green,C & Gass, 1990).. Today different formulations of the synthetic chemical insecticides are in use for the vector control. The Wettable powder formulation which is of different insecticides is used for the adult vector control for indoor residual sprays. On the other hand, emulsion concentrate formulations are mostly used for larval control. In India, after there are repeated infections to the people living in this region, malaria becomes prevalent therefore developing a limited immunity. This partial protection is not a guarantee to the people that they shall not develop malaria again rather they need to protect themselves from more serious effects of infections. The development of the mild form of the disease lasts for a short time. There are also people who have genetic traits which helps them resist malaria which include thalessemia and sickle-cell anemia. People travelling to India are normally warned to take precaution before travelling, especially to the areas where malaria is prevalent. These measures include wearing protective clothing that cover their skins, using insect repellents and sleeping under mosquito nets (Green & Gass, R, 1990). Anti-malaria drugs are also made available as a preventive measure, though these drugs have very serious side effects and more so, they are not suitable for everyone. Research have been for a long time been carried out on vaccine of malaria in India and other countries. Currently, there is no effective malaria vaccine that exists (Williams, 2011).. The researchers in India are working on a vaccine that would either stop infection from developing or becoming more severe. Else they are seeking to develop a vaccine that fully stops the transmission of the infection. The vaccine researchers have been targeting different stages in the lifecycle of the parasite and are hoping to block the liver stage from interfering with the reproduction in the blood cells (World Health Organization, 1973). Another alternative they are working on is to halt the transmission to the mosquito. In the University of Minnesota, India, researchers are investigating on the possibility of including the malaria genes for the malaria antigens in to the vaccine. The development of vaccine has been difficult since the plasmodium parasite has so many different ways through which it can evade the immune system of the human being. Most of these strategies are yet not well understood therefore making it difficult to develop or make a vaccine that is capable of blocking all the parasites from getting in the human immune system. Any successful immune would be that that is able to target different stages of the lifecycle of the parasite (Rajnin, 2011). The progress towards the development of the vaccine has also been slow since the parasites are difficult to produce and study using the university laboratories since they must live inside the cells of another organism. The testing of several potential vaccines is still underway. There have been several successes in controlling malaria. This comes in Indian areas where sound targets and technical approach using skilled human resources and ensuring that there are good infrastructures at both sub-national and national levels (Hardev, 2009). A strong programmatic and technical support is required from all partners if good results are to be expected. The lessons that are learnt from these success stories could also be used to control malaria in other countries. What matters most in achieving success in the malaria control is full implementation of the rapid case management together with the mix of prevention strategies instead of simply procuring the right insecticide or drug. In India, the control efforts were once faulted until the program was redesigned (Rajgopal, 1977). The most notable decentralization of the program financing and implementation has greatly facilitated the progress of these implementation programs (Lawrence, 2006). Strong central malaria control program have also been fully empowered for programmatic and technical support. In some situations, the control and prevention measures have failed due to a number of factors. Due to the high population of citizens in India, it has been difficult for institutions that promote the prevention and control of malaria to reach every person. Sometimes, strategies that have been formulated are not fully executed either due to lack of enough resources or lack of full commitment to those that are involved (Dev, 1999). There have been significant improve in malaria control and intervention in India. World malaria report of 2009 show a great reduction of malaria reported cases from the previous years. This is mostly due to world health organization recommendation to provide bed nets to peoples of all age to prevent the risk of malaria. Overall, most of the institutions that are concerned with the prevention of malaria have achieved their objectives to a greater extent. Most of the success that comes in place is as a result of strong leadership commitment in all levels of government (Garros & Van, 2006). The community and government leaders from local to national levels should consider malaria a priority problem for both the health and the economic development and be dedicated to fully eradicate malaria. The national malaria control programs should be geared towards developing plans that can effectively navigate its bureaucracies towards the implementation of these plans. The government of India through the ministry of health has been issuing mosquito nets to the citizen through the hospitals. This plan has not fully succeeded mostly due to lack of good implementation strategies. The senior ministry of health staff should see malaria control as their responsibility and make the efforts towards the implementation and keeping the malaria programs to have good accountable results (Linton, 2005). While the malaria vaccine research goes on, the government needs to allocate more resources in these areas especially to the institutions of research and the universities. Use of insecticides in vector control is limited due to the non availability of the new molecules of the insecticide in future. The strategies of the replacement of the insecticides that are being followed till now also have limitations because of the limitation and the non-availability of new insecticides. It is also not cost effective and results in the cost escalation of the vector control. There is therefore need for intensive research on the tactics of management and the integration of the tested strategies in the current ongoing vector program. Despite the partial successful eradication of malaria in India, malaria is likely to remain a constant health concern in India. Although the malaria research and control efforts have been underway almost a century there are very significant changes in the last decade and more so in the last 2 years (Ansari, M. & Sharma, 1990). In the last few years there have been emergence and evolvement of malaria advocacy community. It would be presumptive to state that the grace period when malaria exists is due to exclusively to superior advocacy by the malaria community. Critical analysis of the successes and failures of the malaria advocacy efforts and organizations would serve well to inform the future efforts and the investments in malaria prevention, research advocacy and control. 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