Malaria in India -
History and Diagnosis

chillibreeze writer — Priya Menon

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India’s encounters with the king of diseases, Malaria, can be traced back to references of it in Charaka Samhita, an ancient Indian medical text. There are records of epidemics of malaria wiping out entire villages and devastating populations over many years. The contribution of the British towards the spread of this deadly disease is worth a mention. The Indian Railways built under the supervision of British administration provided embankments which were convenient locations for proliferation of mosquitoes and malaria epidemics followed. As the construction work increased, labor needed to be imported allowing widespread distribution of the disease. History records some very famous malaria outbreaks like during construction of the Colaba causeway in the 1800s, epidemics in Punjab and Bengal in the 1920s and the famous epidemic that killed 763,220 people in Bengal in 1944.

Distribution and Control

Malaria is endemic in India and continues to kill even today. The warm tropical climate and living conditions of people here make Indians an easy target for mosquitoes. The annual economic loss due to this menace amounts to millions of dollars. Almost the entire country was affected in 1930s. The anti malarial programs launched by the government time and again have managed to control the disease in certain areas. The states of Karnataka, Orissa, Madhya Pradesh, Rajasthan, Bihar and Pondicherry are generally the worst affected. Monsoon in India brings with it an increase in malarial cases since water logging greatly helps in breeding and hence transmission of disease. The states of Jammu and Kashmir, Sikkim and Himachal Pradesh are free of this dreaded disease owing to their high altitude location.

To curb and control a disease like malaria that is entrenching and huge is not an easy task. The Government of India launched its National Malaria Control Programme in 1953 which was very successful and recorded decreased levels of malarial incidence. But the disease returned and since then there have been many programmes like the Urban Malaria Scheme (UMS), National Malaria Eradication Programme (NMEP) and Modified Plan of Operation (MPO) launched by the government and most of these have served to control the disease to a large extent. The 1990s saw resurgence in malarial incidence with new features like vector resistance to insecticide, exophilic behavior of vector, etc. Thus controlling of the disease became the main concern in contrast to complete eradication previously planned and the National Malarial Eradication Programme has since been renamed as National Anti Malaria Programme.

Types and Diagnosis

Malaria can be caused by four different species of the genus Plasmodia. They are P. malariae, P. vivax, P. falciparum and P. ovale. The parasite is transmitted through bite of the Anopheles mosquito. India has seen cases of all types of malaria. Among them, P. vivax is common and P. falciparum is largely responsible for mortality associated with the disease.

Diagnosis of the disease depends on many factors like different forms of species, their endemic properties, movement of populations, immunity, parasitemia symptoms, stage of erythrocytic schizogony, levels and modes of transmission, drug resistance, etc. Mostly confirmed with blood tests, routine microscopic and non microscopic tests are also conducted for confirmation of diagnosis. During this a blood smear is observed for characteristic visualization of parasite. The two microscopic tests normally conducted are peripheral smear study and Quantitative Buffy Coat (QBC) test.

The major setback associated with the disease is late diagnosis since symptoms go unnoticed in the first few hours. On timely detection, the disease is treatable in just a matter of 48 hours. Malaria is a global problem and is re-emerging as an infectious killer of great proportions. The World Health Organization has prioritized it as number one among tropical diseases that need immediate attention.

The present problem that India is facing is underreporting of malarial cases. Thus when the severity of problem is not authentically quantified, prevention and control prove difficult. Underreporting has been the main reason as to why parts of India still succumb to this fatal disease. There is also a visible lack of knowledge about malaria and its specificities among government health workers. Thus a lot needs to be done from the basic individual level to bring an end to this menace which is the largest killer in this part of the world.

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