Abstract
The National Vector Borne Disease Control Programme (NVBDCP) of the Ministry of Health, Government of India is reporting about 2 million parasite positive cases each year, although case incidence is 30-fold or more under-estimated. Forty five to fifty percent of Plasmodium infections are caused by Plasmodium falciparum, the killer parasite. Anti-malaria drug policy (2007) of the NVBDC recommends chloroquine (CQ) as the first line of drug for the treatment of all malarias. In a Primary Health Centre (PHC) reporting 10% or more cases of CQ resistance in P. falciparum, ACT blister pack is recommended and, so far, the policy has been adopted in 261 PHCs of 71 districts. The NVBDCP still depends on CQ to combat malaria and, as a result, P. falciparum has taken deep roots in malaria-endemic regions, causing unacceptable levels of morbidity and mortality. This policy was a subject of criticism in recent Nature and Lancet articles questioning the World Bank's decision to supply CQ to the NVBDCP. Continuation of an outdated drug in the treatment of P. falciparum is counterproductive in fighting drug resistant malaria and in the containment of P. falciparum. Switchover to Artemisinin-based Combination Therapy (ACT) in the treatment of all P. falciparum cases, ban on artemisinin monotherapy and effective vector control (treated nets/efficient insecticide spraying) would be a rational approach to malaria control in India.
Highlights
The National Vector Borne Disease Control Programme (NVBDCP) is reporting about 2 million parasite positive cases a year, 50% of these Plasmodium falciparum
Blood smears are collected at fortnightly intervals by multi-purpose workers i.e. through Active Case Detection (ACD) and collected at the Primary Health Centres (PHCs) i.e. Passive Case Detection (PCD)
The first line of treatment is chloroquine and the second line is Artemisinin-based Combination Therapy (ACT) combination in case resistant to these formulations and to treat severe and complicated malaria, quinine will be the drug of choice
Summary
The National Vector Borne Disease Control Programme (NVBDCP) is reporting about 2 million parasite positive cases a year, 50% of these Plasmodium falciparum. 2. The first line of treatment is chloroquine and the second line is ACT (artesunate+sulphadoxine/pyrimethamine) combination in case resistant to these formulations and to treat severe and complicated malaria, quinine will be the drug of choice. The antimalarial drug policy states that all Plasmodium vivax cases, undiagnosed fever cases, and clinical malaria cases should be treated with chloroquine in full therapeutic doses. ACT (artesunate+sulphadoxine/pyrimethamine) is the first line of antimalarial drug for treatment of P. falciparum in chloroquine resistant areas. The objective of this paper is to highlight the realistic and evidence-based malaria situation in the country, and how the changes in drug policy and efficient vector control can wipe out malaria, bringing out the importance of the WHO recommendation of a switch over to artemisinin-based fixed-dose combination therapy (ACT) to treat all P. falciparum cases (sensitive or resistant to CQ/SP)
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