Socioecological Perspectives of Malaria in India: A Review

Abstract

P-522 Introduction: Malaria is a major health problem in India and every year it claims the lives of thousands of people and infects millions. Although nearly eradicated, it is significantly on the rise. According to the WHO, in 2003, there were approximately 2.8 million reported cases of malaria in India. There are several opinions regarding the resurgence of malaria and majority of them blame the operational aspect, which are often too simplistic and far from the reality. The present study has tried to establish the complex social and ecological perspective of malaria occurrence in various geographical locations in the country. Methods: Data for the malaria study was retrieved from the Central Bureau of Health Intelligence (CBHI) of India for the years 1994 to 2001. The study also analyzed socio-ecological perspectives of epidemics derived from several secondary sources. The majority of the secondary data on epidemics was collected from online searches (Pub med, google scholar) and unpublished government reports. We also linked the malaria outbreak with the dynamics of recent ecological change due to human interactions. Results: Our analysis led to the identification of states and areas of the county yielding high number of malaria cases in the past decade and to those regions in which there was an increased rate in malaria cases during the same period. State level data analysis identified Orissa, Madhya Pradesh, and Karnataka among the states with high number of malaria cases. Furthermore, we recognized that the states such as Gujarat and Chandigarh were showing a decrease in malaria cases. Falciparum malaria continues to exist in remote tribal forest areas in central and eastern part of the country where health service is very poor. The appearance of vectors in several hilly areas indicates the possible role of global warming and population mobility from endemic areas. Investment and priority in malaria eradication program was found to be linked with recent epidemics. Irrational medication and improper insecticide spray resulted in resistance of parasites and vectors respectively, hence more malaria incidence and fatality. Discussion and Conclusion: This study clearly recognizes a need for better disease and vector surveillance, rational treatment and proper vector control for effective eradication of malaria in India. There is a requirement of micro and macro level analysis on demographics, population behavior and movement, irrigation, deforestation and environment change in order to implement a need based control approach.