Abstract
BackgroundIndia has launched the malaria elimination initiative in February 2016. Studies suggest that estimates of malaria are useful to rationalize interventions and track their impact. Hence, a national study was launched to estimate burden of malaria in India in 2015.MethodsFor sampling, all 624 districts of India were grouped in three Annual Parasite Incidence (cases per thousand population) categories, < two (low); two-five (moderate) and > five (high) API. Using probability proportional to size (PPS) method, two districts from each stratum were selected covering randomly 200,000 persons per district. Active surveillance was strengthened with 40 trained workers per study district. Data on malaria cases and deaths was collated from all health care providers i.e. pathological laboratories, private practitioners and hospitals in private and public health sectors and was used for analysis and burden estimation.ResultsOut of 1215,114 population under surveillance, 198,612 (16.3%) tests were performed and 19,386 (9.7%) malaria cases were detected. The malaria cases estimated in India were 3875,078 (95% confidence interval 3792,018–3958,137) with API of 3.05 (2.99–3.12) including 2789,483 (2740,577–2838,389) Plasmodium falciparum with Annual Falciparum Incidence of 2.2 (2.16–2.24). Out of 8025 deaths investigated, 102 (1.27%) were attributed to malaria. The estimated deaths in India were 29,341 (23,354–35,327) including 19,067 (13,665–24,470) confirmed and 10,274 (7694–12,853) suspected deaths in 2015–2016.ConclusionsEstimated malaria incidence was about four folds greater than one million reported by the national programme, but three folds lesser than thirteen million estimated by the World Health Organization (WHO). However, the estimated deaths were 93 folds more than average 313 deaths reported by the national malaria programme in 2015–2016. The 29,341 deaths were comparable with 24,000 deaths in 2015 and 22,786 deaths in 2016 estimated by the WHO for India. These malaria estimates can serve as a benchmark for tracking the success of malaria elimination campaign in India.
Highlights
India has launched the malaria elimination initiative in February 2016
Mortality estimates for the year 2002 were provided by Dhingra et al based on cause of death by verbal autopsy (COD VA) data of the Million Death Study from 2001 to 2003 [13, 14]
In the low endemic areas, 36 and 133 malaria cases were captured in Jaipur and Kolhapur districts respectively with < 1 test positivity rate (TPR) (Fig. 4, Table 1)
Summary
India has launched the malaria elimination initiative in February 2016. Studies suggest that estimates of malaria are useful to rationalize interventions and track their impact. A national study was launched to estimate burden of malaria in India in 2015. Many studies have been conducted using country data and subjecting it to different methodologies, assumptions and epidemiological models to generate estimates of malaria burden [1, 5–11]. Mortality estimates for the year 2002 were provided by Dhingra et al based on cause of death by verbal autopsy (COD VA) data of the Million Death Study from 2001 to 2003 [13, 14]. Based on Vital Registration System and Medical Certification of Cause of Death, Kumar et al estimated about 146,000 and 141,000 deaths due to malaria in India respectively in 1997 and 1998 [17]. A committee constituted by the Government of India arrived at an estimate of 9.751 million cases and 40,297 deaths due to malaria (30,014–48,660) in the year 2010 [18]
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