Malaria Disease: Causes, Symptoms Prevention and Treatment

Context: India’s malaria challenge is no longer about widespread burden — it now lies in tackling hidden carriers, hard-to-reach regions, and a resilient parasite. The 2030 elimination target is more than a deadline; it is a litmus test of how effectively science, governance, and public health can come together to conquer this age-old disease.

India has made significant progress in malaria control, enabling its exit from the HBHI category.

Malaria Disease

Malaria is a mosquito-borne infectious disease caused by Plasmodium parasites, which are transmitted through the bite of infected female Anopheles mosquitoes. The disease is prevalent in tropical and subtropical regions, particularly in Africa, South Asia, and South America.

Key Strategies for Malaria Reduction

Disease Management

• Early Case Detection:
  • Active, passive and sentinel surveillance for rapid identification of malaria cases.
  • Effective treatment and strengthened referral services.
• Epidemic Preparedness & Rapid Response: Ensuring quick interventions to control outbreaks.

Integrated Vector Management

• Indoor Residual Spraying (IRS): Used in selected high-risk areas.
• Long-Lasting Insecticidal Nets (LLINs): Distributed in high malaria-endemic areas.
• Larval Control Measures:
  • Use of larvivorous fish to control mosquito larvae.
  • Anti-larval interventions using bio-larvicides.
  • Environmental engineering to prevent mosquito breeding in urban areas.

Supportive Interventions

• Behaviour Change Communication (BCC): Educating communities about malaria prevention.
• Inter-Sectoral Convergence: Coordination between different government departments for effective malaria control.
• Human Resource Development: Training and capacity building of healthcare professionals to improve malaria management

Causes and Transmission of Malaria Disease

• Caused by Plasmodium species (P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi).
• Spread through mosquito bites, blood transfusions, organ transplants, or from mother to child during childbirth.

Symptoms

• High fever, chills, and sweating
• Headache and muscle pain
• Fatigue and nausea
• Severe cases can lead to organ failure, anaemia, and cerebral malaria

Prevention & Treatment

• Prevention: Mosquito control measures (nets, repellents, insecticides), vaccination (RTS), and preventive medications.
• Treatment: Antimalarial drugs like artemisinin-based combination therapies (ACTs), chloroquine, and primaquine, depending on the type and severity of infection.

Forms of Malaria

• Plasmodium falciparum (Pf)– Most lethal form.
  • Causes severe symptoms and complications.
  • Predominant in Africa, but also exists in India.
• Plasmodium vivax (Pv) – Common in India.
  • It can remain dormant in the liver and cause relapses.
  • Harder to eliminate due to asymptomatic carriers and delayed symptoms.
• Mixed Infections (Pf + Pv) – Not uncommon in states like Jharkhand (up to 20% of cases).
  • Pose diagnostic and treatment challenges.
• Plasmodium malariae, P. ovale, P. knowlesi – Rare in India.
• Zoonotic strain – Plasmodium cynomolgi
  • A monkey malaria parasite.
  • Emerging as a model for P. vivax research.

Prevalence of Malaria in India

• Reduction: Malaria cases have dropped by over 80% from 2015 to 2023.
• National Average: Significantly improved, showing India’s progress in control measures.
• High-burden pockets remain:
  • Lawngtlai (Mizoram) – 56 cases per 1,000 population.
  • Narayanpur (Chhattisgarh) – 22 cases per 1,000.
• Asymptomatic cases: Serve as silent reservoirs, especially in tribal and forested regions.

Why Malaria Eradication Still Lags

• Biological Complexity of P. vivax: Dormancy and relapse potential complicate treatment.
• Insecticide and Drug Resistance: Mosquitoes are surviving insecticides.
  • Parasites are evolving resistance to existing medications.
• High Asymptomatic Carrier Rate: Hard to detect and treat, facilitating silent transmission.
• Health Access in Remote Areas: Tribal belts and forested regions are underserved in healthcare.
• Fragmented Surveillance and Diagnostics: Weak disease tracking, especially for mixed infections.
• Slow Vaccine Rollout: Existing vaccines have limited efficacy or logistical barriers.

Key Initiatives for Malaria Elimination in India

• National Framework for Malaria Elimination (NFME), 2016–2030: Strategic roadmap targeting elimination by 2030.
• National Centre for Vector Borne Diseases Control (NCVBDC): Coordinates data, surveillance, and vector control.
• Indigenous Vaccine Development:

• • AdFalciVax (ICMR, 2025): India’s first dual-stage vaccine (infection + transmission blocking).
  • Stable at room temperature, useful in rural deployment.

• R&D Collaborations: ICMR, NII, RMRC, and international partners working on PfSPZ, PfRH5, and Pvs230D1M.
• Transmission-Blocking Vaccines (TBVs): Target the mosquito gut stage to halt community transmission.
  • Indian teams are actively contributing.
• New Platforms: mRNA vaccines, protein-ferritin nanoparticles, engineered antibodies, and gene drive

Way Ahead

• Scale up Surveillance and Diagnostics: Especially in tribal and asymptomatic zones.
  • Use of AI, remote sensing, and portable diagnostic kits.
• Fast-track Vaccine Trials and Regulatory Approval: Accelerate AdFalciVax and other indigenous candidates.
  • Leverage COVID-era learnings for logistics and outreach.
• Integrate Vector Control with Genomic Monitoring: Monitor drug and insecticide resistance.
  • Use gene editing and gene drives with ethical safeguards.
• Targeted Public Health Interventions: Focus on hotspots, migrant labour zones, and forested areas.
• Community Awareness and Health Worker Training: Boost IEC campaigns in vernacular languages.
  • Equip ASHAs and tribal health workers with the necessary tools.
• Cross-sectoral Coordination: Align efforts across ministries — Health, Tribal Affairs, Rural Development.

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