Despite noncommunicable diseases dominating the list of India’s most prominent killers, malaria still holds its own as a condition which affects millions.
As a mosquito-borne illness, malaria is a difficult disease to eradicate. Wherever there is the potential for a breeding population of mosquitoes, malaria raises its head. This situation applies in both rural and urban environments, meaning few Indians are ever risk-free when it comes to the disease.
According to the World Malaria Report 2017, more than half of the Indian population (698 million) was at risk of malaria in 2016. The Report estimates there to be a total of 1.31 million malaria cases in the country, with around 23,990 deaths associated with the disease.
According to the estimates of a sixteen-member committee set up by the National Vector Borne Disease Control Programme (NVBDCP) the disease burden may actually be far higher. Their estimates place the total annual number of cases in India at about 9.7 million, with between 30,014 and 48,660 deaths.
Given that the fight against malaria has been ongoing for decades, novel new methods may be needed to come out on top. New research published in The Lancet may provide such a method.
A study that took place in Burkina Faso may provide a new method of reducing malaria cases. The study found that childhood malaria episodes could be reduced by up to twenty percent — from 2.49 to two cases per child. The means by which this occurs, however, may be rather complex in its implementation. The method would require that the whole population be administered a drug called ivermectin every three weeks throughout the mosquito season. In rural stretches of India, where there is limited access to healthcare personnel, mounting a campaign of this kind is likely to prove challenging.
The study was the first randomised trial of its kind, involving 2,700 people — 590 of which were children — from eight villages in Burkina Faso. The drug, ivermectin, is a widely used medication in treating diseases such as scabies and river blindness. The trial showed that side effects were also negligible.
“Ivermectin reduces new cases of malaria by making a person’s blood lethal to the mosquitoes who bite them, killing mosquitoes and therefore reducing the likelihood of infection of others,” explains study author, Dr Brian D Foy of Colorado State University. “Because ivermectin has a unique mode of action compared to other malaria control insecticides and antimalarial drugs, it could be used alongside drugs that treat malaria to combat residual transmission of the disease.”
Though this method is in its initial phases of study, whether it will be cost-efficient if used in India is questionable at best. In India, many issues are caused with medications that require repeat application. If individuals within the community are not receiving the three week reapplications then the efficiency of the treatment will fall.
In addition, huge stockpiles would be needed if three week applications were necessary for every individual of a mosquito prone area in a densely populated urban metropolis. The cost of a programme using this method could quickly outweigh its impact. Given infrastructural and staffing challenges dogging great swathes of India’s public health system, implementing the method may have cons that outweigh its pros.