HEALTH MATTERS: Malaria and Dengue – Early Onset: Is India Prepared?

Photo of Aedes Aegypti mosquito. Photo credit: Centers for Disease Control and Prevention

Photo of Aedes Aegypti mosquito.
Photo credit: Centers for Disease Control and Prevention

With the onset of summers, there comes a major change in weather patterns highlighted with soaring temperatures. This factor impacts health in a number of ways, especially giving rise to vector borne diseases like malaria and dengue.

Malaria and dengue have always been a major health threat across the country. So far, every year, around two million malaria cases have been reported with a thousand deaths.

One of the most life threatening infectious diseases, malaria and dengue continue to pose a serious health risk in both at the urban and rural areas across all states. Due to poor health system support, low awareness and lack of proper sanitation and hygiene, malaria and dengue cases remain high, especially in rural areas.

The biggest challenge for those living in hard to reach areas is that communities do not have access to early diagnosis or treatment and care on time. Multiple lives are lost due this. Vector borne diseases like malaria and dengue have been a threat for decades. However few steps have been taken to survey the extent of disease burden especially in rural areas. For instance, in Jharkhand, where a significant number of vulnerable tribes reside, it was found that a large number of families were found to have malaria. However, few got access to diagnosis and treatment, which resulted in deaths. So far, no surveillance has been done to identify the magnitude of vector diseases like malaria in these groups.

In other states like Odisha, malaria has been found to be rampant and the state has reported the highest malaria deaths, especially in rural areas.

Similarly, in urban centres, the conditions are not appropriate either. Vector borne diseases like malaria, dengue and chikungunya cases are reported every year. Across many areas, water resources, drainage systems and sanitation is not maintained properly, which allows mosquitoes like Aedis aegypti to breed in these flowing waters which transmit the virus and expose people to vector borne diseases like dengue and malaria.

File photo-PTI

File photo-PTI

Though the government has given instructions to departments that oversee the urban centres to ensure fogging is done across the state to prevent the breeding of parasites, often there are delays in the process, therefore it fails to control the parasites.

Apart from Aedis aegypti, which is a vector for malaria and dengue fever, the more virulent virus is Plasmodium Falciparum (PF) that is life threatening.

In India, 50% of overall malaria cases that are reported are due to Plasmodium Falciparum (PF), a parasite which is transmitted by Anopheles mosquito, which causes severe form of malaria. In such cases, if the infected person is not treated on time, it leads to morbidity and death. However, poor knowledge and lack of awareness about the disease among the population has been a significant barrier in controlling and preventing malaria and dengue.

For both malaria and dengue cases, if the patient is not treated on time, the risk of death increases.

In the case of dengue, the patients have dengue hemorrhagic fever which causes severe illness and heavy bleeding as well. Not just in adults but also adolescents and children, malaria and dengue continue to be a serious health threat, especially in newborns and infants who are less than 12 months of age are one of the most vulnerable groups affected by malaria.

However, several surveys conducted have found that many families do not understand the symptoms of malaria and dengue such as fever, vomiting, fatigue, and abdominal pain. Delays in treatment end up harming the patient severely. It has also been found that many families in rural areas are not able to afford treatment and care. Apart from distance from their habitats, which makes it difficult for them to reach the district hospitals on time, the indifference on the part of the health services is another reason why they are provided with no timely diagnosis or adequate treatment in the areas where they reside. Multiple lives are lost due to this.

This year too, according to National Vector Borne Disease Control Programme (NVBDCP) which oversees vector borne diseases, malaria and dengue cases are already being reported in many states much before the onset of monsoon, which is when mosquitoes like Aedes aegypti, which causes malaria usually breed in flowing water.

Malaria outbreak

health-checkupTo identify the extent of malaria and dengue in the country, several survey and tests have been done by NVBDCP. So far blood tests on 1,46,16,241 people have been done to identify malaria cases. According to the survey, 97,178 have tested positive for malaria.

71,370 cases were found to be have Plasmodium Falciparum (PF), which is known to be a virulent virus and is one of the most life threatening infection.

The most affected states were found to be:

A) Chhattisgarh — where 5,25,656 people were tested for malaria, of which 21,798 were found to have malaria and 18,197 had Plasmodium Falciparum.

B) Orissa — where 9,63,068 people were tested for malaria, 45,234 were found to be positive and 37,730 had Plasmodium Falciparum infection. Three people died due to malaria.

C) In West Bengal — where 9,66,815 people were tested for malaria, 1,026 were found to be positive, while 242 had Plasmodium Falciparum infection. One patient died due to malaria.

D) In Maharashtra — where 26,19,164 were tested for malaria, 4,366 were found to be positive for malaria and 2,328 were diagnosed with Plasmodium Falciparum infection.

E) In Jharkhand — where 12,71,529 were tested and 49,808 tested positive for malaria, while 4,808 had Plasmodium Falciparum infection.

F) In Madhya Pradesh — where 7,97,255 were tested, 2,156 were found to have malaria, while 1,011 had Plasmodium Falciparum infection.

I) In Gujarat — where 19,19,714 were tested, 1,302 had malaria, while 186 had Plasmodium Falciparum infection.

J) In Meghalaya — where 55,060 people were tested, 3,451 were positive for malaria, while 3,018 had Plasmodium Falciparum infection.

K) In Mizoram — where 34,998 were tested of which 1066 tested positive for malaria, while 774 had Plasmodium Falciparum infection.

L) In Andhra Pradesh — where 9,90,839 were tested, 1,792 tested positive for malaria while 1,343 had Plasmodium Falciparum infection.

Other states were tested too, but they did not report malaria cases.

Dengue Prevalence

The survey found that 2,929 people were also reported to have dengue and five have succumbed to the disease. Kerala reported 753 dengue cases, while Tamil Nadu reported 752 cases of dengue.

Two died in Kerala and three in Tamil Nadu due to dengue. While Maharashtra reported 341 and Karnataka 331 cases, no deaths were reported in these states.

The question that arises often is why enough measures are not taken prior to the outbreaks. If the population is made aware about the possibility of an outbreak and information is shared about how to protect themselves from getting infected, it can save lives. However, such steps have not been taken at the scale they are required. Currently, these gaps have been addressed.

Way forward to prevent malaria and dengue

Several researches have found that vector borne disease like malaria and dengue are not merely a health issue, but also linked with behavioural, environmental and socio-economic factors.

If malaria and dengue are to be controlled then there is an urgent need to engage with the community both at the urban and rural areas.

Currently, it has been found that in many rural areas, which are away from the mainstream, apart from poor awareness about the symptoms of these infectious diseases, treatment and medications are often not available, which leads to death. Apart from poor knowledge, the prime cause is poor healthcare support from the government.

To prevent vector borne diseases like malaria and dengue from harming the public, several steps have to be taken both by the Centre and the State government, with special focus on the unreachable areas, where the most marginalized communities live, especially in areas where health services and early diagnosis, treatment and care are not provided for ailments like malaria, dengue and other infectious diseases.

For the public to prevent themselves from succumbing to infectious diseases like malaria and dengue, the public needs support at all levels, so that they can themselves take appropriate measures to protect themselves and their families from these life-threatening diseases.

Primarily it is imperative that the community ensures better hygiene and water management in their households and neighbourhood and that awareness can be done through interactions. Community participation and their learning can help them gather better knowledge about the disease and what causes it which will bring about change in the public. During these discussions, people will also be made aware of the risk factors linked to malaria and dengue infections and what steps need to be taken which will help in behavioural change in the public domain. Once these changes happen, the public will be better prepared to tackle these diseases.

So far, efforts to control malaria have not been successful, because there has been no engagement with the public and the community in rural areas. Their needs for health care and struggle with these diseases have not been addressed adequately.

Also, the government’s response, especially in many states has been limited. Even though surveillance and surveys are being executed to identify the disease burden across the country the outreach, however, is poor.

If India wants to eliminated malaria, it is crucial that across all states, districts and unreached areas, along with surveillance to identify the magnitude of vector borne diseases, there is timely monitoring, testing and treatment by using Microscopy or Rapid Diagnostic Kit (RDK) is conducted to intensify malaria control, as well as effective treatment and appropriate vector control measures according to the needs of people, in different regions. Another priority is to strengthen health services across all ignored areas.

If these steps are taken, it will ensure that all people, across all categories will be provided with diagnosis, treatment and monitoring and proper health care.

Such measures once implemented will also make significant decrease in the burden of malaria and dengue and to overall prevent vector borne disease. Only then can India win the battle against malaria and dengue.

(Mohuya Chaudhuri is a journalist and researcher)