Malaria: prevent it

There were few diseases that we know by name since childhood days. One was them was Malaria. We know this because it was such a common thing happening around in the village. I vividly remember that during my childhood days my dad suffered multiple times from malaria. He even had what is called as cerebral malaria which can be life threatening. He would usually have feelings of coldness and shivering (chills and rigor) and later on have high fever followed by profuse sweating. This occurred almost in a regular pattern with few days gap. We had to hold him down in the blanket when he had that kind of episode. Timely interventions at the hospital saved him. When I was in 11^th standard or what we called it pre-university days, my mom also suffered from cerebral malaria. She lost her consciousness and was admitted at Naga Hospital Kohima. We took turns to take care of her. I remember sleeping on the floor one night. We could only pray and hope that the medicine works. Thankfully she recovered from malaria after few days and was back healthy. It was a dreaded disease and one that we know we need to protect ourselves from.

Later on I learnt more about Malaria in detail. The name itself is a misnomer because literally it means ‘bad air.’ The name was given during the period when Miasma theory was popular which suggest that disease was caused by bad air. Later on it was Charles Louis Alphonse Laveran who found out that Malaria was caused by a Parasite, came to be known as Plasmodium. It was classified into P.vivax, P.falciparum, P.ovale and P. Malariae. Plasmodium falciparum was the one responsible for the cerebral malaria.  It was Ronald Ross who proved that mosquitoes are the insects responsible for transmission of malaria (vector for malaria) from one person to another. He was the one to show the complete life cycle of malaria parasite in mosquitoes. Interestingly, all the mosquitoes were not carrying the malaria parasite but a particular type known as female Anopheles mosquitoes were responsible for this deadly disease. Only female species are responsible because they require biting a person to draw blood for the development of the eggs. In the process, they transmit the malaria parasite.

Malaria has claimed so many lives. In fact, the World Health Organisation (WHO) estimates that in 2015 alone there were 212 million cases of malaria and 429000 deaths in the world. Closer to the country’s scenario, as per the National Vector Borne Disease Control Programme report (NVBDCP) there were 1.1 million cases and 384 deaths reported in 2015 alone in India. However, studies and estimates have shown that the actual malaria number cases and deaths are much higher than the actual report since it is underreported. 

There are many species of Anopheles mosquito responsible for malaria transmission in India:

Species	Distribution and special feature
An. culicifacies	Main vector for malaria in India. It is widely distributed in India and occurs sporadically in north-east (NE) India but not reported in A&N islands and Lakshadweep.
An. fluviatilis	Found in the foothill areas of both peninsular and NE India.
An. minimus	Restricted to the NE states and is the primary vector of malaria in NE India.
An. philippinensis	Major vector of malaria in deltaic West Bengal, but also found in NE India
An. dirus	Restricted to the forest areas of the NE states
An. stephensi	Found throughout India but sporadic in NE states and is the primary vector for urban malaria.
An.annularis	Occurs all over India except A&N islands and Lakshadweep.
An. varuna	Distributed widely in the country from north east plains peninsular India and the Lakshadeep
An.sundaicus	Restricted only to the Andaman and Nicobar islands.

Source: Malaria vectors in India. Dte National Anti Malaria Programme, Government of India-2002.

With lots of forest and natural vegetation, many species of Anopheles mosquitoes find their habitat in the NE India. Another interesting thing is that the three predominant vectors in the NE (An. dirus,    An. philippinensis and An. fluviatilis) seems to collaborate together to maintain a continuous transmission throughout the year. So, residing in one of the NE states makes us quite vulnerable to the attacks of malaria especially when many are involved in agriculture.  

The only way forward is prevention. On the World Malaria Day, 25^th April 2017, WHO called for efforts to prevent malaria and saves lives with the theme “Malaria prevention works: let’s close the gap.” The proven and still recommended methods are using personal protective measures and insecticide treated bednets along with other vector control measures. Good news is 7 countries have been certified by WHO as having eliminated malaria: United Arab Emirates, Morocco, Turkmenistan, Armenia, Maldives, Sri Lanka and Kyrgyzstan. India would require a concentrated effort to move forward. A much researched and awaited vaccine for malaria, an injectable vaccine known as “RTS,S.” is to go on pilot programme from 2018 coordinated by WHO. So, perhaps there is hope for those living in the remote villages to fight against malaria.