Malaria is a vector-borne disease caused by Plasmodium, carried and spread by Anopheles species of mosquito. It is prevalent across the globe, largely in the countries near to the equator as well as tropical countries and is associated with many risk factors (Midekisa et. al., 2012). Associated malarial risk factors are largely favoured by the climatic and economic conditions. It largely occurs in the regions having high rates of precipitation, humidity, and rainfall making it optimum for the malaria vector to breed and flourish. In addition economic conditions of the people and incompetence of the national government also leads to the prevalence of malaria. The article explores the associated major risk factors of malaria prevalence in India. These associated malarial risk factors are also helpful in the implementation of public healthcare policies.
Climatic conditions are major malarial risk factors
The risk of malaria infection occurs mainly in the rainy season i.e. from the month of June to September in India (Midekisa et al., 2012). Moreover, the malaria transmission rates increase as the temperature rises up to a threshold level of approximately 37ᵒ C and rarely gets surpassed (Beck-Johnson et al., 2013). This type of climatic condition is very much prevalent in over 90% of India. Climatic condition is responsible for the higher prevalence of malaria cases in states of Madhya Pradesh, Odhisa, Chattisgarh, Jharkhand, Maharashtra, Telangana, and Andhra Pradesh.
Since these states of India hold the majority percentage of malaria cases, the government’s majority expenditures and medical initiatives for healthcare are also focused towards these states. National Rural Health Mission (NRHM) is one such initiative by the government to focus on rural and tribals of the mentioned states and mitigate climatic condition associated malarial risk factors in India.
Socio-economic factors as a risk
Socio-economic factors like employment, education, and income impose a major risk of causing malaria (Yukich et al., 2013). According to a report, the unemployment rate in India increased to 3.52% in 2017 from 3.51% in 2016. On the other hand, 25% to 27% of the total population in India are illiterate. This intimates the lack of awareness about the preventive and control measures of the disease, the knowledge about the government policies against malaria and its methods of implementation.
In this regard, the government imposes various initiatives like the NRHM, along with the collaboration of private healthcare investments like ITC’s healthcare initiative and TATA’s Transform Rural India. Lack of income also impacts the lifestyle of the public, leading to poor quality of hygiene, sanitation, and living conditions. These initiatives by the government and the private healthcare organization help improve the conditions of employment, education, and income of the poor and rural population to mitigate socio-economic associated malarial risk factors in India.
Migration and travel as a risk
Human migration and short-term travel pose as malarial risk factors globally (Yukich et al., 2013). Scientifically, the risk of the situation occurs with the people travelling from malarial endemic regions to regions not endemic to malaria. One such example is, P. falciparum and P. vivax species are prevalent in India, but with international travels and immigrants from different regions of the globe has led to the malarial cases with P. ovale and Plasmodium malariae strains (Siwal, et al., 2018).
Therefore the government and the National Vector Borne Disease Control Programme have set up compulsory tests for immigrants (Ministry of Health & Welfare, 2017). International travellers and government expatriates use Chemoprophylaxis and Doxycycline while travelling to a country listed as a risk of malaria. These are some policies by the government plan to mitigate migration and short-term travel associated with malarial risk factors in India.
Knowledge gaps as risk
The last and the most important associated malarial risk factor is the lack of knowledge or knowledge outreach in India, in both rural and urban (Kulkarni et al., 2016). Knowledge gaps are not just limited to the population of India, but also to the government and the pharmaceutical industry. Lack of hierarchy and implementation procedure of the government to impart malarial education has resulted in the prevalence of malaria in both urban and rural areas of India. However, knowledge gaps of the pharmaceutical R&D are limited to lack of technical capabilities and failure to treat drug-resistant malarial strains (Kulkarni et al., 2016).
Therefore the government has associated with WHO and World Bank towards effective implementation of knowledge outreach to the people of rural, remote, and urban areas (Ministry of Health & Welfare, 2017). Moreover, it also helps the R&D to associate and retrieve advanced information of methods to control drug-resistant malaria strains. Mitigating the associated malarial risk factors of knowledge gap assists public health resource allocations and reduce the risk of malaria prevalence.
- Beck-Johnson, L. M. et al. (2013) ‘The Effect of Temperature on Anopheles Mosquito Population Dynamics and the Potential for Malaria Transmission’, PLoS ONE. Edited by F. T. M. Costa. San Francisco, USA: Public Library of Science, 8(11), p. e79276. doi: 10.1371/journal.pone.0079276.
- Kulkarni, M. A. et al. (2016) ‘10 Years of Environmental Change on the Slopes of Mount Kilimanjaro and Its Associated Shift in Malaria Vector Distributions’, Frontiers in Public Health. Frontiers Media S.A., 4, p. 281. doi: 10.3389/fpubh.2016.00281.
- Midekisa, A. et al. (2012) ‘Remote sensing-based time series models for malaria early warning in the highlands of Ethiopia’, Malaria Journal. BioMed Central, 11, p. 165. doi: 10.1186/1475-2875-11-165.
- Ministry of Health & Welfare, G. (2017). Malaria :: National Vector Borne Disease Control Programme (NVBDCP). Retrieved August 28, 2018, from http://nvbdcp.gov.in/index1.php?lang=1&level=1&sublinkid=5784&lid=3689.
- Siwal, N., Singh, U.S., Dash, M., Kar, S., Rani, S., Rawal, C., Singh, R., Anvikar, A.R., Pande, V. and Das, A., 2018. Malaria diagnosis by PCR revealed differential distribution of mono and mixed species infections by Plasmodium falciparum and P. vivax in India. PloS one, 13(3), p.e0193046.
- Yukich, J. O. et al. (2013) ‘Travel history and malaria infection risk in a low-transmission setting in Ethiopia: a case control study’, Malaria Journal. BioMed Central, 12, p. 33. doi: 10.1186/1475-2875-12-33.