Malarial prevalence with respect to public health expenditure in India

Malarial prevalence in India is a major health problem that is continuously prevailing in the country for a very long time. In the previous article, the factors prevailing from urbanization was presented, which is another reason for the increase or decrease of the prevalence of Malaria. The National Vector Borne Disease Control Program monitors the prevalence of malaria in India (Ministry of Health & Welfare, 2017). It is a surveillance body that monitors and evaluates the disease trends, epidemiology, and current status in India. It helps the government of India to make an essential decision regarding the public health expenditure to fight against the disease burden.

In this article the trends analysis of the malaria prevalence in India was done and also correlated with the trend of health expenditure made by the government of India, to study the relationships among them. Trend-based statistics help the health care members plan precautionary measures and generate awareness amongst the population prone to malaria (Vaiserman, et. al., 2016). It also helps the government, pharmaceuticals and healthcare expenditure to control malaria.

Data for malarial prevalence

The trend analysis of malaria prevalence in India is done on the basis of data collected from the time period 2009 to 2017. The incidence cases, mortality cases and cases of malaria caused by Plasmodium falciparum in India were collected from the official site of National Vector Borne Disease Control Program (http://nvbdcp.gov.in/, Ministry of Health & Welfare, 2017).

  • Total Cases is the total number of cases of malaria from various factors.
  • Pf cases are malarial cases from Plasmodium falciparum.
  • Deaths are the mortality frequency due to malaria.
  • Public health expenditures by the government for better healthcare.

The malaria prevalence correlated with the trends followed by the health expenditure done by the government in India. The data on public health expenditure in crores and public health expenditure as a % of GDP collected from the official site of the Central Bureau of Health Intelligence, Directorate general of health services, Ministry of health and family welfare, GOI for the year 2009 to 2017 (Ministry of health and family welfare, 2018).

Trend analysis of the malaria prevalence in terms of incidence, mortality and Plasmodium falciparum cases determine the intensity of disease burden caused by the disease on the population of India in the course of time period i.e. 2009 to 2017. It helped in determining the time of reemergence of the disease in the country. This trend of Malaria prevalence enables comparison with the trends of health expenditure by the government of India in the time same time period i.e. 2009 to 2017. The results from this study could help the government to identify the relationship between the malaria prevalence in India with the amount of health expenditure. A trend-based descriptive assessment was the best method to conduct this test using MS Excel.

Plasmodium falciparum incidence and number of deaths

The trend of the total number of cases of malaria, Plasmodium falciparum cases (Pf) and deaths caused by malarial prevalence (Ministry of Health & Welfare, 2017)

The trend of the total number of cases of malaria, Plasmodium falciparum cases (Pf) and deaths caused by malarial prevalence (Ministry of Health & Welfare, 2017)

From the above graph, the number of total malaria incidence is decreasing i.e. from 15 lakh cases in the year 2009 to 8.8 lakh cases in 2013. Although there is a slight increase of up to 11 lakh total malaria incidence cases in the year 2014-15, the overall trend is decreasing with the least number of cases recorded in 2017 i.e. 8.4 lakh incidence cases. However, the malaria cases caused by Plasmodium falciparum shows a different trend.

At first, the cases of P. falciparum are lower in number (11 lakh cases) as compared to the incidence cases. However, it increased up to approx. 53 lakh cases in 2017 that show that the parasite is becoming more and more resistant to the antimalarial drugs (Shah et al., 2011). Hence, the cases caused by the P. falciparum are increasing among the overall incidence cases as compared to another protozoan parasite, for example, P. ovale and P. vivax.

Research shows that the strain that causes malaria had the capacity to mutate and develop resistance to the anti-malarial drug, which might be the reason for increased cases. The number of death is following the overall decreasing trend throughout the years. The death toll due to malaria reached up to only 31 cases in the year 2017 which is significantly lower. It shows a fast progress in healthcare facilities over the years to prevent deaths caused by malaria (World Health Organisation, 2017).

Implications

Pharmaceuticals use this data to assess the prevalence of malaria on the basis of different strains. Moreover, this also serves as a grounded clinical study to assess the efficacy of drugs against malaria used in India. The trend-based outcomes also help the health care members to improve treatment methods for better control and prevention of malaria cases. Healthcare and pharmaceuticals partner up to improve the intervention methods using drug development and clinical studies of the existing patients (Zetterqvist, et. al., 2015 and Vaiserman, et. al., 2016). This partnership, in turn, helps the government of India fulfil its objectives from the policies and/or develop new policies against malaria control.

Incidence and deaths with respect to public health expenditure

Trends of Public health expenditure (in crores) along with the incidence cases of malaria prevalence (Ministry of health and family welfare, 2018)

Trends of Public health expenditure (in crores) along with the incidence cases of malaria prevalence (Ministry of health and family welfare, 2018)

The public health expenditure increased over the years, from 72,536 crores in the year 2009 to 213,719 crores in the year 2017. On the contrary, the number of incidence of malaria decreased over 15.68 lakh cases in 2009 to 8.81 lakh cases in 2013. However, there was a surge from 8.81 lakh cases in 2013 to  11.69 lakhs in 2015, which again decreased in the corresponding year. This indicates that the healthcare expenditure was either not effective or the fact that the parasites were becoming resistant to the antimalarial drugs (Shah et al., 2011). Although, public health expenditures helps reduce the malarial incidence cases.

Similar cases found globally where efficient antimalarial drugs due to healthcare expenditures helped reduce the cases of malaria. Moreover, effective preventive and healthcare infrastructure have proven to help in decreasing the overall incidence of malaria (World Health Organisation, 2017). Comparing the number of deaths to the public health expenditure, it is clear that the public health expenditure resulted in an efficient health care system that led to the least number of deaths in 2017 (World Health Organisation, 2017). However, the expenditures are still not effective as malarial cases are still prevalent.

Implications

Outcomes from trend-based analysis help the political epidemiologists to assess the efficacy and proper usage of finances for malarial control in district level or state level. This helps the future government and/or the present government to implement and develop public healthcare objectives. Better healthcare objectives and expenditure plans help the pharmaceuticals and healthcare members to indulge in R&D for control and treatment procedures of malaria (Zetterqvist, et. al., 2015 and Vaiserman, et. al., 2016). Thus, the interveners are inter-related in the development of policies, expenditures, and treatment strategies for control of malaria in India.

Implications of the trend analysis

The article draws a significant relationship between the public health expenditure with the incidence and mortality cases of malaria in the country. It can leverage to provide a strong measure to fight against malaria to eradicate the problem in its entirety (Shah et al., 2011). The trends in the mortality rates of malaria in India are decreasing over the years and reached a minimum of 31 cases in the year 2017.

The prevalence of malaria as compared to the public health expenditure from the year 2009 to 2017 has significantly decreased. Improvement in public health facilities responsible for the decreased prevalence of malaria in India. However, there is also a big chance of reemergence of Malaria as it happened in 2013-14 (Shah et al., 2011). So, the situation remains versatile and every precaution applied to avoid re-emergence of Malaria. Healthcare expenditures, therefore, has an important role in improving the health conditions of populations of a country.

Applications of the trend-based outcomes

The implications from the previous sections indicate a positive role of interventions and expenditures against malarial cases in India. Healthcare expenditures are an integral part to modulate the efficacy of policies and malaria prevalence in India. The cases of malaria are at a steady downfall from interventions by the healthcare and pharmaceuticals (Zetterqvist, et. al., 2015 and Vaiserman, et. al., 2016).  The outcomes have application in assessing the efficacy of different intervention methods implemented by the interveners.

Pharmaceuticals apply this outcome to check the efficacy of drugs, whereas healthcare applies the outcome to assess the efficacy of treatment and awareness methods (Vaiserman, et. al., 2016). Political epidemiologists, on the other hand, apply the outcome to check the capabilities of the government and for future planning. Lastly, the government apply the outcomes to evaluate the efficacy of the current health care policy and develop or modify the existing policy for control of malaria. Therefore, a correlation and regression are needed to check the degree and significance of expenditures by the government against malaria control in India.

Challenges faced in controlling malaria

Interveners of malaria in India comprise pharmaceuticals, governments, healthcare etc. The use of statistics by the interveners is aimed at the development of better and efficient interventions, policies, expenditures, and drugs against malaria. An accurate data collection and trend-based study analysis will provide a proof to the interveners on the effective use of the healthcare expenditures over the years and the prevalence of malaria. However, the major challenges according to Shah et al., (2011) against the malaria control in India are:

  • Difficulties faced by the government to implement the strategies and collection of data.
  • Financial support is another challenge, and ineffective expenditures or monitoring.
  • The challenges also include the development of resistance against insecticides and anti-malarial drugs.

Statistical assessments and presentations help the interveners to address the challenges and plan effective measures against malarial prevalence.

References

  • 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.
  • Ministry of health and family welfare. (2018). National Health Profile (NHP) of India- 2018 :: Central Bureau of Health Intelligence. Retrieved August 30, 2018, from http://www.cbhidghs.nic.in/index1.php?lang=1&level=2&sublinkid=88&lid=1138.
  • Shah, N. K., Dhillon, G. P. S., Dash, A. P., Arora, U., Meshnick, S. R., & Valecha, N. (2011). Antimalarial drug resistance of Plasmodium falciparum in India: changes over time and space. The Lancet Infectious Diseases, 11(1), 57–64. https://doi.org/10.1016/S1473-3099(10)70214-0.
  • Vaiserman, A.M. and Marotta, F., 2016. Longevity-promoting pharmaceuticals: is it a time for implementation?. Trends in pharmacological sciences37(5), pp.331-333.
  • World Health Organisation. (2017). WHO | Key points: World malaria report 2017. WHO. Retrieved from http://www.who.int/malaria/media/world-malaria-report-2017/en/.
  • Zetterqvist, A.V., Merlo, J. and Mulinari, S., 2015. Complaints, complainants, and rulings regarding drug promotion in the United Kingdom and Sweden 2004–2012: A quantitative and qualitative study of pharmaceutical Industry self-regulation. PLoS medicine12(2), p.e1001785.

Diksha Tomer

Research Analyst at Project Guru
She is a bachelor in Botany honours from Miranda House (Delhi University) and is pursuing her master’s in Plant Biotechnology at TERI SAS. She is a recipient of Hemendra Kothari Scholarship and her interests lie in the field of Bioinformatics and Biotechnology.
Diksha Tomer

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