Distribution of Plasmodium strains of Malaria in India

Plasmodium genus causes an estimated 438,000 global deaths annually. In India, mainly two species of Plasmodium is prevalent, Plasmodium falciparum and Plasmodium vivax (Siwal, et al., 2018). P. vivax accounts for 53% of the total malaria cases in India. However, more drug-resistant Plasmodium falciparum has been identified in India over the last two decades. The burden of malaria in India is complex from highly variable malaria epidemiological profiles, transmission factors, and the presence of multiple Plasmodium species. Therefore this article explores the distribution of both strains in India in four states of India, i.e. Odisha, Jharkhand, Madhya Pradesh and Chhattisgarh. These states have indicated consistent high cases of malaria.

Plasmodium falciparum strain distribution in India

Plasmodium falciparum strain is more prevalent in India than Plasmodium vivax. Statistical assessments found that Odisha had the maximum prevalence whereas, the minimum prevalence is in Madhya Pradesh. The higher prevalence in Odisha is contributed by ambient temperature and relative humidity. On the other hand, in Jharkhand, the prevalence increased between the period of 2014-2017. Out of one million cases of malaria in India, 7% occurs in Jharkhand and out of which 95% of cases are caused primarily by the Plasmodium falciparum (Das et al., 2017).

The forest, hilly terrain, favourable climate, inaccessible area, tribal culture, migration and social unrest are the main contributing factors to the malaria burden in Jharkhand and Chhattisgarh (Saxena et al., 2014). Prevalence for the Plasmodium falciparum in Chhattisgarh also increased over the years. The higher transmission rate of the pathogen and vector is facilitated by the climatic conditions and living conditions in the tribal and rural areas of Chhattisgarh and Jharkhand. However, Madhya Pradesh indicated lower prevalence in comparison to Odisha, Jharkhand, and Chhattisgarh. This is contributed by the population difference between the four states. The density of malaria distribution of Odisha, Jharkhand, and Chhattisgarh is higher than in Madhya Pradesh. Increased drug-resistant strains of P. falciparum is also another cause for the distribution

Plasmodium vivax strain distribution in India

The prevalence of Plasmodium vivax showed a decreasing trend in three states of Madhya Pradesh, Chhattisgarh and Jharkhand. On the other hand, prevalence is increasing in Odisha from 2014 to 2017. Around 13% of the total cases of malaria are due to Plasmodium vivax in the country and occur mostly in Odisha. The high prevalence in Odisha is contributed by climatic and socio-economic factors (Anvikar et al., 2016). It is also concentrated in the urban areas of Madhya Pradesh. Odisha and Madhya Pradesh have seen rapid construction, and the mushrooming of slums, leading to the increased cases of Plasmodium vivax. On the other hand, the migration of population from tribal and rural conflicted zones of Jharkhand and Chattisgarh has shown a decrease in cases of Plasmodium vivax.

The intervention strategies of Plasmodium vivax and Plasmodium falciparum

The statistics found that the prevalence of Plasmodium vivax is greater than Plasmodium falciparum in the states of Jharkhand and Madhya Pradesh. However, in Chhattisgarh, the Plasmodium falciparum indicated more prevalence. In Odisha, both strains are highly prevalent equally. Statistics indicate an increase in the number of cases caused by both strains every year in Odisha. Poor living conditions and knowledge gaps of the rural and tribal population living in Odisha, Jharkhand, Madhya Pradesh, and Chhattisgarh contributes to the increased cases. Moreover, the poor socio-economic climate of Odisha, Jharkhand, and Chhattisgarh increased the prevalence of Plasmodium falciparum (Srinath et al., 2018).

However, to control the prevalence of both strains, the National Vector Borne Disease Control Programme (NVBDCP) along with the Government of India provides large healthcare expenditures (Srinath et al., 2018). These expenditures are mainly for National Rural Health Mission towards free medication and services, free medical education, emergency medical education and training, awareness, and a better lifestyle. T

State healthcare scheme to control the distribution

Madhya Pradesh implemented the MP Swasthya Suraksha Yojana to look after public healthcare and eradicate diseases like malaria. Expenditures include free medical and healthcare services to the poor and the rural population (Pricewaterhouse Coopers, 2018). Similarly, Jharkhand too implemented the chief minister’s Health Insurance Scheme, Sarva Swasthya Mission, and Prime Minister Jan Swasthya Yojana for improving the cases of malaria in Jharkhand and better healthcare outreach to the tribal and rural population.

Odisha has Biju Krushak Kalyan Yojana and Mukhyamantri Swasthya Seva Mission for healthcare services to control the prevalence of malaria. Lastly, Chhattisgarh has Baal Hriday Suraksha Yojana and Janani Suraksha Yojana to intervene and management of malaria prevalence, especially in the rural and tribal regions (Pricewaterhouse Coopers, 2018). These initiatives also involve collaborations with healthcare organizations like Apollo Hospitals, Fortis, and Wockhardt to help the state governments in the provision of treatments and medical support to the rural and poor populations.

References

• Anvikar, A. R. et al. (2016) ‘Epidemiology of P. vivax Malaria in India’, The American Journal of Tropical Medicine and Hygiene, 95(6 Suppl), pp. 108–120. doi: 10.4269/ajtmh.16-0163.
• Das, M. K. et al. (2017) ‘Malaria epidemiology in an area of stable transmission in tribal population of Jharkhand, India’, Malaria Journal. BioMed Central, 16(1), p. 181. doi: 10.1186/s12936-017-1833-9.
• Pricewaterhouse Coopers. (2018). Ayushman Bharat – National Health Protection Mission Providing. Mumbai. Retrieved from https://www.pwc.in/assets/pdfs/publications/2018/ayushman.pdf.
• Saxena, R. et al. (2014) ‘Identification of risk factors for malaria control by focused interventions in Ranchi district, Jharkhand, India.’, Journal of vector borne diseases, 51(4), pp. 276–81.
• 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.
• Srinath, P., Kotasthane, P., Kher, D., & Chhajer, A. (2018). A Qualitative and Quantitative Analysis of Public Health Expenditure in India: 2005-06 to 2014-15. Retrieved from http://takshashila.org.in/wp-content/uploads/2018/07/TWP-Public-Health-Expenditure-in-India-PS-PK-DK-AC-2018-01.pdf.