Influence of urbanization on the prevalence of Malaria in India

Urbanization is one of the many risk factors for malaria prevalence in India (Anvikar et al., 2016). Urbanization influenced malaria prevalence has escalated over the past two decades in India. According to the UN Department of economics and social affairs, 55% of the world’s population lives in urban areas, which is expected to increase up to 68% by the year 2050 (UN Department of Economics and Social Affairs, 2018). This rise of urbanization predicts a massive rise in malarial prevalence, mainly, drug-resistant and mutated strains of Plasmodium. This also means that the government of India, along with the pharma industry has a bigger role to play in managing the new challenge of increasing drug-resistant malarial vectors in India.

Heterogeneity of urbanization influenced malaria prevalence

An urban population is a heterogeneous group of a population consisting of both the urban and the migrated rural population,  living in the slum areas. Better education, job opportunities, and healthcare facilities motivate migration of people from not only rural regions but also from 3-tier cities and smaller towns (Ganguly et al., 2014). Poor economic development, environmental changes, lack of appropriate housing, and poor drainage in urban cities are the main reasons for increasing cases of malaria prevalence in Indian urban cities. In addition, slum areas of urban cities have very poor living conditions, lack of fresh water, and bad sanitation facilities. All these factors are the driving force for the increase in malaria (WHO, 2015).

In this regard, the government with its healthcare policies are indulged in improving household mosquito proofing and effective diagnosis and treatment methods (Wilson et al., 2015). The government approaches the poor and the slum population with free medications and better sanitation infrastructure (Alirol et al., 2011).

Urbanization influenced malaria transmission

One of the main factors that indicate the role of urbanization influenced malaria transmissions are the infection in urban areas where it is being diagnosed. Plasmodium falciparum in India has reported with the most cases of mutated strains and drug-resistant strains (Anvikar et al., 2016). There are vast indications as to how urban transmission differs from that in rural malaria prevalences and transmission (Wilson et al., 2015). Urban microhabitats are the main reason responsible for drug-resistance and mutated strains. Urban microclimate like temperature, relative humidity, and precipitation, along with house construction sites, overuse of insecticide treatments, and repellents by the urban population is another reason (Kabaria et al., 2017).

According to the reports of  Anvikar et al., (2016), more mutated strains of Plasmodium falciparum are prevalent than Plasmodium vivax in the urban areas of India. Although, Plasmodium vivax more commonly found in the urban setting, drug-resistant strains of Plasmodium falcipurm found in the majority.  Therefore, urbanization is the most relevant asset for malaria parasite transmission mapping (Wilson et al., 2015). Governments use this mapping in the allocation of healthcare funds to the state governments for the better provision of healthcare services and manage the prevalence of drug-resistant malaria. In the 11th 5 year plan, independency was provided to the research wings of the pharma industry to exploit and find the resources to control the outbreak of antimalarial drug-resistant strains.

Control techniques for urbanization influenced malaria

In India, there is an increase in the transmission of malaria specifically in urban areas due to the fact that the National Malaria Eradication Program only focuses on rural areas, ignoring the problem of urban malaria (Ghosh, 2017). There are various types of movement of population that influence malaria prevalence and transmission in urban India. Circulation from stable rural malaria prevalent areas to unstable urban areas had firmly established malaria transmission to urban India. After the National Malaria Eradication Program, rural areas became free of endemic malaria but were receptive, thus circulation from urban areas back to rural areas reintroduced malaria transmission (Kabaria et al., 2017).

Epidemics are more likely to take place in areas where health care are poor and lacking. Hence, the influx of the affected people get identified and treated at early stages to avoid any risk of the epidemics (Ghosh, 2017). Particular attention should be paid to sustainable urban development in consideration with urban malaria prevalence.

Reference

• Alirol, E. et al. (2011) ‘Urbanisation and infectious diseases in a globalised world’, The Lancet Infectious Diseases. Elsevier Ltd, 11(2), pp. 131–141. doi: 10.1016/S1473-3099(10)70223-1.
• Ganguly, S., Saha, P., Chatterjee, M. and Maji, A.K., 2014. Prevalence of polymorphisms in antifolate drug resistance molecular marker genes pvdhfr and pvdhps in clinical isolates of Plasmodium vivax from Kolkata, India. Antimicrobial agents and chemotherapy, 58(1), pp.196-200.
• Ghosh, S.K., 2017. Molecular monitoring of antimalarial drug resistance in India. Indian journal of medical microbiology, 35(2), p.155.
• Kabaria, C.W., Gilbert, M., Noor, A.M., Snow, R.W. and Linard, C., 2017. The impact of urbanization and population density on childhood Plasmodium falciparum parasite prevalence rates in Africa. Malaria journal, 16(1), p.49.
• UN Department of Economics And Social Affairs (2018) Revision of World Urbanization Prospects | Multimedia Library – United Nations Department of Economic and Social Affairs. Available at: https://www.un.org/development/desa/publications/2018-revision-of-world-urbanzation-prospects.html (Accessed: 23 July 2018).
• WHO (2015) Urbanization and Communicable diseases. Available at: http://www.searo.who.int/entity/world_health_day/media/2010/fs_6.pdf?ua=1 (Accessed: 1 September 2018).
• Wilson, M.L., Krogstad, D.J., Arinaitwe, E., Arevalo-Herrera, M., Chery, L., Ferreira, M.U., Ndiaye, D., Mathanga, D.P. and Eapen, A., 2015. Urban malaria: understanding its epidemiology, ecology, and transmission across seven diverse ICEMR network sites. The American journal of tropical medicine and hygiene, 93(3_Suppl), pp.110-123.