How can the complex epidemiology of malaria in India impact its elimination?

• Published in: Trends in parasitology Vol. 39; no. 6; pp. 432 - 444
• Main Authors: Khan, Nikhat, Awasthi, Gauri, Das, Aparup
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2023
• Subjects: Animals; Anopheles; Anopheles - parasitology; elimination; epidemiology; Humans; India; India - epidemiology; malaria; Malaria - epidemiology; Malaria - parasitology; Malaria - prevention & control; Mosquito Vectors; Plasmodium; India; Plasmodium; epidemiology; Anopheles; malaria; elimination; India
• ISSN: 1471-4922; 1471-5007; 1471-5007
• DOI: 10.1016/j.pt.2023.03.006

Malaria epidemiology in India is complex due to a wide distribution of all five species of human malaria parasites of the genus Plasmodium and ten different species of malaria vectors of the genus Anopheles.The presence of species complexes of Anopheles vectors, mixed Plasmodium species infections in a single human, rising numbers of asymptomatic P. falciparum cases, and host-switching of P. falciparum from Indian rhesus monkey to Indians make malaria epidemiology even more complex.A wide distribution of drug-resistant P. falciparum, insecticide-resistant Anopheles vectors, and malaria-susceptible humans create an environment conducive to malaria transmission in India.Two malaria-elimination models were demonstrated in the recent past in highly endemic tribal and inaccessible areas in India, indicating that malaria can be eliminated with planned and concerted efforts. Malaria is a human health hazard in the tropical and subtropical zones of the globe and is poised to be eliminated by the year 2030. Despite a decrease in incidence in the past two decades, many endemic countries, including India, report cases regularly. The epidemiology of malaria in India is unique owing to several features of the Plasmodium parasites, Anopheles vectors, ecoepidemiological situations conducive to disease transmission, and susceptible humans living in rural and forested areas. Limitations in public health reach, and poor health-seeking behaviour of vulnerable populations living in hard-to-reach areas, add to the problem. We bring all of these factors together in a comprehensive framework and opine that, in spite of complexities, targeted elimination of malaria in India is achievable with planned programmatic approaches.