Malaria continues to dominate the scene involving infectious diseases even though the figures suggest that the incidence of malaria is decreasing. Transmitted by the bite of the anopheles mosquito, malaria has undergone varying epidemiological and clinical changes with Plasmodium vivax malaria becoming complicated along with the Falciparum malaria with multi-organ involvement and can be fatal at times. Early and accurate diagnosis of malaria is imperative for effective management. More recently, Rapid Diagnostic Tests (RDTs) have been introduced into routine use, and molecular methods like polymerase chain reaction are useful in certain situation. Artemesinin based combination therapy have become the drug of choice especially for complicated malaria with Synriam being the latest addition which is a fixed dose formulation containing the short acting arterolane and long acting piperaquine.
Introduction:
Malaria, the disease which infected 500,000 [1] and killed over 60,000 men during World War II [2] still continues to be a significant public health problem in the 21st-century world and causes 1-3 million deaths every year. Transmitted by the bite of the female anopheles mosquito, malaria is caused by members of the genus Plasmodium (P.) namely P. vivax, P. falciparum, P. ovale, P. malariae and P. knowlesi.
Changing Epidemiology:
World Health Organization (WHO) estimates that global malaria incidence has decreased by 17% and death due to malaria by 26% from 2000-2010. 91% of deaths and 81% of the cases were reported from the African Region [3]. These improvements are attributed to human interventions, greater funding, greater use of insecticide-treated bednets, indoor residual spraying, rapid diagnostic tests, and artemisinin-based combination therapies. Many epidemiologic changes have been noted in malaria-eliminating countries. Malaria cases are increasingly male, adult, clustered geographically, imported, among migrant and other hard-to-reach groups, and caused by Plasmodium vivax.
Despite these encouraging trends, the sad fact is that 219 million cases and 660,000 deaths from malaria were reported by WHO in 2010. When undocumented deaths were taken into account, this number was a staggering 1.24 million. 65% of the cases occurred in children under 15 years of age [6]. Malaria is presently endemic in broadband around the equator, in areas of the Americas, many parts of Asia, and much of Africa. The efforts of the Malaria Atlas Project, which aimed to map the global endemic levels of malaria and assess disease burdens, led to the publication of the P. falciparum endemicity map in 2010.
The Indian Scenario:
Malaria is one of the major public health problems in India with around 1.5 million confirmed cases reported annually by the National Vector Borne Disease Control Programme (NVBDCP) [8]. About 50% of cases are attributed to Plasmodium falciparum as compared to only 14% in 1970 [9]. The increased proportion of falciparum cases is mainly due to the continued use of chloroquine despite the drastic increase in chloroquine-resistant falciparum. Another significant factor is the role played by mosquito vectors including increasing resistance to insecticides seen in Anopheles culicifacies and Anopheles fluviatilis- the two main vectors in rural India [10]. The poor functioning of Government schemes like the Urban Malaria scheme has also contributed to the resurgence of malaria.
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