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Written by Dr.Swati Rajagopal

Today is World Malaria Day. Drug-resistant variant of the disease still a cause of concern

Though the number of malaria cases is on the decline, rising relapse and drug-resistant malaria cases are the major concern for city-based doctors. The State Health and Family Welfare Department is struggling to contain malaria in Mangalore and Udupi where the percentage is as high as 50 in the state.

In 2010, the health department had registered 44,319 cases with 11 deaths. The number came down to 24,237 in 2011 and subsequently to 16,466 in 2012. There was a further decline in 2013 when 12,023 cases were reported with five deaths.

Major global efforts in the past 15 years have helped reduce malaria mortality rates by 42%. However, more than 20 crore cases are reported every year and malaria kills an estimated 6.27 lakh people. A large number of these are children, according to estimates of the World Health Organization (WHO). India remains one of the countries where malaria is still endemic.

Speaking with dna, Dr Usha, entomologist, Karnataka Health and Family Welfare Department, said: “The problem is with urban areas in Mangalore and Udupi. We are trying to work in tandem with the urban local bodies but these two districts top the chart. As against other years, where we used monovalent vaccine used to immunize against a single antigen, this year we are planning to introduce bivalent vaccine which can be used to immunise against two or more antigens.”

However, the bigger problem that is being faced by malaria control programmes currently is the malaria vector, which has turned resistant to insecticide, chloroquine and other anti-malarial drugs. Dr Swati Rajagopal, consultant, Infectious Disease, Columbia Asia Hospital, said, “In India, malaria is endemic, hence they are prone to drug resistance. Falciparum malaria, which is the most complicated form, is resistant to chloroquine. As of now we just depend on rapid test. There is an urgent need to invest contain the spread of resistance to these drugs and on proper diagnostic.”

Another danger lies in the fact that the anopheles mosquitoes, which carry malaria parasites, are increasingly becoming resistant to insecticides. There is a need to contain the emergence and spread of resistance of anopheles mosquitoes to insecticides. Moreover, re-introduction of transmission in areas free of malaria is always a threat if surveillance and rapid response are not sustained.

Meanwhile, Dr R Manjunath, Internal Medicine, Dr Malathi Manipal Hospital, also stressed on how relapse and drug resistant malaria has been a major cause of concern. He said: “If one gets high fever, it is necessary to undergo test for malaria as cases of relapse are coming up even after 12 months.”

Symptoms for malaria

The first symptoms – fever, headache, chills and vomiting which are mild and difficult to diagnose as malaria. In adults, multi-organ involvement is also frequent.

Children with severe malaria frequently develop severe anaemia, respiratory distress.

In malaria-endemic areas, people may develop partial immunity, allowing asymptomatic infections to occur.

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