Malaria, a disease that has plagued humanity for centuries, continues to pose a significant threat to global public health, with India bearing a substantial burden where despite concerted efforts, barriers to effective prevention and treatment persist, perpetuating the cycle of transmission. To truly combat malaria, we must address these barriers comprehensively and adapt our approaches to the evolving landscape of the disease.

In an interview with HT Lifestyle, Dr Susanta Kumar Ghosh, formerly with ICMR-National Institute of Malaria Research in Bangalore and currently the Scientific Advisor at Eco BioTraps, shared, “One of the primary challenges in combating malaria is the lack of understanding of its causes and effective prevention methods in most malaria-endemic areas. Misconceptions, such as the belief that malaria cannot be prevented or treated, contribute to fatalistic attitudes and hinder proactive measures. Additionally, reliance on traditional remedies further complicates the issue, often leading to delays in seeking proper medical care.”

He added, “Furthermore, the assessment of malaria burden and transmission patterns is crucial, particularly in low-transmission settings where the disease may go unnoticed. Also in endemic settings residual transmission from low-parasitaemia cases. Incorporating serological markers of recent infection and molecular diagnosis in future studies can provide valuable insights into the true extent of the problem and guide targeted interventions.”

India bears a staggering 79% of the global malaria burden in the southeast region, according to a 2024 study published in the Clinical Epidemiology and Global Health journal, and faces unique challenges in its efforts towards elimination. Dr Susanta Kumar Ghosh revealed, “Factors such as meteorological conditions, environmental changes and socioeconomic disparities all influence malaria transmission dynamics. Rapid urbanisation, deforestation and unplanned construction activities disrupt vector ecology, exacerbating the problem. Weak disease surveillance systems and varying seasonal transmission patterns further complicate control efforts, especially in the face of climate change-induced fluctuations in case numbers.”

He pointed out, “In response to these challenges, initiatives like the Tribal Malaria Action Plan have been implemented to reduce parasite reservoirs and strengthen control services. However, achieving malaria elimination by 2030, as outlined in the National Framework for Malaria Elimination, remains a daunting task. Most recent National Strategic Plan: Malaria Elimination 2023-27 has emphasized strengthening surveillance and action in outreach areas. The persistence of malaria parasites, coupled with socio-cultural and environmental factors, necessitates a multifaceted approach.”

Central to any effective malaria control strategy is community engagement and awareness. Dr Susanta Kumar Ghosh stressed, “Informational campaigns play a crucial role in educating vulnerable populations about malaria symptoms, prevention methods, and the importance of seeking timely treatment. By fostering community participation and collaboration with local authorities, we can enhance the impact of control activities and work towards achieving the Sustainable Development Goal of ending the malaria epidemic by 2030. Moreover, understanding the socio-demographic determinants of malaria knowledge and practices is essential for targeted interventions. Factors such as age, education, socioeconomic status, and locality influence individuals' ability to adopt preventive measures effectively. By addressing these disparities and tailoring interventions to specific population groups, we can optimise the impact of malaria control efforts.”

According to him, insecticide resistance poses a significant challenge to malaria control efforts in India. Dr Susanta Kumar Ghosh said, “Anopheles culicifacies, one of the primary vectors of malaria in the region, exemplifies this threat. This mosquito species has developed complete resistance to the insecticide dichloro-diphenyl trichloroethane (DDT), showing substantial resistance to malathion and synthetic pyrethroids. What's more concerning is the emergence of multiple insecticide resistance in a single Anopheles culicifacies mosquito, further complicating control measures. Long use of long lasting insecticide-treated nets (LLINs) have caused changes in vector behaviour avoiding LLINs. The ongoing challenge is to replace the old nets. Moreover, other key vectors such as Anopheles fluviatilis, Anopheles sundaicus, and Anopheles stephensi also exhibit resistance to the commonly used insecticides. These findings underscore the urgent need for innovative approaches to mosquito control beyond conventional insecticides. This necessitates a shift towards alternative strategies that can effectively target resistant mosquitoes while minimising environmental impact.”

Dr Susanta Kumar Ghosh suggested, “One promising approach is the use of biological control methods such as use of ovitraps, which specifically target mosquito breeding. These methods offer a sustainable and environmentally friendly alternative to chemical insecticides and can help reduce the selective pressure driving insecticide resistance. Additionally, improved housing design to reduce mosquito entry or community-based environmental management to eliminate breeding sites, can enhance the effectiveness of malaria control efforts. Understanding the factors that increase malaria risk is essential for designing comprehensive control strategies. By addressing barriers to prevention and treatment, enhancing surveillance efforts, and engaging communities, we can make significant strides towards malaria elimination. With concerted efforts and innovative approaches, the goal of a malaria-free future is within our reach.”

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