Malaria in India: The Center for the Study of Complex Malaria in India

doi:10.1016/j.actatropica.2011.11.008

Acta Tropica

Volume 121, Issue 3, March 2012, Pages 267-273

https://doi.org/10.1016/j.actatropica.2011.11.008 Get rights and content

Abstract

Malaria is a major public health problem in India and one which contributes significantly to the overall malaria burden in Southeast Asia. The National Vector Borne Disease Control Program of India reported ∼1.6 million cases and ∼1100 malaria deaths in 2009. Some experts argue that this is a serious underestimation and that the actual number of malaria cases per year is likely between 9 and 50 times greater, with an approximate 13-fold underestimation of malaria-related mortality. The difficulty in making these estimations is further exacerbated by (i) highly variable malaria eco-epidemiological profiles, (ii) the transmission and overlap of multiple Plasmodium species and Anopheles vectors, (iii) increasing antimalarial drug resistance and insecticide resistance, and (iv) the impact of climate change on each of these variables. Simply stated, the burden of malaria in India is complex. Here we describe plans for a Center for the Study of Complex Malaria in India (CSCMi), one of ten International Centers of Excellence in Malaria Research (ICEMRs) located in malarious regions of the world recently funded by the National Institute of Allergy and Infectious Diseases, National Institutes of Health. The CSCMi is a close partnership between Indian and United States scientists, and aims to address major gaps in our understanding of the complexity of malaria in India, including changing patterns of epidemiology, vector biology and control, drug resistance, and parasite genomics. We hope that such a multidisciplinary approach that integrates clinical and field studies with laboratory, molecular, and genomic methods will provide a powerful combination for malaria control and prevention in India.

Graphical abstract

We present plans for a Center for the Study of Complex Malaria in India (CSCMi), a partnership between Indian and United States scientists, made possible through funding from the National Institutes of Health and their commitment to establish International Centers of Excellence in Malaria Research. Through the CSCMi, we will work to develop knowledge, tools, and evidence-based strategies to help support intervention and control programs of the Indian government. We are also committed to building research capacity in India by helping to train the next generation of malaria and mosquito vector biologists. Among our research projects is a comprehensive epidemiological surveillance study of the malaria burden in diverse ecological sites, which will help improve the accuracy of the current estimations. Malaria endemicity in India. State boundaries are color-coded according to total malaria endemicity (see key). Data taken from the National Vector Borne Disease Control Programme (http://www.nvbdcp.gov.in/) for year 2010. NIMR field stations are indicated as red dots. The three NIMR field stations incorporated as part of the CSCMi are: Nadiad (Gujarat), Rourkela (Odisha) and Chennai (Tamil Nadu), each with different eco-epidemiological profiles as shown. EIR: entomological inoculation rate; API: annual parasite incidence.

Highlights

► Malaria is a significant public health problem in India. ► Malaria in India is ‘complex’ involving multiple Plasmodium species and vectors. ► Improved knowledge, tools, and evidence-based strategies are needed to support Indian control programs. ► Determining the ecological and evolutionary determinants of malaria transmission is key. ► New genomics technology can be used to propel investigation of malaria mixed species and mixed genotypes.

Section snippets

Malaria in India

As the second most populous country in the world, with a population exceeding one billion people, India's public health system faces many challenges including implementation of surveillance programs to accurately estimate and control the national malaria burden. Historically, the highest incidence of malaria in India occurred in the 1950s, with an estimated 75 million cases and 0.8 million deaths per year (World Health Organization, Country Office for India). The launch of the National Malaria

India has a diverse topography, ecology and climate

India's expansive geography and diverse climate supports ideal environments for sustaining malaria parasites and their vectors. The climate varies from tropical monsoon in the south of the country to temperate in the north, but has four major climatic zones: mountain climate, tropical wet climate, tropical dry climate, and subtropical humid climate. Such climatic variation is due to a sharp temperature gradient caused by atmospheric changes in wind circulation and precipitation, lending to

National Vector Borne Disease Control Programme (NVBDCP)

The National Vector Borne Disease Control Programme (NVBDCP) is the agency responsible for the prevention and control of all vector-borne diseases in India, including malaria. It is one of the technical departments of the Directorate General of Health Services under the Ministry of Health and Family Welfare and is responsible for framing technical guidelines and policies, and monitoring implementation through regular reports on malaria control. The NVBDCP goals are to develop a well-informed

The Center for the Study of Complex Malaria in India

The Center for the Study of Complex Malaria in India (CSCMi) is a partnership between Indian and U.S.-based investigators to develop the knowledge, tools and evidence-based strategies needed to support the intervention and control programs of Indian government organizations, and to build research capacity in India and help train the next generation of malaria and mosquito vector biologists. Our research focus is the analysis of mixed-species and mixed-genotype infections (complex malaria), with

Conclusion

Malaria is a major public health problem in India, the world's largest democracy and its second most populous country. We intend to leverage the existing strong relationship between Indian and U.S scientists to develop a Center for the Study of Complex Malaria in India. The CSCMi is a collaborative scientific research center working towards the goal of enhancing malaria intervention and control programs in India.

Acknowledgments

We thank the previous NIMR Directors Professor A.P. Dash and Dr. V.K. Dua for facilitating the CSCMi, and the Director General of the Indian Council of Medical Research, Dr. V.M. Katoch, for project permissions and encouragement. We are also indebted to Dr. Hema Joshi who was central to the project before her untimely death in March 2010. We also thank CSCMi Project Coordinator Dr. Lalitha Ramanathapuram and Dr. A.C. Dhariwal, Director of the National Vector Borne Disease Control Programme,

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Malaria in India: The Center for the Study of Complex Malaria in India

Abstract

Graphical abstract

Highlights

Section snippets

Malaria in India

India has a diverse topography, ecology and climate

National Vector Borne Disease Control Programme (NVBDCP)

The Center for the Study of Complex Malaria in India

Conclusion

Acknowledgments

Trans. R. Soc. Trop. Med. Hyg.

Lancet

Lancet

Lancet

Trends Parasitol.

Lancet

Trends Parasitol.

Lancet Infect. Dis.

Trans. R. Soc. Trop. Med. Hyg.

Acta Trop.

Trends Parasitol.

Lancet

Rolling back malaria—the next ten years

Lancet

Comparative genomics of the neglected human malaria parasite Plasmodium vivax

Nature

The biology and control of malaria vectors in India

Curr. Sci.

Malaria in India: challenges and opportunities

J. Biosci.

The practical implications of resistance of malaria vectors to insecticides

Bull. WHO

Artemisinin resistance in Plasmodium falciparum malaria

N. Engl. J. Med.

Identification of all members of the Anopheles culicifacies complex using allele-specific polymerase chain reaction assays

Am. J. Trop. Med. Hyg.

The billion-dollar malaria moment

Nature