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Table of Contents
REVIEW ARTICLE
Year : 2019  |  Volume : 56  |  Issue : 1  |  Page : 4-10

ICMR research initiatives enabling malaria elimination in India


1 Indian Council of Medical Research, Puducherry, India
2 ICMR–Vector Control Research Centre, Puducherry, India
3 ICMR–Regional Medical Research Centre, Port Blair, India
4 ICMR–National Institute for Research in Tribal Health, Jabalpur, India
5 ICMR–Regional Medical Research Centre, Bhubaneswar, India
6 ICMR–Regional Medical Research Centre, Dibrugarh, India
7 ICMR–National Institute of Malaria Research, New Delhi, India

Date of Submission15-Mar-2019
Date of Web Publication7-May-2019

Correspondence Address:
Dr Manju Rahi
Scientist ‘E’, Indian Council of Medical Research, Ansari Nagar, New Delhi–110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-9062.257772

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  Abstract 


Keywords: Demonstration projects; ICMR; malaria; malaria elimination; NVBDCP; vector control; therapeutic efficacy


How to cite this article:
Rahi M, Das P, Jambulingam P, Vijayachari P, Das A, Pati S, Narain K, Kumar A, Gangakhedkar R R, Valecha N. ICMR research initiatives enabling malaria elimination in India. J Vector Borne Dis 2019;56:4-10

How to cite this URL:
Rahi M, Das P, Jambulingam P, Vijayachari P, Das A, Pati S, Narain K, Kumar A, Gangakhedkar R R, Valecha N. ICMR research initiatives enabling malaria elimination in India. J Vector Borne Dis [serial online] 2019 [cited 2019 Jun 18];56:4-10. Available from: http://www.jvbd.org/text.asp?2019/56/1/4/257772




  Introduction Top


India is endemic to malaria and the intensity of malaria transmission is heterogeneous. Malaria is a serious public health concern and almost all 36 states/ UTs are consistently contributing cases, but transmission intensities varies from low to moderate and just few states of the east, central and northeast contribute bulk (80%) of total positive cases[1],[2].

In India, malaria control interventions have been scaled up after the launch of National Framework for Malaria Elimination (NFME)[2] in February 2016. Given the evidence-based present-day intervention tools and their large-scale implementation, India has recorded almost three million fewer malaria cases in 2017, a 24% decrease over the previous year, while there was an increase of two million cases worldwide in 2017, according to the World Malaria Report 2018[3]. In the present scenario, the country accounts for 4% of the world’s total malaria cases which was 6% in 2016, and is no longer among the world’s top three countries— Nigeria (25%); Democratic Republic of the Congo (11%); and Mozambique (5%) in terms of number of cases[3].

In 2017, India launched its five-year National Strategic Plan for malaria elimination that shifted focus from malaria “control to elimination” and provided a road-map with targets to end malaria in 571 districts out of 678 Indian districts by 2022[4] and National Framework for Malaria Elimination describes the target of 2024 for the Category 3 states to enter elimination phase. By 2027 the indigenous transmission of malaria in India will be interrupted and by 2030 there will be prevention of reestablishment of local transmission in areas where malaria has been eliminated and the malaria-free status will be maintained throughout the nation[2]. The target for malaria elimination is in line with the WHO Global Technical Strategy[5] adopted by the World Health Assembly in May 2015 and subsequent commitments by the other Heads of Government in the Asia Pacific Region[4],[5].

The Indian Council of Medical Research (ICMR), through its institutes is supporting Government of India by demonstrating the best strategies which could be implemented in the public health settings for elimination of malaria. ICMR has taken up several multicentric concerted research studies having specific mandate and objectives, wherein standard protocols are developed which all sites follow to generate uniform data. ICMR has partnered with the Directorate of National Vector Borne Diseases Control Programme (NVBDCP) and other stakeholders to identify the key thrust areas of research and programme priorities.

The objective of research programmes undertaken by ICMR institutes working in the field of malaria is to identify neglected areas in malaria research, to review and prioritize research areas for the elimination of malaria. ICMR also identifies the cutting-edge areas of science which could be translated to the field and provide platform where researchers and institutes can share information available with them and also discuss the current status and future trends of the malaria disease.

ICMR has a network of 26 national and regional level institutes. Out of 26, eight institutes have the mandate to work on vector-borne diseases. These institutes and centres have further field units strategically located in areas which are endemic, tribal or marginalized in some way [Figure 1]. Also, ICMR has a mandate to support research studies on vector-borne diseases in medical colleges, universities, science colleges, other research bodies.
Figure 1: Map showing ICMR and its institutes working in the field of VBDs.

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Summary of the major initiatives and key achievements of ICMR

The Indian Council of Medical Research–National Institute of Malaria Research (NIMR), NVBDCP and Medicines for Malaria Venture, Geneva carried out a project in 2013, the ‘Comprehensive Case Management Programme (CCMP)' in four districts of Odisha— Dhenkanal, Angul, Bolangir and Kandhamal. CCMP demonstrated that universal access to malaria diagnosis and treatment, follow-up of patients with enhanced surveillance can dramatically reduce the number of malaria cases. ICMR has been complementing the National programme by conducting operational research on various vector borne diseases, and this project was an example of the same. The Programme provided universal access to malaria diagnosis and treatment, and improved the quality of services and surveillance. There was 85% decline in the malaria burden in the intervention blocks, 47% of which could be attributed to CCMP, from the period when universal access to malaria services was reached (pre: 2013–2015) to after (post: 2016–2017)[6].

The Malaria Elimination Demonstration Project (MEDP) in Mandla, Madhya Pradesh was started in the year 2017 for a period of 5 years (2017-22) as a first-of-its-kind public-private-partnership between the ICMR, Government of Madhya Pradesh and the Foundation for Disease Elimination and Control of India established by Sun Pharmaceutical Industries Ltd. as a not-for-profit entity. The project uses track, test, treat and track (T4) strategy for rapid identification of malaria cases followed up with prompt treatment. The project is also monitoring and providing support to indoor residual spray (IRS) and use of long lasting insecticidal nets (LLINs) to ensure the optimum utilization of these measures. Using this approach, a reduction in malaria cases at district level by over 80% in 15 months has been observed, with reduction of about 90% in blocks with high transmission. The study is going on and expected to complete in 2022 (Unpublished report).

Government of Punjab and ICMR–NIMR, Delhi are working together with an aim to find out prevalence of sub-microscopic infections in low transmission areas of Punjab using highly sensitive molecular tool. This study which started in 2017 is particularly important because Punjab State is in category-I for malaria elimination and is targeted to achieve elimination by 2021. Diagnostic methods used were light microscopy, RDT and PCR. Of the total positive cases detected by PCR, 23.40% infections were found to be sub-microscopic, which could not be detected by conventional methods of diagnosis. Such undetected cases may support continuation of transmission. Therefore, more studies are warranted to understand role of more sensitive diagnostic tools such as PCR and LAMP in combination with conventional methods in case detection particularly in low transmission settings to achieve malaria elimination (Unpublished report).

ICMR has established Malaria Elimination Research Alliance (MERA India) with an aim to harness and reinforce research in coordinated and combinatorial manner to achieve tangible impact on malaria elimination. It will provide a framework to the research community through establishment of a common platform for a trans-institutional alliance to strengthen the efforts of national programme in eliminating malaria.

In addition to above major initiatives, ICMR since decades, has undertaken research studies with tangible health impact. A brief of these is given in [Table 1].
Table 1: Studies having public health impacts

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With the rolling out of the available intervention tools, malaria elimination is a foreseeable goal yet there are multiple challenges which must be addressed in most robust manner. ICMR is strongly committed to support the national programme and state governments towards malaria elimination. ICMR advocates implementation and intensification of core-interventions for management of malaria disease and vector control through integrated approach and cohesive and collaborative efforts of all partners and stakeholders to create an enabling environment towards achievement of zero transmission. ICMR’s initiative of MERA India is a step towards bringing one and all on a single platform to steer research towards malaria elimination.


  Acknowledgements Top


The authors are grateful to the Indian Council of Medical Research for the facilities and support provided to carry out the research activities. The tremendous work of ICMR scientists and support of Institutes cited in the paper is deeply acknowledged.[63]



 
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