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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 56 | Issue 1
Special Issue On Malaria Elimination
Page Nos. 1-86

Online since Tuesday, May 7, 2019

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REVIEW ARTICLES  

MERA India: Malaria Elimination Research Alliance India p. 1
Manju Rahi, Anupkumar R Anvikar, OP Singh, P Jambulingam, P Vijayachari, Aparup Das, Sanghamitra Pati, Kanwar Narain, RR Gangakhedkar, Neeraj Dhingra, Balram Bhargava
DOI:10.4103/0972-9062.257766  PMID:31070158
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ICMR research initiatives enabling malaria elimination in India p. 4
Manju Rahi, Payal Das, P Jambulingam, P Vijayachari, Aparup Das, Sanghamitra Pati, Kanwar Narain, Ashwani Kumar, RR Gangakhedkar, Neena Valecha
DOI:10.4103/0972-9062.257772  PMID:31070159
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Essential guidance on malaria elimination in its history p. 11
J Kevin Baird
DOI:10.4103/0972-9062.257768  PMID:31070160
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Partnering to fight malaria in India: Past, present and future p. 15
Kirandeep Samby, Hanu Ramachandruni, Jaya Banerji, Jeremy N Burrows, Penny Grewal Daumerie, Rob A.M. Hooft van Huijsduijnen, Stephan Duparc, Timothy N.C. Wells
DOI:10.4103/0972-9062.257769  PMID:31070161
The global fight against malaria requires continual development of new tools. Collaborations in India have played a key role in MMV’s partnerships to discover, develop and deliver new medicines. Over the last decade, India has become a focal point of global medicinal chemistry, and combined with investments in basic science, this has led to the discovery of new potential drugs. India also brings significant experience to drug development, in clinical trials, but also in formulation and manufacturing. Finally, innovative new approaches in case management have streamlined impact at the level of communities and the patients.
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Some considerable issues concerning malaria elimination in India p. 25
Ashwani Kumar
DOI:10.4103/0972-9062.257770  PMID:31070162
Malaria elimination is a health priority of India for the national development and to meet UN sustainable development goals. In this article, an attempt has been made to highlight some of the key issues that need attention and consideration. These include addressing the gaps in malaria burden and adopting District Health Information System (DHIS) for real time data gathering, transfer and analysis for rapid response. The article highlights threat to malaria elimination from human migration, asymptomatic malaria, P. malariae as a neglected species, need for updating vector information and devising strategies to control relay vector species especially in the high burden states of India. Additionally, scale-up of vector control interventions, integrated vector management and enhancement of vector control capacity and capability have been emphasized. It is suggested that process, performance and progress indicators for malaria elimination may be clearly spelt out and disseminated. What are the data needs for malaria elimination certification, must be well-understood? Lessons learnt by the countries that have eliminated malaria recently shall be of great value to malaria elimination efforts in India.
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Malaria elimination in India—The way forward p. 32
Susanta K Ghosh, Manju Rahi
DOI:10.4103/0972-9062.257771  PMID:31070163
The World Malaria Report 2018 published by the World Health Organization highlights that no significant progress in reducing global malaria cases was achieved for the period 2015–2017. India carries 4% of the global malaria burden and contributes 87% of the total malaria cases in South-East Asia. India is in malaria elimination mode, and set targets for malaria-free status by 2030. Diagnosis and treatment of asymptomatic falciparum malaria cases continues to be a challenge for health care providers. To overcome these hurdles innovative solutions along with the existing tools and strategies involving vector control, mass drug administration, disease surveillance hold the key to solve this gigantic health problem.
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Malaria control in India: A national perspective in a regional and global fight to eliminate malaria p. 41
PJ Guerin, M Dhorda, NK Ganguly, CH Sibley
DOI:10.4103/0972-9062.257773  PMID:31070164
Since the declaration of the vision of malaria eradication in 2007, the overall burden of malaria has been reduced substantially in many countries in the endemic world. This progress has, however, recently slowed worldwide and even an increase of morbidity and mortality has been observed in some regions. That reality has led to reflection on the strategy for malaria elimination, noting that focusing only on low transmission sites has competed with the efforts in countries that still have foci with high malaria burdens. This opinion piece outlines the collaboration of the ICMR-National Institute of Malaria Research (ICMR–NIMR) and other partner Institutions in India with the WorldWide Antimalarial Resistance Network (WWARN), one part of a global effort to manage the spread of Plasmodium falciparum parasites associated with antimalarial resistance.
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Preparedness for malaria elimination in the wake of climate change in the State of Uttarakhand (India) p. 46
Ramesh C Dhiman, Poonam Singh, Yogesh Yadav, Shweta Saraswat, Gaurav Kumar, RK Singh, VP Ojha, BC Joshi, Pankaj Singh
DOI:10.4103/0972-9062.257774  PMID:31070165
Background & objectives: Climate change is an emerging issue particularly in the context of vector-borne diseases. A study was undertaken in Nainital and Almora districts of Uttarakhand to provide evidences of changing climatic conditions, abundance of vectors, and knocking of malaria in hilly areas. Material and methods: Longitudinal data on temperature and relative humidity were procured from Tussar Silk Centre, Bhimtal, India as well as generated using HOBO device. Monthly density of malaria vectors, their positivity for sporozoite proteins of malaria parasite and fever surveys were conducted as per the standard procedures from 2010 to 2013. Epidemiological data were procured from the State Programme Officer of Uttarakhand state. Results: It was found that the temperature has increased since 1990 resulting in extension in windows of malaria transmission, temporal distribution as well as man hour density of Anopheles culicifacies and An. fluviatilis in hilly districts of Uttarakhand state. Both the vectors were found in high density up to a maximum man hour density of 110 (An. culicifacies) and 69 (An. fluviatilis) as compared to 32 and 33, respectively during 1998. The field collected vector species were also found positive for sporozoite proteins of malaria parasites in the month of October and November. Evidence of occurrence of malaria cases was also found in areas hitherto free from malaria. Interpretation & conclusion: The findings reveal that Himalayan region needs attention to strengthen surveillance for malaria to identify emerging new foci of malaria transmission in view of climate change. Health education to communities about preventive measures to contain breeding of vectors and seeking timely treatment should be imparted so as to achieve the goal of malaria elimination in category-1 in the first instance.
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Malaria elimination drive in Odisha: Hope for halting the transmission p. 53
Madan Mohan Pradhan, PK Meherda
DOI:10.4103/0972-9062.257775  PMID:31070166
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Comprehensive case management of malaria: Operational research informing policy p. 56
MM Pradhan, Anupkuamar R Anvikar, P Grewal Daumerie, S Pradhan, A Dutta, NK Shah, PL Joshi, J Banerji, S Duparc, K Mendis, S Murugasampillay, N Valecha
DOI:10.4103/0972-9062.257776  PMID:31070167
In 2013, the Odisha state Vector Borne Disease Control Programme led a five year operational research project, under programmatic conditions, in close collaboration with several partners. This Comprehensive Case Management Project covered a population of 900,000 across paired control and intervention blocks in four districts, each with different transmission intensities. Key gaps in access to malaria services were identified through household surveys and a detailed situation analysis. The interventions included ensuring adequate stocks of rapid diagnostic tests and antimalarial drugs at the village level, the capacity building of health workers and ASHAs, setting up microscopy centres at the primary health care level, and conducting mass screening and treatment in poorly accessible areas. The programme strengthened the routine health system, and improved malaria surveillance as well as the access to and quality of care. Initially, the programme led to increased case reporting due to improved detection, followed by a decline in malaria incidence. Lessons from the project were then scaled up statewide in the form of a new initiative—Durgama Anchalare Malaria Nirakaran (DAMaN).
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Malaria elimination: Using past and present experience to make malaria-free India by 2030 p. 60
Altaf A Lal, Harsh Rajvanshi, Himanshu Jayswar, Aparup Das, Praveen K Bharti
DOI:10.4103/0972-9062.257777  PMID:31070168
Malaria causes significant morbidity and mortality worldwide. Since 2005, malaria cases have been declining globally with many countries having eliminated malaria and several other countries heading towards malaria elimination. The World Health Organization’s Global Technical Strategy for malaria targets at least 90% reduction in case incidences and mortality rates, and elimination in 35 countries by 2030. India along with other Asia-Pacific countries has pledged to eliminate malaria by 2030. Sustainable vector control and case management interventions have played a pivotal role in malaria control leading to elimination. Malaria is complex in India due to the presence of multiple parasites and vectors species, asymptomatic cases, resistance against antimalarials and insecticides, social, demographic, cultural and behavioural beliefs. Therefore, maintaining zero indigenous malaria transmission and preventing malaria through importation of cases requires well-planned multi-pronged intervention strategies. This article provides insights into the past and present malaria control and elimination efforts that may be useful for the national programme for eliminating malaria from India by 2030.
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RESEARCH ARTICLES Top

Role of a dedicated support group in retaining malaria-free status of Sri Lanka p. 66
Rittika Datta, Kamini Mendis, Rajitha Wikremasinghe, Risintha Premaratne, Deepika Fernando, Jane Parry, Benjamin Rolfe
DOI:10.4103/0972-9062.257778  PMID:31070169
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Unravelling the trends of research on malaria in India through bibliometric analysis p. 70
Upasana Shyamsunder Singh, Sampriti Mahanty
DOI:10.4103/0972-9062.257779  PMID:31070170
Background & objectives: With the development of technological know-how, in recent years, malaria research in India has advanced to a great extent and the corresponding research is being translated into the form of publications, which has started to pile in thousands over the years. The purpose of the present study was to perform a bibliometric analysis on malaria research in India from its inception. Methods: The Web of Science (WoS) platform developed by Clarivate Analytics was utilized to retrieve publications on malaria research in India. The publications were retrieved in bibtex format and were further used for analysis in “R” Bibliometrix package. The analysis included number of publications in each year along with their keywords, title, authors, institutes, abstract, journal name and countries. Results: A total of 2334 publications on malaria in India were obtained from 1909 to 2019 (March). The emerging trends on themes of malaria research in India were unraveled with the help of keywords co-occurrence network analysis. The bibliometric analysis shed light on the evolution of journals and trends on choice of journals that the authors made over the years and the contribution of different countries in malaria research. Interpretation & conclusion: The bibliometric analysis performed over 110 yr not only contributes towards understanding the trends based on research topics, but also on the importance of data science. Assuming the fact that the number of publications would increase from thousands to lakhs in future; going forward, it has become imperative for the researchers and students to develop methods using computer-based algorithms and carry out literature review which allows for in-depth study of vast amount of literature.
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Prevalence of submicroscopic malaria in low transmission state of Punjab: A potential threat to malaria elimination p. 78
Taruna Kaura, Jaspreet Kaur, Ayush Sharma, Ashish Dhiman, Mangesh Pangotra, AK Upadhyay, Gagandeep Singh Grover, Surya K Sharma
DOI:10.4103/0972-9062.257780  PMID:31070171
Background & objectives: Submicroscopic malaria infections with low parasite density serve as a silent reservoir for maintaining residual transmission in the population. These infections should be identified and targeted to be eliminated for sustained malaria control. The conventional methods of diagnosis such as light microscopy and rapid diagnostic kits often fail to detect low density infections. Therefore, the more sensitive molecular techniques should be employed to detect low density infections. The objectives of the study was to explore the prevalence of sub-microscopic infections in low transmission areas of Punjab using highly sensitive molecular tool. Methods: A total of 1114 finger prick blood samples were collected through active surveillance and tested for malaria diagnosis using light microscopy, RDT and PCR. Nested PCR amplification was performed using a pair of Plasmodium genus-specific primers from the 18S rRNA small subunit gene (18S rRNA). The amplified PCR products were analysed using a 2% agarose gel, stained with ethidium bromide and observed under transilluminator. Results: Test positive rate (TPR) by microscopy, RDT and PCR was 4.4, 3.95 and 5.75%, respectively. Microscopy and RDT failed to detect mixed infections whereas 0.26% cases were found to be mixed infection in PCR. Compared to LM and RDT, PCR has detected 1.3% additional positive cases. However, of the total positive cases detected by PCR, 23.4% infections were found to be submicroscopic, which could not be detected by conventional methods of diagnosis. Interpretation & conclusions: The molecular study revealed the existence of submicroscopic malaria cases in the study population which would have remained undetected by conventional methods of diagnosis. This is particularly important because Punjab state is in malaria elimination phase and targeted to achieve elimination in 2021. However, such undetected parasite positive cases may pose bigger problem any time due to continued transmission. Therefore, application of more sensitive diagnostic tools like PCR and LAMP with conventional methods may be much more useful in case detection particularly in low transmission settings for malaria elimination.
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LETTER TO THE EDITOR Top

Deletions in the Plasmodium falciparum histidine-rich protein 2 gene: An emerging threat to the elimination of malaria in India p. 85
Vineeta Singh, Loick Pradel Kojom
DOI:10.4103/0972-9062.257781  PMID:31070172
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