|Year : 2019 | Volume
| Issue : 1 | Page : 4-10
ICMR research initiatives enabling malaria elimination in India
Manju Rahi1, Payal Das1, P Jambulingam2, P Vijayachari3, Aparup Das4, Sanghamitra Pati5, Kanwar Narain6, Ashwani Kumar7, RR Gangakhedkar1, Neena Valecha7
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 Submission||15-Mar-2019|
|Date of Web Publication||7-May-2019|
Dr Manju Rahi
Scientist ‘E’, Indian Council of Medical Research, Ansari Nagar, New Delhi–110 029
Source of Support: None, Conflict of Interest: None
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 2021 Jan 27];56:4-10. Available from: https://www.jvbd.org/text.asp?2019/56/1/4/257772
| Introduction|| |
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,.
In India, malaria control interventions have been scaled up after the launch of National Framework for Malaria Elimination (NFME) 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. 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.
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 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. The target for malaria elimination is in line with the WHO Global Technical Strategy adopted by the World Health Assembly in May 2015 and subsequent commitments by the other Heads of Government in the Asia Pacific Region,.
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.|
Click here to view
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).
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].
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|| |
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.
| References|| |
Pradhan S, Pradhan MM, Dutta A, Shah NK, Joshi PL, Pradhan K, et al
. Improved access to early diagnosis and complete treatment of malaria in Odisha, India. PLoS One
2019; 14(1): e0208943.
Anvikar AR, Arora U, Sonal G, Mishra N, Shahi B, Savargaonkar D, et al
. Antimalarial drug policy in India: Past, present & future. Indian J Med Res
2014; 139(2): 205.
Das LK, Sahu SS, Krishnamoorthy N. Tolerability, efficacy and operational feasibility of artesunate combination therapy (ACT) (artesunate–sulphadoxine-pyrimethamine): As 1st line anti-malarial drug for falciparum malaria control in a tribal area of Odisha state, India. In: Annual Report 2014
. Puducherry: ICMR-Vector Control Research Centre 2014.
Bharti PK, Alam MT, Boxer R, Shukla MM, Gautam SP, Sharma YD, et al
. Therapeutic efficacy of chloroquine and sequence variation in pfcrt
gene among patients with falciparum malaria in central India. Trop Med Int Health
2010; 15(1): 33-40.
Bharti PK, Shukla MM, Ringwald P, Krishna S, Singh PP, Yadav A, et al
. Therapeutic efficacy of artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum
malaria from three highly malarious states in India. Malar J
2016; 15(1): 498.
Mishra S, Bharti PK, Shukla MM, Ali NA, Kashyotia SS, Kumar A, et al
. Clinical and molecular monitoring of Plasmodium falciparum
resistance to antimalarial drug (artesunate+ sulphadoxine-pyrimethamine) in two highly malarious district of Madhya Pradesh, central India from 2012–2014. Pathog Glob Health
2017; 111(4): 186-94.
Mishra N, Anvikar AR, Shah NK, Kamal VK, Sharma SK, Srivastava HC, et al
. Prescription practices and availability of artemisinin monotherapy in India: Where do we stand? Malar J
2011; 10(1): 360.
Mukim ASM, Patel J, Patel H, Naik S, Pandyas N, Sanghani K. A phase III clinical trial of alpha, beta-arteether injection 150 mg/ml in patients of P. falciparum
malaria. J Indian Med Assoc
2011; 109(8): 597-9.
Valecha N, Savargaonkar D, Srivastava B, Rao BK, Tripathi SK, Gogtay N, et al
. Comparison of the safety and efficacy of fixed-dose combination of arterolane maleate and piperaquine phosphate with chloroquine in acute, uncomplicated Plasmodium vivax
malaria: A phase III, multicentric, open-label study. Malar J
2016; 15(1): 42.
|15.|Annual Report 2013–14
. New Delhi: Science and Technology Project on Integrated Disease Vector Control, ICMR-NIMR 2014.
Toure OA, Valecha N, Tshefu AK, Thompson R, Krudsood S, Gaye O, et al
. A phase 3, double-blind, randomized study of arterolane maleate-piperaquine phosphate vs
artemether-lumefantrine for falciparum malaria in adolescent and adult patients in Asia and Africa. Clin Infect Dis
2016; 62(8): 964–71.
Gargano N, Ubben D, Tommasini S, Bacchieri A, Corsi M, Bhattacharyya PC, et al
. Therapeutic efficacy and safety of dihydroartemisinin-piperaquine versus
artesunate-mefloquine in uncomplicated Plasmodium falciparum
malaria in India. Malar J
Mayxay M, Keomany S, Khanthavong M, Souvannasing P, Stepniewska K, Khomthilath T, et al
. A phase III, randomized, non-inferiority trial to assess the efficacy and safety of dihydroartemisinin-piperaquine in comparison with artesunate-mefloquine in patients with uncomplicated Plasmodium falciparum
malaria in southern Laos. Am J Trop Med Hyg
2010; 83(6): 1221-9.
Worldwide antimalarial resistance network (WWARN) AS-AQ study group, Adjuik MA, Allan R, Anvikar AR, Ashley EA, Ba MS, Barennes H, et al
. The effect of dosing strategies on the therapeutic efficacy of artesunate-amodiaquine for uncomplicated malaria: a meta-analysis of individual patient data. BMC Med
Mohapatra PK, Khan AM, Prakash A, Mahanta J, Srivastava VK. Effect of arteether alpha/beta on uncomplicated falciparum malaria cases in Upper Assam. Indian J Med Res
Bharti PK, Chandel HS, Ahmad A, Krishna S, Udhayakumar V, Singh N. Prevalence of pfhrp2
gene deletion in Plasmodium falciparum
population in eight highly endemic states in India. PloS One
2016; 11(8): e0157949.
Bharti PK, Chandel HS, Krishna S, Nema S, Ahmad A, Udhayakumar V, et al
. Sequence variation in Plasmodium falciparum
histidine rich proteins 2 and 3 in Indian isolates: Implications for malaria rapid diagnostic test performance. Sci Rep
2017; 7(1): 1308.
Pati P, Dhangadamajhi G, Bal M, Ranjit M. High proportions of pfhrp2
gene deletion and performance of HRP2-based rapid diagnostic test in Plasmodium falciparum
field isolates of Odisha. Malar J
2018; 17(1): 394.
Kumar N, Pande V, Bhatt RM, Shah NK, Mishra N, Srivastava B, et al
. Genetic deletion of HRP2 and HRP3 in Indian Plasmodium falciparum
population and false negative malaria rapid diagnostic test. Acta Trop
2013; 125(1): 119-21
Singh N, Mishra AK, Shukla MM, Chand SK, Bharti PK. Diagnostic and prognostic utility of an inexpensive rapid on site malaria diagnostic test (ParaHit f) among ethnic tribal population in areas of high, low and no transmission of central India. BMC Infect Dis
2005; 5: 50.
Singh N, Saxena A. Usefulness of rapid on site Plasmodium falciparum
diagnosis (Paracheck®Pf) in forest migrants and among indigenous population at the site of their occupational activities in central India. Am J Trop Med Hyg
2005; 72(1): 26-9.
Singh N, Shukla MM, Shukla MK, Mehra RK, Sharma S, Bharti PK, et al
. Field and laboratory comparative evaluation of rapid malaria diagnostic tests versus
traditional and molecular techniques in India. Malar J
Raghavendra K, Ghosh S, Eapen A, Tiwari S, Satyanarayan T, Ravindran J, et al
. Field evaluation of lambda-cyhalothrin (ICON 10 CS) indoor residual spraying against Anopheles culicifacies
in India. J Vector Borne Dis
|29.|Annual Report DHR
2014–2015. New Delhi: Division of Publication and Information, ICMR, Ministry of Health & Family Welfare 2015.
Ranjit MR, Das A, Chhotray GP, Dash BP, Das BN. The PfCRT (K76T) pointmutation favours clone multiplicity in P. falciparum
infection. Trop Med Int Health
2004; 9(8): 857-61.
Ranjit MR, Sahu U, Khatua CR, Mohapatra BN, Achraya AS, Kar SK. Chloroquine-resistant P. falciparum
parasites and severe malaria in Orissa. Curr Sci
2009, 96(2): 1608-11.
Gunasekaran KSS, Nallana K,Tharmalingama V, Swaminathana S, Beherab KP, Pradhan MM, et al
. Comparative efficacy of two rounds of indoor residual spraying of DDT 75% @ 1 g/m2
with that of DDT 50% @ 1 g/m2
against the malaria vectors in India. Acta Trop
|33.|Annual Report 2009–2010
. New Delhi: ICMR-National Institute of Malaria Research 2010.
|34.|Revised common protocol for uniform evaluation of public health pesticides including bio-larvicides for use in vector control
. New Delhi: Indian Council of Medical Research–National Vector Borne Disease Control Programme–National Centre for Disease Control 2014.
Prakash A, Bhattacharyya DR, Mohapatra PK, Gogoi P, Sarma DK, Bhattacharjee K, et al
. Evaluation of PermaNet 2.0 mosquito bednets against mosquitoes including Anopheles minimus
s.l. in India. Southeast Asian J Trop Med Public Health
2009; 40(3): 449-57.
Cluster-randomized village-scale (Phase III) evaluation of deltamethrin SC 62.5 g ai/l for indoor residual spraying against Anopheles minimus s.l., the major malaria vector in Northeast India. Dibrugarh: Final Report submitted by ICMR-RMRC
|37.|Annual Report DHR 2013–2014
. New Delhi: Department of Health Research 2014.
|38.|Annual Report 2014–2015
. Bhubaneshwar: ICMR-Regional Medical Research Centre 2015.
Jambulingam P, Gunasekaran K, Sahu SS, Dash S, Sonia T, Krishnmoorthy N, et al
. Comparative assessment of the impact of combo vector control (long-lasting insecticide treated nets plus indoor residual spraying) versus
single measure (only LLIN or IRS) on malaria transmission in east-central India (Unpublished).
Mittal P, Sreehari U, Razdan R, Dash A. Efficacy of cyphenothrin [Gokilaht (R)-S 5% EC] as space spray against mosquitoes in sentinel cages. J Vector Borne Dis
2009; 46(3): 241-4.
Sunish IP, Khan ZA, Shriram AN, Sunish PV. Declining trend of malaria in Car Nicobar Island, inhabited by the Nicobarese tribe: Plausible factors. J Vector Borne Dis
2015; 52(2): 178-81.
Sunish IP, Shriram AN, De A, Vijayachari P. Malaria in the Andaman and Nicobar Islands: Challenges and opportunities for elimination. Asian Pacific J Trop Dis
2015; 5(10): 837-40.
Gunasekaran K, Sahu SS, Vijayakumar T, Vaidyanathan K, Yadav RS, Pigeon O, et al
. Comparison of efficacy of five types of long-lasting insecticidal nets against Anopheles fluviatilis
, the primary malaria vector in east-central India. J Med Entomol
2014; 51(4): 78594.
Gunasekaran K, Sahu SS, Vijayakumar T, Subramanian S, Yadav RS, Pigeon O, et al
. An experimental hut evaluation of Olyset plus, a long-lasting insecticidal net treated treated with a mixture of permethrin and piperonylbutoxide, against Anopheles fluviatilis
in Odisha state, India. Malar J
Gunasekaran K, Sahu SS, Vijayakumar T, Subramanian S, Jambulingam P. Bio-efficacy of LifeNet, a deltamethrin incorporated long-lasting insecticidal net, as assessed in experimental huts against Anopheles fluviatilis
, a major malaria vector in east-central India. Acta Trop
Gunasekaran K, Sahu SS, Vijayakumar T, Subramanian S, Rahi M, Jambulingam P. Evaluation of MAGNet, a long-lasting insecticidal mosquito net against Anopheles fluviatilis
in experimental huts in India. Malar J
Sahu SS, Gunasekaran K, Krishnamoorthy N, Jambulingam P. Bionomics of Anopheles fluviatilis
and An. culicifacies
in relation to transmission of malaria and its control in east-central India. J Med Entomol
2017; 54(4): 821-30.
|48.|Operational manual for malaria elimination in India
. Delhi: National Vector Borne Disease Control Programme 2016.
Panigrahi BK, Marai N, Hazra RK, Kar SK, Mohapatra N. Anopheline ecology and malaria transmission during the construction of an irrigation project area in Dhenkanal district, Odisha, India. Malaria transmission and irrigation. J Vector Borne Dis
2013; 50(4): 248-57.
Panigrahi BK, Kerketta AS, Mohapatra A, Hazra RK, Parida SK, Marai NS, et al
. Effect of construction of an irrigation canal on malaria situation in two primary health centres of Dhenkanal district of Orissa, India. Trop Biomed
2011; 28(1): 76-84.
Health impact assessment (HIA) of development projects with reference to mosquito-borne diseases. New Delhi: ICMR-National Institute of Malaria Research 2016
Pradhan S, Pradhan MM, Dutta A, Shah NK, Joshi PL, Pradhan K, et al
. Improved access to early diagnosis and complete treatment of malaria in Odisha, India. PLoS One
Raghavendra K, Chourasia MK, Swain DK, Bhatt RM, Uragayala S, Dutta GDP, et al
. Monitoring of long-lasting insecticidal nets (LLINs) coverage versus utilization: A community-based survey in malaria endemic villages of central India. Malar J
2017 17; 16
Kona, MP, Kamaraju R, Donnelly MJ Bhatt RM, Nanda N, Chourasia MK, et al
. Characterization and monitoring of deltamethrin-resistance in Anopheles culicifacies
in the presence of a long-lasting insecticide-treated net intervention. Malar J
Saha KB, Sharma RK, Mishra R, Verma A, Tiwari B, Singh N. Establishing communication mechanism for malaria prevention in Baiga tribal villages in Baiga Chak area of Dindori district, Madhya Pradesh. Indian J Med Res
. 2015; 141(5): 576.
Singh N, Mishra AK, Saha KB, Bharti PK, Sisodia DS, Sonal GS, et al
. Malaria control in a tribal area of central India using existing tools. Acta Trop
Singh N, Shukla M, Mishra A, Singh M, Paliwal J, Dash A. Malaria control using indoor residual spraying and larvivorous fish: A case study in Betul, central India. Trop Med Int Health
2006; 11(10): 1512-20.
Sarma NP, Prakash A, Bhattacharyya DR, Kalita MC, Mohapatra PK, Singh S, et al
. Spatial distribution and molecular characterization of Anopheles nivipes
and Anopheles philippinensis
(Diptera : Culicidae) in Northeast India. Acta Trop
2012; 122(3): 247-54.
Bhattacharyya DR, Prakash A, Sarma NP, Mohapatra PK, Singh S, Sarma DK, et al
. Molecular evidence for the involvement of Anopheles nivipes
(Diptera : Culicidae) in the transmission of Plasmodium falciparum
in North-eastern India. Annals Trop Med Parasitol
2010; 104(4): 331-6.
Sharma J, Khan SA, Soni M, Dutta P. Prevalence of multiple drug-resistant Plasmodium falciparum
malaria cases in Northeast India. Indian J Med Microbiol
2017; 35(1): 140-2.
Handique BK, Khan SA, Dutta P, Nath MJ, Qadira A, Raju PLN. Spatial correlations of malaria incidence hotspots with environmental factors in Assam, Northeast India. ISPRS Annals of the Photogrammetry, Remote Sensing and Spatial Information Sciences
2016; III(8): 51-6.
Sharma J, Dutta P, Khan SA. Epidemiological study of malaria cases in Northeast region of India. Indian J Med Microbiol
2016; 34(2): 261-2.
Mahapatra N, Marai N, Dhal K, Nayak RN, Panigrahi BK, Mallick G, et al
. Malaria outbreak in a non-endemic tribal block of Balasore district, Orissa, India during summer season. Trop Biomed
2012; 29(2): 277-85.