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Malaria, a growing concern in India cities

By Dr Siddharth Agarwal

India marked World Malaria Day (April 25) with over 1 million cases of the disease in 2008, half of them of the dangerous P falciparum strain. Since this is largely due to unplanned urban growth and the growing number of urban poor, urban planning that is done keeping community needs in mind would go a long way in checking the spread of malaria

World Malaria Day on April 25 has just gone by, and it is important not to forget that India’s battle with malaria is far from over. The country had an estimated 10.6 million malaria cases in 2006, accounting for 60% of the malarial incidence in South East Asia, according to the World Health Organisation (World Malaria Report 2008). India is among the countries classified as having 95% of the population with moderate to high risk of malaria in the South East Asian Region.

There were over 1 million cases of malaria in India in 2008, as per the National Vector Borne Disease Control Programme (NVBDCP), and these figures itself are believed to be a gross underestimation.

A cause for concern is the increasing incidence of P falciparum, the more fatal form of malaria. According to the World Malaria Report, with over 100 million slides examined every year in India, all reported cases are confirmed and about half are due to P falciparum. 

What can we do to help control malaria?

  • Malaria is a potentially life threatening parasitic disease caused by parasites known as Plasmodium genus
  • It is transmitted by the infective bite of the female Anopheles mosquito
  • Typically, malaria produces fever, headache, nausea and other flu-like symptoms.
  • Promoting community involvement to check vector breeding sites – For eg: construction areas that have water collection points.
  • All household water containers should be kept tightly closed, regularly emptied and cleaned.
  • Utensils, buckets, tyres, etc should not be thrown out into the open indiscriminately.
  • Biological larvicides that destroy the larvae are a safe and effective method.

Malaria in urban India

As India rapidly urbanises, it is especially significant to note the malarial incidence in urban areas and among the urban poor.

While the malarial incidence is much higher in rural areas, it increased significantly after 1963 in towns and cities as well. A conservative estimate is that nearly 1 lakh cases of malaria are reported every year from urban and peri-urban areas.

The proposal to control malaria in towns was named the Urban Malaria Scheme, under the National Malaria Eradication Programme that had been launched in 1958. UMS was approved during 1971 and is at present functioning in 131 towns. Chennai, Vadodara, Allahabad, Kolkata, Greater Mumbai and Pune, are among the cities that report the maximum number of malaria cases.

Urban malaria poses problems because of the haphazard and unplanned expansion of cities and towns. Increased construction in cities leads to the migration of workers from endemic areas whereby parasites are transported to non-endemic zones. Construction activities and aggregation of labour provide ideal opportunities for vectors to breed and transmit malaria in urban areas. Large scale human mobility is also heightened by inter-state movement for trade and other activities.

Malaria is being freely disseminated by the movement of people to big cities and towns in search of employment. While moving out of urban areas they carry the infection to rural areas that have been cleared of malaria.

One of the most vulnerable segments of the population with regard to incidence of malaria is the urban poor. There has been an increase in the population of urban poor, who number nearly 100 million in India today. Poor sanitary conditions in slum clusters and water being stored in domestic containers due to shortages in supply encourage the breeding of mosquitoes.

Malaria is now being freely disseminated by the movement of people to the big cities and towns in search of employment in various developmental activities like industries, construction, etc. While moving out of urban areas they carry the infection to rural areas that have been cleared of malaria.

Climate change and greater warming in urban areas is increasing the population’s vulnerability to malaria. Warming results in a longer window of favourable temperature for mosquito breeding; the rate of development from the stage of egg to mosquito is faster and they feed more frequently as digestion is more rapid.

Further, with the rising incidence of P falciparum, one of the most serious concerns in checking the spread of malaria is its increasing resistance to the commonly available anti-malarial drug chloroquine.

More effective vector control needed

Effective vector control is critical in controlling the incidence of malaria. It is necessary to give attention to more effective control interventions like larvicides. The most effective malaria control strategies are the use of biological methods like larvivorous fish (Gambusia affinis and Poecilia reticulata) and chemical larvicides (abate, fenthion) in water collection areas, which are cost-effective and have no side-effects. Personal prophylactic measures like using mosquito nets and repellents are also crucial, but larval control measures are more important.

As most people know, stagnant pools of water encourage the breeding of mosquito larvae.  Strengthening the behaviour change component in NVBDCP by promoting community awareness and involvement in checking the spread of malaria and detecting mosquito breeding sites is vital because malaria control if seen only as a government responsibility cannot be successful.

For maximising effectiveness, convergence among the activities of municipal authorities, health department, development authorities (responsible for regulating construction activities), schools, NGOs and other agencies, is also necessary.

Finally, urban planning that is done keeping community needs in mind would go a long way in checking the spread of malaria. These include:

  • Participatory planning for better preparedness for potential urban water supply; waste disposal challenges; migration and growth of slums.
  • Spatial mapping, monitoring and tracking of potential vector breeding sites (blocked drains, water collections, colonies with predominant open water storage) and construction sites in the city
  • Promotion of urban architecture to minimise water collection and facilitate water harvesting
  • Sensitisation of builders and construction companies to prevent mosquito breeding areas on their work sites

(Dr Siddharth Agarwal is a public health practitioner and presently executive director, Urban Health Resource Centre, that works on urban health issues and provides technical support to government health programmes. Email: This email address is being protected from spambots. You need JavaScript enabled to view it.)

InfoChange News & Features, April 2009