The World Health Organization estimates that India has 15 million cases of malaria each year, with 19,500-20,000 deaths, compared to 2 million cases and 1,000 deaths reported in the United States.

What is Malaria?

Malaria is a potentially fatal disease caused by a parasite that infects a specific type of mosquito that feeds on humans. Malaria typically causes severe illness, including high fevers, shaking chills, and flu-like symptoms.

WHO Malaria Report

WHO celebrates World Malaria Day each year on April 25th to underscore the collective energy and commitment of the global malaria community in uniting around the common goal of a world free of malaria.

Every year, the World Malaria Report from WHO provides detailed information on the most recent trends in malaria control and elimination at the global, regional, and national levels. The report highlights progress toward global goals and discusses opportunities and challenges for reducing and eliminating the disease. This year’s report includes a special analysis of the impact of COVID-19 pandemic disruptions on malaria prevention, diagnosis, and treatment.

According to the WHO Malaria Report 2021, India accounted for about 82% of all malaria deaths in the WHO South-East Asia Region.

Download the WHO Malaria Report 2021

Epidemiological types of malaria in India

Plasmodium falciparum and Plasmodium vivax are the two major human malaria species in India; P. malariae has been reported in the eastern Indian state of Orissa, while P. ovale appears to be extremely rare. Surprisingly, the proportions of the two major infecting species vary across India. For example, P. vivax infects the southern state of Tamil Nadu, P. falciparum is the dominant parasite in Orissa, and mixed-species infections are common in the west (e.g., Gujarat state). Although P. falciparum and P. vivax are distributed unevenly across India, this is not due to Anopheles vector restriction (despite the fact that the vector species also differ in geographical distribution, see below), because both species are transmitted by the same vectors.

Malaria cases in India are reported all year because of a perfect combination of average temperature (15-30°C), rainfall, and precipitation-inducing conditions that persist across the country during all seasons.

Malaria Types

The World Health Organization categorizes malaria as “severe” or “uncomplicated”. When any of the following criteria are present, it is considered severe; otherwise, it is considered uncomplicated.

• Reduced consciousness
• Significant weakness to the point where the person is unable to walk
• Feeding difficulty
• Two or more convulsions
• Blood pressure is too low (less than 70 mmHg in adults and 50 mmHg in children)
• Breathing difficulties
• Circulatory shock
• Kidney failure 
• Bleeding issues or low haemoglobin levels 
• Pulmonary oedema
• Low Blood glucose levels 
• Acidosis

A parasite level in the blood that exceeds 100,000 per microlitre (L) in low-intensity transmission areas or 250,000 per L in high-intensity transmission areas.

Cerebral malaria is characterized by severe P. falciparum malaria with neurological symptoms.

Mosquitoes that cause malaria

It is transmitted solely through the bites of infected Anopheles mosquitos.

Malaria causative agent or malaria parasite or protozoan that causes malaria

Five Plasmodium (single-celled parasite) species can infect humans and cause illness:

• Plasmodium falciparum (or P. falciparum)
• Plasmodium malariae (or P. malariae)
• Plasmodium vivax (or P. vivax)
• Plasmodium ovale (or P. ovale)
• Plasmodium knowlesi (or P. knowlesi)

Falciparum malaria has the potential to be fatal. Severe falciparum malaria can cause liver and kidney failure, convulsions, and coma. Infections with P. vivax and P. ovale, while occasionally severe, generally cause less serious illness. However, the parasites can remain dormant in the liver for many months, causing symptoms to reappear months or even years later.

How is malaria spread by mosquitoes?

Malaria is usually spread by older female Anopheles mosquitoes. The parasites from the mosquito’s saliva enter a person’s bloodstream through the bite. The parasites migrate to the liver to mature and reproduce.

The life cycle of the malaria parasite

Anopheles mosquitos have four life stages: egg, larva, pupa, and adult. These mosquitos lay their eggs in a variety of bodies of fresh or brackish water. As a result, the first three stages are aquatic and last 7–14 days.

The natural history of malaria involves cyclical infection of humans and female Anopheles mosquitoes. Female mosquitoes suck human blood (take blood meals) for egg production. In the parasite life cycle, blood meals serve as the link between humans and mosquito hosts.

Parasites grow and multiply first in the liver cells and then in the red cells of the blood, due to which the infected cells burst open. Parasites growing inside the red blood cells release daughter parasites that continue the cycle by invading other red cells. Humans get infected with malaria when bitten by an infected mosquito.

The blood-stage parasites are responsible for causing malaria symptoms in humans. When these parasites are ingested by a female Anopheles mosquito while blood feeding, they initiate a cycle of growth and multiplication in the mosquito, after which a form of the parasite known as a sporozoite migrates to the mosquito’s salivary glands.

When the Anopheles mosquito sucks another human’s blood, anticoagulant saliva is injected along with the sporozoites, which then migrate to the liver, eventually starting a new cycle.

Blood smear test for malaria

Under the microscope, malaria parasites can be identified by examining a drop of the patient’s blood spread out as a “blood smear” on a microscope slide. Prior to the examination, the specimen is stained (usually with the Giemsa stain) to distinguish the parasites. This method is still considered the gold standard for laboratory confirmation of malaria. However, the quality of the reagents, the microscope, and the laboratorian’s experience all play a role.

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Symptoms of malaria

P. falciparum is the most common cause of severe malaria (often referred to as “falciparum malaria”). Falciparum malaria symptoms appear 9–30 days after infection.

The classic symptom of malaria is Paroxysm, which is a cyclical occurrence of sudden coldness followed by shivering, fever, and sweating that occurs every two days in P. vivax and P. ovale infections and every three days in P. malariae infections. Infection with P. falciparum can cause recurrent fever every 36–48 hours, or less severe and almost continuous fever.

Adults with malaria typically experience chills and fever generally in six-hour bursts followed by sweating and fever relief as well as headaches, fatigue, abdominal discomfort, and muscle pain. Children typically exhibit more general symptoms such as fever, cough, vomiting, and diarrhea.

Signs of cerebral malaria

Individuals suffering from cerebral malaria frequently exhibit neurological symptoms such as abnormal posturing, nystagmus, conjugate gaze palsy (inability of the eyes to turn in the same direction), opisthotonus, seizures, or coma.

Malaria vs. dengue symptoms

Dengue and malaria symptoms are similar, such as high fever, fatigue, and nausea, but some dengue symptoms stand out, such as pain behind the eyes, swollen glands, and rashes.

Symptoms of severe dengue include vomiting, blood in the vomitus or stool, abdominal pain, and so on.

How is malaria treated?

Malaria is treated with antimalarial medications; the type and severity of the disease determine which medications are used.

Antimalarial drugs include:

• Artemisinin drugs (artemether and artesunate). The best treatment for Plasmodium falciparum malaria, if available, is artemisinin combination therapy.
• Atovaquone
• Chloroquine
• Doxycycline
• Mefloquine
• Quinine
• Primaquine

Lariago medicine for malaria

Lariago 250mg Tablet (Chloroquine 250mg) is an antiparasitic medication used to prevent and treat malaria. It works by increasing haeme levels in the blood, which is toxic to the malarial parasite. This kills the parasite and prevents the infection from spreading further.

How is malaria prevented?

Precautions should be taken to avoid mosquito bites. To reduce your risk of getting malaria, you should:

• Apply DEET (diethyltoluamide) mosquito repellent to exposed skin.
• Drape mosquito netting over mattresses.
• Install window and door screens.
• Permethrin, an insect repellent, should be applied to clothing, mosquito nets, tents, sleeping bags, and other fabrics.
• Cover your skin by wearing long pants and long sleeves.

Malaria vaccine

In 2015, European regulators approved the RTS,S/AS01 (RTS,S) malaria vaccine. As part of the WHO’s Malaria Vaccine Implementation Programme, it is being tested in three Sub-Saharan African countries: Ghana, Kenya, and Malawi (MVIP).

The pilot program in three African countries resulted in a 40% reduction in malaria episodes and one life saved for every 200 vaccines. Based on these findings, WHO recommended the use of the malaria vaccine RTS,S in children in Sub-Saharan Africa and moderate-to-high transmission areas on October 6, 2021.

Frequently asked questions (FAQ’s)