National maleria eradication programme
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National Malaria Eradication Programme history objectives strategies
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National Malaria Eradication Programme (NMEP)
Background
Malaria was one of India's most devastating public health problems in the early 20th century, with an estimated 75 million cases and 0.8 million deaths annually before independence. This led to the launch of one of the world's largest public health initiatives.
Phase 1: National Malaria Control Programme (NMCP) — 1953
Launched in 1953, the NMCP aimed to reduce malaria morbidity and mortality. Key activities included:
- Indoor residual spraying (IRS) with DDT
- Case detection and treatment
Within a few years, annual cases dropped dramatically — from 75 million to around 2 million by 1958 — prompting a more ambitious goal.
National Malaria Eradication Programme (NMEP) — 1958
Launched on 1 April 1958, the NMEP was a bold national effort to completely eradicate malaria from India, encouraged by the WHO Global Malaria Eradication Campaign (1955).
Objectives
- Complete eradication of malaria transmission
- Elimination of the parasite reservoir in the human population
- Prevention of re-establishment of malaria
Four Phases of NMEP
| Phase | Duration | Activities |
|---|---|---|
| Preparatory Phase | 1–2 years | Infrastructure setup, training, baseline surveys |
| Attack Phase | 3 years | Mass DDT indoor residual spraying (IRS) every 6 months; active case detection |
| Consolidation Phase | ~3 years | Surveillance intensified; spraying in endemic foci only; treatment of cases |
| Maintenance Phase | Ongoing | Passive surveillance; preventing re-introduction |
Key Strategies
1. Indoor Residual Spraying (IRS) with DDT
- DDT was the cornerstone insecticide due to its residual efficacy
- Targeted Anopheles mosquito vectors, particularly An. culicifacies, An. stephensi, An. fluviatilis, and An. minimus
- As noted in the medical literature, "DDT indoor residual spray remains an effective tool to control An. fluviatilis-transmitted P. falciparum malaria in India" (Malaria, p. 300)
2. Active Surveillance (ABER — Annual Blood Examination Rate)
- Target: examine at least 10% of the population annually
- Blood smears taken from fever cases; laboratory diagnosis of species (P. vivax vs P. falciparum)
3. Case Detection and Radical Treatment
- Presumptive treatment with chloroquine for all fever cases
- Radical cure with primaquine for P. vivax to eliminate hypnozoites
4. Epidemiological Indicators Monitored
- API (Annual Parasite Incidence) = Positive cases per 1,000 population/year
- SPR (Slide Positivity Rate)
- SFR (Slide Falciparum Rate)
- ABER (Annual Blood Examination Rate)
Initial Success and Subsequent Resurgence
| Year | Estimated Cases |
|---|---|
| Pre-1953 | ~75 million |
| 1961 | ~49,151 (near eradication) |
| 1976 | ~6.4 million (resurgence) |
| 1980s–90s | 2–3 million (stabilized) |
The dramatic decline to under 50,000 cases by 1961 was a remarkable achievement. However, several factors led to resurgence from the late 1960s–1970s:
- Complacency and premature withdrawal of DDT spraying
- Development of DDT resistance in vectors
- Development of chloroquine resistance in P. falciparum
- Inadequate funding and manpower
- Population movement and urbanization
- Breakdown in surveillance
Programme Evolution Post-NMEP
| Programme | Year | Key Change |
|---|---|---|
| NMEP continues | 1958 onwards | Shift from eradication to control |
| Modified Plan of Operations | 1977 | Focused on P. falciparum control |
| Malaria Action Programme | 1983 | Emphasis on Pf and tribal/remote areas |
| Enhanced Malaria Control Project (EMCP) | 1997 | World Bank assisted; selective vector control |
| National Vector Borne Disease Control Programme (NVBDCP) | 2003 | Merged malaria with filaria, kala-azar, dengue, JE, chikungunya |
| National Framework for Malaria Elimination (NFME) | 2016–2030 | Target: elimination by 2030 |
Current National Framework for Malaria Elimination (2016–2030)
India's current strategy follows the WHO Global Technical Strategy and aims for:
- Category 1 states (low transmission): Elimination by 2022
- Category 2 states (moderate transmission): Elimination by 2024
- Category 3 states (high transmission, tribal): Elimination by 2027
- National elimination: 2030
Modern Tools Employed
- Long-Lasting Insecticidal Nets (LLINs)
- Artemisinin-based Combination Therapies (ACTs) for P. falciparum
- Rapid Diagnostic Tests (RDTs) for field diagnosis
- Indoor residual spraying with newer insecticides (malathion, synthetic pyrethroids)
- Mobile health technology for surveillance
- As noted by Harrison's: "The two main tools used to control malaria are insecticide-treated bed nets (ITNs) and the ACTs" (Harrison's, p. 6452)
Challenges to Eradication
- Widespread Anopheles breeding sites across diverse ecosystems
- Large reservoir of infected individuals
- Drug resistance (P. falciparum resistance to chloroquine; emerging artemisinin resistance)
- Insecticide resistance in vectors
- Hard-to-reach tribal and forested populations
- Cross-border transmission (Northeast India, Myanmar border)
- Co-infection with P. vivax (hypnozoite reservoir)
Summary
The NMEP (1958) was a landmark programme that brought India to the brink of malaria eradication by 1961, only to see resurgence due to operational, entomological, and parasitological factors. Its legacy shaped all subsequent malaria control efforts in India. The current goal under the NFME 2016–2030 is complete malaria elimination — a renewed commitment backed by modern tools, global partnerships, and better surveillance infrastructure.
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