[ Ajay Tripathy ]
Malaria used to be a major public health problem of Arunachal Pradesh. However, in recent years, the government’s data show that there has been a significant decline in caseload. In one way, we may feel happy about it, but before that, let’s try to understand the issue.
The obvious question is, how has such decline in malaria cases taken place? Or, is there anything wrong in Arunachal’s malaria information system? If such declines are real, then the state vector-borne diseases control programme (SVBDCP) may bring up a credible publication supporting how it happened in Arunachal, where most villages and towns have mosquito-friendly conditions, mainly from April to September.
The government data say that, in this year, until 25 October, there were nine malaria cases, whereas in 2022 18 people suffered from malaria. Likewise, Arunachal also reported eight malaria cases in 2021 and 33 in 2020.
During 2018 and 2019, the malaria cases in Arunachal were in the three digits. Arunachal’s annual malaria number remained at four digits during 2012, 2013, 2014, 2015, 2016 and 2017. Between 2000 and 2011, continuously for 12 years, Arunachal reported malaria cases in five digits every year, varying from 13,950 to 56,030.
Arunachal reported 196 malaria deaths in 2006, with 39,182 cases. Altogether 103 people died due to malaria in 2010, out of the 17,944 patients.
Malaria deaths were in two digits during 2001, 2007, 2008, 2009, 2011, 2012 and 2013. Arunachal reported single-digit malaria deaths during 2014, 2015 and 2016.
Zero or no malaria death was reported in 2000, 2002, 2003, 2004, 2005, 2017, 2018, 2019, 2020, 2021 and 2022. This year, until October, no malaria death has been reported.
Although, as per government data, no one died due to malaria in 2000 but 46,165 people suffered from malaria during that year, the number of malaria cases in Arunachal during 2002, 2003, 2004 and 2005 were 46,431, 34,810, 29,849 and 31,215, respectively, although no malaria death was reported in those years. Can such zero-death reports be accepted when so many people suffered from malaria?
During the last six years, it’s not just about zero or no malaria death, but the number of reported cases showed a steady decline too. Altogether 1,546 people had malaria in 2017, whereas in 2018 there were 625 cases.
Then the number of cases came down to 139 in 2019. And in 2020, only 33 people suffered from malaria in Arunachal.
In 2021, it further declined to eight malaria cases, and 18 in 2022. As mentioned, Arunachal has only nine malaria cases this year, until the last report came in. Such decline in the number of malaria cases, especially since 2020, creates doubt about the credibility of malaria information system.
What kind of magic has the Arunachal Pradesh SVBDCP done in recent years that it successfully prevented malaria to such low caseloads? If such a model exists, where is the proof?
In the absence of credible evidence of successful malaria control programme, such data hint at the possible collapse of the state’s malaria information system. The health policymakers may verify the entire data generation system from the sub-centre level.
This year, until the latest available report, Arunachal conducted 93,582 blood smear examination (BSE), which only identified nine malaria cases. Out of the 1,09,635 BSEs, eight malaria cases were detected in 2021. Likewise, during 2022, Arunachal reported 1,36,563 BSEs and 18 malaria cases.
It appears that something is wrong with the testing kits or reporting system that might be producing several false negatives. Unless properly audited or critically reviewed, such reports may make the government complacent than help eliminating malaria in Arunachal. (The contributor is a public health expert who worked at CMC Vellore, ICMR, etc. He may be contacted at @tripathyajay (on X), or through his email address ajaytripathy@hotmail.com. The views expressed are personal).
