Malaria Epidemiology Along the Indian Districts Bordering Bhutan and Implications for Malaria Elimination in the Region

Abstract

It is important for malaria-endemic countries to address malaria control across international borders, and in particular to prioritize appropriate rapid diagnosis, treatment, and surveillance. Bhutan and India aim to achieve malaria elimination by 2023 and 2030, respectively. Malaria elimination along the Indo–Bhutan border is of common concern. We delineated malaria epidemiology along the border to provide a blueprint for focusing malaria control efforts in key foci within this region. Epidemiological data from 2015 to 2019 were analyzed, as the most drastic reductions in malaria burden across most parts of India were witnessed in this time frame. Several areas of concern include low surveillance in most border districts, favorable climatic conditions for perennial malaria transmission, and movement of potential parasite carriers because of the porous borders. India and Bhutan need to control the importation/exportation of malaria cases. We highlight the key foci of concern for which implementing tailor-made malaria control strategies may benefit both countries.

What India can learn from globally successful malaria elimination programmes

“…India has porous borders with many neighbouring malaria-endemic countries and also poses a threat to the neighbouring countries which are at the cusp of elimination such as Bhutan. 39 Therefore, India should institute strong parasite and vector surveillance programmes to curtail exchange. Cross-border malaria issues have been handled well by China, Algeria, El Salvador, Sri Lanka, Armenia, Paraguay and Uzbekistan by intense surveillance of migrants and travellers.…”

“…National and international partners are crucial to achieving malaria elimination, especially for overcoming the last-mile challenges. 39 Prevention of re-establishment strategies POR of malaria transmission in a malaria-free country is a daunting task. After elimination, active case detection (ACD) with mobile malaria clinics is still maintained in Sri Lanka.…”

“…Strict surveillance of cross-border transmission as embraced by China, Algeria, El Salvador, Sri Lanka, Armenia, Paraguay and Uzbekistan with deployment of mobile teams and examination of travellers from malaria-endemic countries through RACD could be possible steps which need induction in our control guidelines. India has porous borders with many neighbouring malaria-endemic countries and also poses a threat to the neighbouring countries which are at the cusp of elimination such as Bhutan 39. Therefore, India should institute strong parasite and vector surveillance programmes to curtail exchange.…”

“…Involvement of intersectoral ministries and uninterrupted funding were adopted in Sri Lanka to eliminate the disease. National and international partners are crucial to achieving malaria elimination, especially for overcoming the last-mile challenges 39…”

Linkages between malaria and malnutrition in co-endemic regions of India

“…Further, Meghalaya, Mizoram and Tripura share international borders with Bangladesh and Myanmar which are malaria endemic. Cross-border malaria along with poor surveillance and high climatic suitability are major drivers of malaria transmission in these states 31. Recent studies have been unable to find a clear association between malnutrition and malaria in high malaria-endemic districts in the northeast 32…”