Malaria control - lessons learned from trends of Malaria indices over three decades in Karnataka, India

BACKGROUND

Karnataka is one of the largest states in India and has a wide range of geographical terrains, ecotypes, and prevalence of malaria. It experiences a voluminous influx and efflux of people across the state that affects the spread of malaria. The state deployed focused intervention measures keeping the national objective of malaria elimination as the foremost priority. This brought down malaria cases below a thousand by the year 2021. Furthermore, the state is motivated toward malaria elimination by 2025. This study analyzes the trends in malaria indices over the past three decades in the state and highlights the key intervention measures that impacted the reduction in the malaria burden.

METHODS

Data from 1991 to 2021 at the district level was collected from the archives of Regional Office for Health & Family Welfare (ROH&FW), Bangalore. Time-tend analysis on this data was conducted after categorization into three decades. Sequence plots were then plotted on the moving average of Annual Parasite Index for all those three decades. Generalized estimating equation model with Poisson distribution were used to evaluate difference in these indicators with pre and post interventions like LLIN, RDT with ACT and Guppy and Gambusia fishes.

RESULTS

Malaria burden across the state has consistently declined over the last three decades with few years of exception. This has coincided with the mortality also steadily declining from 2006 and culminating in zero malaria deaths reported from 2011 to 2019. Morbidity had drastically reduced from the hundred-thousand (1993-2003) to ten thousand (2004-2016) thousands (2017-2020) of cases in this period and less than thousand cases were reported by 2021. Generalized estimating equation (GEE) model revealed significant difference of incidence risk ratio of malaria incidence and deaths, post introduction of interventions like LLIN, RDT with ACT and Guppy and Gambusia fishes, indicating these three as important interventions for reducing the malaria burden. Time trend analysis revealed a linear decreasing trend in malaria cases during 2011-2021 decade.

CONCLUSIONS

A linear decreasing trend in malaria cases was observed during 2011-2021 decade. LLIN, RDT with ACT and Guppy and Gambusia fish's interventions significantly helped in reducing the state malaria burden.

Recent Declines in Nutrient Concentrations and Fluxes in the Lower Changjiang River

To elucidate nutrient variation patterns and trends over various timescales under combined effects of human activities and climate change, nutrient concentrations were monitored monthly in Lower Changjiang (Yangtze) River from November 2016 to August 2020. They were also monitored daily during an extreme flood in July 2020. Over daily and seasonal timescales, the Changjiang River discharges had a dominant influence on nutrient concentrations. By combining existing data over recent decades with those from the current study, we found that turning points for concentration trends for most nutrients emerged in the recent decade (2010-2020), i.e., 2012 for NO3-, PO43-, and NH4+ and 2014 for SiO32-. After these turning point years, NO3-, SiO32-, and PO43- concentrations decreased at annual rates of 2.953, 3.746, and 0.108 μM/year, respectively. Regarding NO3- and PO43-, their concentrations and fluxes increased from 1960s to 2012, similar to the increasing trends of anthropogenic N and P fertilizer inputs from the drainage basin. After 2012, concentrations and fluxes of NO3- and PO43- showed significant decreasing trends, largely due to the control of N and P fertilizer usage. A comparison among eight rivers in East and South China (including the Changjiang River) indicated that basin latitudes were essential to determining areal nutrient yields, implying that latitude-related factors, such as temperature, precipitation, and areal population density, significantly impacted nutrient fluxes. This study emphasized that the deteriorating Changjiang River aquatic environment (which lasted from 1960s to 2010) has been successfully terminated over the last 10 years in 2010s.