Impact assessment of Intensified Malaria Control Project in transitioning a high malaria-endemic district to a low-endemic district: an epidemiological aspect

ABSTRACT

Intensified Malaria Control Project (IMCP) was implemented in 2005 to control malaria in all North-Eastern and Odisha states of India. The present study aimed to investigate the impact of IMCP in reducing the malaria burden in Udalguri district, Assam state of North-East India. Malaria epidemiological data were obtained for IMCP intervention (Udalguri) and nonintervention district (West Singhbhumi, Jharkhand state). IMCP activities include introducing bi-valent rapid diagnostic kits (RDTs), Artemether-Lumefantrine drug in North-East India, long-lasting insecticidal nets (LLINs) distribution, and creating awareness programs about malaria in an intensified mode. The data revealed a significant decline in annual parasite incidence (API) from 14.94 (2005) to 2.61 (2018), −37% (95%CI: −57%, −19%, p = 001) after using LLINs in 2009 and −64% (95%CI: −116%, −14%, p = 013) after the introduction of RDTs in district Udalguri. Whereas control district showed a −28% (95%CI: −63%, 6.3%, p = 0.051) decrease in API using LLINs and a 10% (95%CI: −7.6%, 28%, p = 0.122) increase after the introduction of RDTs. Plasmodium falciparum (Pf) and P. vivax (Pv) were the major malarial parasites in Udalguri. Pv-malaria was much higher (71%) than Pf-malaria (29%) during the study period. An increasing trend of Pf cases was observed in Udalguri. Udalguri and Khoirabari BPHCs showed an overall reduction of 94% (95%CI: −143%, −45%, p = 0.001) and 84% (95%CI: −126%, −39%, p = 0.003), respectively; however, only a 10% (95%CI: −65%, −41%, p = 0.360) reduction in API was observed in Orang BPHC. An overall decrease in malaria indicates the effective implementation of vector and disease control strategies in the Udalguri district.

KEYWORDS:

• Annual parasite incidence
• epidemiology
• malaria
• Plasmodium falciparum
• Plasmodium vivax

Acknowledgements

The authors acknowledge the financial support in the form of the Intensified Malaria Control Project (2005 to 2017), the Government of India, and GFATM for carrying out this work. The authors are also thankful to the District NVBDCP unit, Udalguri, for their active collaboration during the study. Specially thanks to Dr. Tayebur Rahman, Jt. Director of Health Services, Udalguri and Sri Jatin Chandra Rabha, Asst. Malaria Officer, Udalguri, for their active support during the study. The authors would also like to thank the State NVBDCP unit, Assam, for their guidance during the study. The Directorate of NVBDCP, New Delhi, and GFATM is also acknowledged for giving the opportunity to conduct the study

Disclosure statement

No potential conflict of interest was reported by the authors.

Availability of data and material

All relevant data are available in the manuscript

Authors’ contribution

RAA, DK, and AB wrote the first draft of the manuscript and contributed substantially to data collection and interpretation of the results. AS performed the data analysis and made graphs. SSAH, in collaboration with HS, performed the statistical modeling and time series analysis. RAA and HSS executed the field investigations. AK and HSS coordinated the field operations and logistic arrangements. HS drafted the final version of the manuscript. HS, GK, AK, and RAA critically reviewed the manuscript, and all authors provided intellectual inputs, reviewed and approved this manuscript.

Ethical approval

This study comprised secondary data analysis, and the inferences drawn in this study are from the data collected by the District Programme Office National Vector Borne Disease Control Programme as routine malaria management activities.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.