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Malaria: The view from India

In India, malaria has become a hidden problem.

Rapid diagnostic kits only tell you if the disease is present, not how severe or advanced it is, so they are not a substitute for microscope diagnosis, said Yogesh Jain of Jan Swasthya Sahyog, a volunteer organization in Chhattisgarh state. And perhaps more importantly, the kits only last six months to a year — compared with a quarter-century for a good microscope — and they don't eliminate the need for qualified personnel. Even if the kits do make it to India's remote villages, Kaul asked, “Who will use them?”

The disease control program's answer to that question is another program that sounds good, but isn't working. The government has trained workers to make diagnoses and administer malaria treatment. But most of them actually know precious little about malaria — and because they are also responsible for prenatal care, the immunization of children and other schemes, they are often unavailable to dispense anti-malarial medication.

The sudden rush to convert to ACT treatment has also raised hackles. "In the Mekong delta already 20 percent have developed a resistance to ACT that is otherwise considered invincible," Jain said. The reason: "If you handle it poorly you will develop resistance. The drug (ACT) has to be given for a minimum of four days with two doses a day," he explained. When chloroquinine — a cure for certain kinds of malaria that has been around for decades — is not being administered properly, it is almost certain that ACT will be misused.

Jain doesn't hesitate to blame the WHO for the ACT push. "At some level (India's) malaria department is better than other departments, but daddies like the WHO and World Bank are able to influence the department in such a way that the interest of the poor is not finding its way into decision making," he said.

And even as India continues to pretend it doesn't have a malaria crisis, the problem is set to worsen with climate change and increased development.

"With over 650 million depending on climate-sensitive sectors for their livelihood, over 973 million people are exposed to malarial parasites," said Sumana Bhattacharya, a consultant to India's environment ministry. Also, because developmental activities such as hydro-electric dams and irrigation canal systems widen the breeding grounds for malaria, malaria exposure will likely increase unless precautions are taken. Jain said that the town of Jabalpur in Madhya Pradesh state had almost no malaria cases until the 1980s. But since the construction of the Bargi dam on the Narmada river, there has been a 25-fold increase in malaria cases.

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