Health Bulletin 2009

in pre-monsoon (March-May) and post-monsoon (September-November) periods. There is also
reporting of outbreaks from bordering districts in the north and north-east. Both falciparum and
vivax malaria are prevalent in the country of which the number of falciparum cases are 75% of
the total cases in recent years due to increasing drug resistance. The first line drug chloroquin
has been replaced by artemesinin based Combination Therapy (ACT) for treatment of
falciparum malaria cases in 2004. An. dirus, An. minimus and An.Philipinensis are the principal
vectors and all are susceptible to malathion and synthetic pyrethroid. Promotion and use of
Insecticide Treated Nets, selective activities for containment of outbreaks and intensive
campaigning for increasing awareness of the people are the main components for vector
control. The malaria cases reported annually are an under estimate of the total disease burden
because of shortcomings in surveillance and information management. The epidemiological
data of 13 high endemic districts 2000-2008 is presented in the table below.
On an average, 60,000 confirmed cases are reported by the health institutions every year. This
is, however, a gross under-reporting because of the fact that the medical college hospitals,
specialized hospitals, NGO hospitals, private clinics and the private practitioners are not
reporting malaria cases through the routine surveillance system except in few cases.
The surveillance system needs to add reports from all these service providers. Similarly those
deaths are reported which are in hospitals and are diagnosed as confirmed cases during
hospital admission only. Deaths are thus also grossly under reported. According to the expert
opinion, the estimated burden of malaria may be three times higher than that of current
reporting.
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