The changing dynamics of Plasmodium vivax and P. falciparum in central India: trends over a 27-year period (1975--2002).

The changing epidemiology of malaria since 1975 was studied in a tribal forested belt of central India, Chhattisgarh state, which is the second most highly malarious state in India. Chhattisgarh, which accounts for 2% of the total population of the country, contributed >16% of the total malaria cases, 23% of Plasmodium falciparum, and 7% of deaths due to malaria in the country. Retrospective analysis further revealed that, in 1975--76, P. vivax was the predominant species (58%); however, since 1979, P. falciparum showed a steady upward trend (50%), and in 2002. P. vivax reduced to 28%. Between 1986 and 2000, P. falciparum cases reported by the National Anti Malaria Programme have increased 500%, and the number of deaths also showed a similar alarming increase. From 2000 to 2002, though the number of malaria infections and number of deaths declined sharply as a result of intensive intervention measures (30% and 95%, respectively), which included new drugs like Sulfadoxine Pyrimethamine and Arteether under Enhanced Malaria Control Programme, the proportion of P. falciparum has held steady without any decline. Moreover, along with Anopheles fluviatilis, the traditional vector in the forest, An. culicifacies has also established itself in the forest. The comeback of malaria and establishment of new vectors was largely due to the deterioration of health services along with emergence of resistance in P. falciparum to Chloroquine and in An. culicifacies to DDT. Therefore, a more diversified malaria control program might be needed for sustainable malaria control.