Part 8 · Intestinal, Vector-Borne and Zoonotic Diseases

74. Malaria — Epidemiology, Diagnosis and Indicators

Foundation Clinical Reasoning

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The reasoning: epidemiology

Feature	Detail
Agents	P. vivax and P. falciparum (≈ half each nationally, Pf dominant in forested/tribal areas and the north‑east); P. malariae, P. ovale rare; P. knowlesi (zoonotic, Andaman/NE reports)
Vectors	An. culicifacies, stephensi, fluviatilis, minimus, baimaii, sundaicus
Host factors	Age (children in high transmission), pregnancy (placental malaria), HbS/thalassaemia, Duffy‑negative (vivax resistance), G6PD deficiency (protective; primaquine risk), acquired immunity
Environment	Temperature 20–30 °C, humidity > 60%, rainfall, irrigation, deforestation, urbanisation, migration, forest work
Burden trend	India's cases and deaths fell ≈ 80% between 2015 and 2025; high‑burden districts fell from 155 to 33, which carried ≈ 64% of cases in 2025 (MoHFW review, August 2026). India exited WHO's "High Burden to High Impact" group in 2024

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Feature

Detail

Agents

P. vivax and P. falciparum (≈ half each nationally, Pf dominant in forested/tribal areas and the north‑east); P. malariae, P. ovale rare; P. knowlesi (zoonotic, Andaman/NE reports)

Vectors

An. culicifacies, stephensi, fluviatilis, minimus, baimaii, sundaicus

Host factors

Age (children in high transmission), pregnancy (placental malaria), HbS/thalassaemia, Duffy‑negative (vivax resistance), G6PD deficiency (protective; primaquine risk), acquired immunity

Environment

Temperature 20–30 °C, humidity > 60%, rainfall, irrigation, deforestation, urbanisation, migration, forest work

Burden trend

India's cases and deaths fell ≈ 80% between 2015 and 2025; high‑burden districts fell from 155 to 33, which carried ≈ 64% of cases in 2025 (MoHFW review, August 2026). India exited WHO's "High Burden to High Impact" group in 2024