Doctors struggle to cure malaria

MUMBAI: After three bouts of malaria in 11 months, city resident Sarita Seshan has been left without a job and with scepticism of modern medicine’s ability to combat malaria.
Each time she came down with the infection, it took long and complicated diagnoses, and multiple rounds of different drugs before her fever finally subsided. “Malaria finds mention in Vedic texts of 1600 BC,’’ mused Seshan.
“However, its cure, still seems a challenge.’’ Cases like hers are on the rise as treatment of malaria becomes increasingly complicated.Many of the complications stem from changes in plasmodium, the parasite that causes the disease. For one, there has been an increase in plasmodium falciparum, a species that causes cerebral malaria.
Till about a decade ago, this species accounted for only 20 per cent of malaria infections in the city. Falciparum infections can be fatal.
The remaining 80 per cent of malaria infections were caused by the less lethal plasmodium vivax. However, new data collected at the KEM Hospital and anecdotal evidence from private practitioners in Mumbai and Navi Mumbai indicate that falciparum now accounts for 30 to 40 per cent of malaria infections in the city.
The problem is compounded by falciparum’s resistance to common anti-malarial drugs. Studies from the KEM Hospital indicate that over 50 per cent of plasmodium falciparum cases in Mumbai are resistant to chloroquine, which is the first-line treatment recommended by the national malaria control programme.
In addition, there have been reported cases of falciparum resistance to other common anti-malarials such as artemisinin, primaquine, sulfadoxine and pyrimethamine.
Despite the steadily increasing drug resistance, public health experts do not recommend abandoning chloroquine. “The majority of malaria infections in Mumbai are still caused by plasmodium vivax, which is sensitive to chloroquine,’’ explained N.A. Kshirsagar, dean of KEM Hospital.
Doctors are quick to add that treatment with chloroquine demands close followup to ensure that patients complete their full dose and that they respond adequately to the drug. However, multiple studies reveal irrational and indiscriminate use of anti-malarials.
“Private doctors especially are under pressure to show quick results or else the patient will go to another physician. This market pressure coupled with patients’ often unrealistic expectations prompt doctors to switch drugs rapidly without completing full doses,’’ said Chandana Behl, private physician and a public health activist in Navi Mumbai.
While resistance to existing anti-malarial drugs grows, there are few new drugs that are affordable and easy to administer.
Shobhona Sharma, a molecular biologist at the Tata Institute Fundamental Research who works on malaria, added that the prospect of malaria vaccines also remains bleak because not enough is known about the workings of the pathogen. “Mosquito nets are the best option at this stage. The idea is not to get bitten,’’ Sharma said.