Malaria Management
On this page
Direct answer
India's malaria control runs under the National Centre for Vector Borne Diseases Control, whose National Framework for Malaria Elimination targets zero indigenous cases by 2027 and elimination by 2030. Uncomplicated falciparum malaria is treated with artemisinin-based combination therapy — artesunate plus sulfadoxine–pyrimethamine for three days — while vivax malaria receives chloroquine over three days followed by a 14-day radical cure with primaquine after excluding G6PD deficiency. Severe malaria, almost always falciparum, is an emergency treated with intravenous artesunate followed by a full oral course.
What you must remember
- The female Anopheles mosquito transmits malaria; Plasmodium falciparum causes the severe, potentially fatal disease (cerebral malaria, severe anaemia, renal failure, hypoglycaemia, pulmonary oedema), while P. vivax classically relapses from liver hypnozoites.
- Diagnosis under the programme is by microscopy (gold standard, allows species and parasite count) or rapid diagnostic tests detecting falciparum histidine-rich protein 2 and vivax-specific lactate dehydrogenase.
- Uncomplicated falciparum malaria: artesunate plus sulfadoxine–pyrimethamine daily for three days under the national drug policy; artemisinin monotherapy is banned to protect the partner drugs.
- Vivax malaria: chloroquine 25 mg base per kg over three days plus primaquine 0.25 mg per kg daily for 14 days for radical cure, after G6PD screening, since primaquine can trigger haemolysis.
- Severe malaria: intravenous artesunate 2.4 mg per kg at 0, 12 and 24 hours, then daily until oral therapy is tolerated, followed by a full oral combination course.
- Cerebral malaria presents with fever and altered sensorium, often with anaemia and jaundice; look for hypoglycaemia (especially in pregnancy and quinine therapy) and avoid fluid overload.
- Chemoprophylaxis is advised for high-risk travellers; vector control combines insecticidal nets, indoor residual spraying and larval source reduction.
Common confusion
Candidates frequently pair the wrong drug with the wrong species: chloroquine alone is no longer adequate for falciparum infection in India, and primaquine is not an alternative therapy for falciparum but a gametocidal addition in some policies. Another trap is treating a febrile smear-negative patient as malaria without revisiting dengue, typhoid or leptospirosis — rapid tests must match the clinical story. Blackwater fever is classically linked to erratic quinine use; today's severe-disease answer is artesunate, not quinine.
Exam-focused takeaway
FMGE stems usually give you fever with a suggestive smear or rapid test and ask for the first-line drug under Indian policy: falciparum means artesunate-based combination therapy, vivax means chloroquine plus 14 days of primaquine, and coma, convulsions, severe anaemia or dark urine means intravenous artesunate now. Learn the two target years of the elimination framework and the vector–species pairs, because they appear as direct one-liners. Watch for the G6PD clause attached to primaquine and the pregnancy clause — artemisinin combinations are avoided in the first trimester, where quinine with clindamycin is used instead.
Frequently asked questions
What is the first-line treatment for uncomplicated falciparum malaria in India?
Artemisinin-based combination therapy with artesunate plus sulfadoxine–pyrimethamine for three days, as laid down in the national drug policy on malaria.
How is vivax malaria radically cured?
Chloroquine over three days for the blood stage, then primaquine 0.25 mg per kg daily for 14 days to eradicate liver hypnozoites, after G6PD testing.
Which drug is first line for severe malaria?
Intravenous artesunate, given 2.4 mg per kg at 0, 12 and 24 hours and then daily, followed by a full oral combination course once the patient improves.
What are the target years of India's malaria elimination framework?
The National Framework for Malaria Elimination aims for zero indigenous cases by 2027 and certified elimination by 2030.
Why is primaquine risky in some patients?
It can cause acute haemolysis in G6PD-deficient individuals, so screening is advised before radical-cure therapy, especially in pregnancy, where primaquine is contraindicated.