Prior to the launch of the National Malaria Control Program in1953, malaria was a major problem in India. The disease contributed 75 million cases with 0.8 million deaths every year.

After a significant decline in the 1960s, malaria emerged as a major health problem of India in the 1970s. Presently, malaria is a major challenge with 2 to 2.5 million incidences every year.

According to statistical data published by National Malaria Eradication Program, or NMEP, in the year 1997, the incidence of Plasmodium vivax malaria in India is 60-70 per cent, while that of falciparum malaria is 30-45 per cent. Around 50 per cent of complicated malaria may lead to mortality if timely treatment is not given, the report says.

As per NMEP survey report (1995), the "National Average" of falciparum malaria has increased to 35.5 per cent from a meager 9.34 per cent in 1972.

Drug resistant malaria
Drug resistant malaria means malaria caused by a plasmodium resistant to usual anti-malarial drugs. Although chloroquine resistant strains of P vivax have been described, drug resistance poses a serious clinical problem only with P falciparum, which accounts for over 70 per cent of cases and much of the mortality of human malaria.

Drug resistance in India
The incidence of drug-resistant malaria is difficult to determine because in many cases it may not be recorded.

Incidence of drug resistance in India is more common with P falciparum compared to P vivax. Occasionally, P vivax may also be drug resistant and this occurs specially as a result of improper treatment and inadequate dosage.

Originally, both the Plasmodia – vivax and falciparum – were sensitive to chloroquine, but, in recent years, increasing number of chloroquine drug resistance cases are seen with P falciparum.

In India, the first confirmed report of chloroquine resistance in P falciparum was reported in Diphu area of Karbianglong district of Assam in 1973.

To overcome this problem of chloroquine resistance, a sulfadoxine-pyrimethamine combination was used. But, very soon, some strains of falciparum developed resistance to this combination also.

P falciparum resistances to traditional drugs like quinine have also been reported.

Worldwide incidence
Chloroquine resistant strains of P falciparum are found now in nearly all areas of chloroquine use including South America, Central America east of Panama Canal, the Western Pacific, East Asia and many regions of Africa south of the Sahara.

Resistance to the combination of pyrimethamine and sulfadoxine is prevalent in some areas of Southeast Asia, the Amazon Basin of South America and many foci in sub-Saharan Africa.

Similarly, variable degrees of decreased responsiveness to quinine and quinidine have been reported, though rarely, in SouthEast Asia and Oceania and apparently in sub-Saharan Africa.

Recent reports from Indonesia (Irian Jaya, Simitra) and Papua New Guinea indicate high levels of P vivax schizonts resistant to chloroquine. Resistance of P vivax blood schizonts to pyrimethamine and sulfadoxine has been reported in many areas of the world, particularly Southeast Asia.