Which Indicator Should Be used to Monitor Malaria Elimination in India?

The Annual Parasite Incidence (API) is currently being used by the National Vector Borne Disease Control Programme (NVBDCP) as an indicator to monitor malaria elimination efforts in states and union territories. This article is an attempt to find out how effective is the API as a tool to measure malaria elimination efforts in the country by reviewing documents published by the NVBDCP (for 2018 data) and National Statistical Office (for 2021 data) and by doing a web search. It was found that in the 2018 data set, there was no direct correlation between API and the number of malaria cases. Even in territories having low API, the number of malaria cases was high and in areas having high API, the number of malaria cases was low. From the 2021 data set, it was seen that the malaria problem was greatest in Chhattisgarh and least in Lakshadweep Islands. Thus, API by itself is not a useful indicator of malaria elimination efforts. Attention must also be paid to the actual number of malaria cases occurring in the state/ union territory, and at the present time, the focus must be on Chhattisgarh.