Malaria transmission and disease burden in Assam: challenges and opportunities.

Malaria is major public health illness in Assam and 30-40% of the population is estimated to be at high-risk. Despite decades of attempted control interventions, malaria transmission is perennial and persistent in most parts of the state mostly transmitted by Anopheles minimus. Malaria outbreaks are returning associated with high rise in Plasmodium falciparum and attributable death cases. Therapeutic efficacy investigations for treatment of malaria revealed that chloroquine resistance was widespread for which artemisinin-based combination therapy (ACT) is being instituted in the control program. For data based on the preceding years, we briefly reviewed the available information on transmission dynamics, vector biology and control, drug policy, and discuss the challenges and opportunities for strengthening interventions for malaria control to help design situation specific strategies to check impending disease outbreaks with special reference to Assam. Under increased assistance from external agencies, we strongly advocate scaling up interventions based on mass distribution of long-lasting insecticidal nets (LLINs) for prevention and ACTs for treatment of drug-resistant malaria, and developing strong health delivery system in high-risk areas for meeting the complex emergencies and achieving transmission reduction.