Urban Malaria: Challenge to India’s 2030 Malaria elimination target

Urban Malaria Scheme (UMS) was launched to address the Vector-Borne Diseases in India’s Cities. The rapid spread of the invasive vector is threatening India’s goal of eliminating the mosquito-borne disease by 2030. Read here to learn more.

India’s ambition to eliminate malaria by 2030 faces a renewed challenge from the rapid spread of urban malaria, particularly driven by the invasive mosquito vector Anopheles stephensi, according to the Malaria Elimination Technical Report, 2025, released by the Ministry of Health and Family Welfare.

Once largely confined to rural and peri-urban areas, malaria transmission is increasingly becoming an urban public health concern, especially in large metropolitan regions such as Delhi.

Urban malaria

Urban malaria was long perceived as a marginal health problem confined to a few megacities, with local bodies considered capable of managing it independently.

Consequently, when the National Malaria Eradication Programme (NMEP) was launched in 1958, urban malaria did not receive focused attention. However, by the 1970s, while rural malaria incidence declined sharply, urban areas witnessed a rising trend in cases.

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Recognising the potential of urban malaria to reverse rural gains, India launched the Urban Malaria Scheme (UMS) in 1971 as a complementary strategy under the broader framework of vector-borne disease control.

Role of Anopheles stephensi in Urban Malaria

Anopheles stephensi is uniquely adapted to urban environments. Unlike rural vectors, it breeds efficiently in:

• Overhead water tanks
• Construction sites
• Artificial containers
• Poorly managed urban water storage systems

Its expansion into cities has transformed malaria from a predominantly rural disease into an urban vector-borne threat, undermining traditional control strategies focused on rural transmission.

Persistent Drivers of Malaria Transmission

The report identifies several structural and epidemiological challenges that continue to sustain malaria transmission:

• Asymptomatic infections: Individuals without symptoms act as silent reservoirs, evading surveillance and treatment.
• Difficult terrain and forested regions: Particularly in Odisha, Tripura, and Mizoram, which continue to harbour high-burden pockets.
• Population mobility: Migrant workers and seasonal movement disrupt the continuity of diagnosis and treatment.
• Cross-border transmission: Porous borders with Myanmar and Bangladesh contribute to sustained transmission in northeastern districts, complicating elimination efforts.

Implications for India’s Malaria Elimination Goal

• Urban vulnerability: Expansion of malaria into cities like Delhi increases population exposure and strains urban health systems.
• Surveillance gaps: Traditional passive surveillance is inadequate for detecting asymptomatic and mobile populations.
• Regional spillovers: Cross-border transmission highlights the need for regional cooperation beyond national strategies.

Urban Malaria Scheme

• The Madhok Committee (1970) revealed that 10-12% of total malaria cases originated from urban areas.
• The committee emphasised anti-larval measures, warning that unchecked urban malaria could spread to rural regions.
• Under the Modified Plan of Operation (MPO), urban malaria control was institutionalised.
• The Urban Malaria Scheme (UMS) was approved in November 1971 as a centrally sponsored scheme, providing 100% central assistance in kind to States.

Coverage:

• UMS currently covers 131 towns across 19 States and Union Territories.
• It protects approximately 142.9 million urban population from malaria and other mosquito-borne diseases.

Objectives of the Urban Malaria Scheme

The overarching goal of UMS is to reduce malaria to a tolerable level where transmission is controlled with available means.

Specific Objectives

• Prevention of deaths due to malaria
• Reduction in malaria transmission and morbidity

Eligibility Norms for Towns under UMS

A town qualifies for inclusion under UMS if:

• The population is 50,000 or more
• Annual Parasite Incidence (API) ≥ 2
• Local bodies enforce civic by-laws to eliminate domestic and peri-domestic mosquito breeding sites

Urban Malaria Situation in India

• About 10% of malaria cases in India originate from urban areas.
• Major contributors include cities like Chennai, Kolkata, Visakhapatnam, Vadodara, Mumbai, Vijayawada, etc.
• Over the years (2005-2021), urban malaria cases and deaths have declined significantly, reflecting improved control strategies, though periodic spikes remain a concern.

Control Strategies under the Urban Malaria Scheme

UMS adopts a dual-pronged strategy:

1. Parasite Control

• Diagnosis and treatment through:
  • Government and private hospitals
  • Dispensaries
  • Private practitioners
• Dedicated malaria clinics in mega cities run by:
  • Municipal Corporations
  • Railways
  • Defence services

2. Vector Control

• Vector control is the cornerstone of UMS and includes the following components:

a) Source Reduction

• Environmental management to eliminate breeding sites:
  • Filling pits and ditches
  • Desilting and deweeding drains
  • Proper solid and liquid waste disposal
  • Weekly “Dry Day” observance
  • Improved sanitation and water management

b) Anti-larval Measures

• Chemical larvicides:
  • Temephos
  • Bacillus thuringiensis israelensis (Bti- WP & AS)
• Applied at weekly intervals in breeding-prone water bodies

c) Biological Control

• Use of larvivorous fish:
  • Gambusia affinis
  • Poecilia reticulata (Guppy)
• Suitable for ponds, lakes, and slow-moving water bodies

d) Aerosol Space Spray

• Pyrethrum extract (2%) sprayed in:
  • Around 50 houses surrounding malaria or dengue-positive cases
• Aimed at killing infective adult mosquitoes

e) Engineering and Legislative Measures

• Enforcement of building by-laws
• Regulation of construction sites
• Health safeguards in urban development projects

Emerging Challenges of Urban Malaria

Rapid urbanisation has introduced new vulnerabilities:

• Unplanned urban growth and slums with poor sanitation
• Water storage practices due to irregular water supply, aiding:
  • Anopheles stephensi (urban malaria vector)
  • Aedes aegypti (dengue vector)
• Expansion of cities and emergence of peri-urban hotspots (e.g., Gurugram, Noida, Navi Mumbai)
• Insufficient manpower and over-reliance on chemical larvicides
• Poor integration of health impact assessments in infrastructure projects
• Rising drug resistance, especially Plasmodium falciparum
• Inadequately trained workforce for vector-borne disease control

Way Forward

• Shift from chemical-centric control to Integrated Vector Management (IVM)
• Strengthen urban local bodies with manpower and finances
• Mandatory health impact assessments for urban infrastructure projects
• Digital surveillance and GIS-based mapping of breeding sites
• Community participation and behaviour change communication
• Convergence with Swachh Bharat Mission, AMRUT, and Smart Cities Mission

Conclusion

The Urban Malaria Scheme represents a critical public health intervention in India’s rapidly urbanising landscape. While it has significantly reduced malaria morbidity and mortality, emerging urban challenges demand a renewed focus on integrated, preventive, and participatory approaches.

Strengthening UMS is essential not only for malaria control but also for safeguarding urban health security in the era of climate change and rapid urban expansion.