Time to address the drawbacks in estimation and reporting of malaria cases in India and beyond

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Abstract
India is committed to eliminate malaria by 2030. However, there has been a continuous debate between National Malaria Control Programmes (NMCPs) and World Health rganization (WHO) on the differential perception of malaria burden. The evident gap between the reported cases by NMCPs and WHO estimations, particularly for India, has never been unbiasedly addressed. This work provides a critical understanding of gaps between estimated and reported cases (ERR) of malaria and the possible reasons thereof. We calculated the ratio between estimated and reported cases, called ERR thereof, for highlighting this gap from 2010 to 2022. We also dissected some of the assumptions/adjustments used by WHO to compensate for data inadequacy while estimating malaria cases. The contribution of private sector in reporting malaria cases and contemporary research data on malaria burden in India were correlated with ERR. ERR remained consistently high (WHO-South-East Asia Region >6; India >10) from 2010 to 2022. Certain assumptions/adjustment factors used by WHO for estimation were unclear. Malaria case reporting from private sector in India was virtually non-existent contributing to consistently high ERR. Data from contemporary research in India also reveal a high burden gap with microscopy-positivity being 3 to 55 times higher than that reported by the NMCP. There still remain a few areas where more detailed clarification is needed both from the WHO and the NMCPs reporting malaria burden specifically regarding malaria case reporting from the private health sectors. If these issues are addressed and resolved, the gap between ERR can be narrowed down or even zeroed.
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