Mumbai’s malaria outbreak

Dr Rhona MacDonald, Freelance editor, rhonamacdonald@gmail.com

Last month’s monsoons brought a rapid increase of Plasmodium vivax malaria to the Indian city of Mumbai. Although usually labelled as a “mild” form of malaria, this strain of P. vivax can be fatal and causes many unusual symptoms ranging from a cough, sore throat and back ache right through to internal bleeding, heart attacks, and multi-organ failure.   According to the latest statistics, (quoted in the latest Update from the Global health Forum of the Council of Foreign Relations) at the end of July, in Mumbai 34,712 residents were positive for malaria infection,10,048 had been admitted to hospital, and forty people had died of P vivax malaria. There are reports of huge queues in suburban hospitals where almost half of all beds are occupied by patients with fever and malaria.

Local authorities (BMC-Brihanmumbai Municipal Corporation) has been quick to respond to the outbreak: it has employed 700 paramedics to go door to door to collect blood samples from residents and around 400 employees for the cleaning operations across the city.  However, it has also been heavily criticised for not doing more to prevent this outbreak.

But could this outbreak have been easily prevented? The answer lies in the debate surrounding the source of the outbreak. Indian newspapers have been discussing whether the outbreak is caused by poor migrant labourers from the suburbs of Mumbai where construction work is actively taking place (good breeding ground for mosquitoes), or whether the mosquitoes and active transmission are occurring in the more wealthy urban areas? Some commentators blame the migrant workers and give the impression that there is therefore nothing to worry about, as the problem only affects poor people and cannot impair business and investment.  Thankfully, most Indian politicians have deplored this view.

This difference of opinion is just another example of the huge wealth divide in the world’s second most populous country, which has the highest number (note, NOT proportion) of people living in absolute poverty but also has a predicted 9.4% increase in GDP by the end of this year—a staggering figure. It will be interesting to see how much of this economic growth will be spent on the nation’s poorest people, including migrant labourers.