International Journal of Clinical Science and Medical Research

Background: Despite substantial progress towards malaria elimination in India, Mizoram continues to experience persistent and fluctuating transmission. Previous studies have established the spatial concentration of malaria in high-burden districts. However, recent changes in transmission in relation to routine surveillance performance remain insufficiently understood. 

Objectives: To assess temporal changes in malaria transmission and surveillance performance in Mizoram during 2017-2024 and examine the relationship between surveillance indicators and malaria incidence 

Methods: A retrospective ecological study was conducted using district-level malaria surveillance data from the National Vector Borne Disease Control Programme for 2017-2024. Annual Parasite Incidence (API), Annual Falciparum Incidence, Slide Positivity Rate (SPR), Plasmodium falciparum percentage, Annual Blood Examination Rate (ABER), blood-slide collection and examination, confirmed cases, and malaria deaths were analysed. Temporal trends and district-level variation were assessed using descriptive statistics, Spearman’s rank correlation, and multivariate linear regression. 

Results: Malaria transmission declined during 2017-18 but resurged from 2019, with marked increases during 2022-2024. Transmission remained concentrated in Lawngtlai, Mamit and Lunglei, while several districts maintained low incidence. Rising API coincided with increasing SPR, whereas ABER declined after 2022, indicating that increased malaria burden was accompanied by higher parasite positivity despite changing surveillance intensity. SPR showed the strongest positive association with API (ρ=0.99, p<0.001) and remained statistically significant after adjustment. Falciparum-related mortality persisted, although the case fatality rate declined from 0.09 per cent in 2019 to 0.05 per cent in 2024. 

Conclusion: Malaria resurgence in Mizoram during the elimination phase reflects persistent focal transmission despite sustained routine surveillance. The close association between API and SPR indicates continuing transmission intensity, while changing surveillance patterns highlight the need to strengthen timely diagnostic processing and case detection. Elimination strategies should prioritise surveillance responsiveness and targeted transmission reduction in persistently affected districts.

Malaria, surveillance, elimination, transmission, Mizoram, NVBDCP

1. Das, A., Anvikar, A. R., Cator, L. J., Dhiman, R. C., Eapen, A., Mishra, N., Nagpal, B. N., Nanda, N., Raghavendra, K., Read, A. F., Sharma, S. K., Singh, O. P., Singh, V., Sinnis, P., Srivastava, H. C., Sullivan, S. A., Sutton, P. L., Thomas, M. B., Carlton, J. M., & Valecha, N. (2012). Malaria in India: The Center for the Study of Complex Malaria in India. Acta Tropica, Tackling The Malaria ‘End Game’: Regional Needs And Challenges For Successful Malaria Elimination, 121(3), 267–273. https://doi.org/10.1016/j.actatropica.2011.11.008
2. Lalchhandama, G., & Saitluanga, Benjamin L. (2024). Climate Change and Malaria Epidemics in the North-Eastern State of India, Mizoram. Disaster Advances, 17(6), 33–39. https://doi.org/10.25303/176da033039
3. Laldinsanga, Sarma, H., Jahan, T., Kumar, A., & Sharma, H. K. (2019). TRADITIONAL ANTI-MALARIAL DRUGS FROM SERCHHIP AND LUNGLEI DISTRICTS OF MIZORAM. Current Trends in Pharmaceutical Research, 6(1), 77–104.
4. Lalmalsawma, P., Balasubramani, K., James, M. M., Pautu, L., Prasad, K. A., Sarma, D. K., & Balabaskaran Nina, P. (2023). Malaria hotspots and climate change trends in the hyper-endemic malaria settings of Mizoram along the India–Bangladesh borders. Scientific Reports, 13(1), 4538. https://doi.org/10.1038/s41598-023-31632-6
5. MOHFW. (2016). National framework for malaria elimination in India 2016-2030 (p. 43) [Meeting Report]. Ministry of Health and Family Welfare, GOI.
6. Mopuri, R., Kadiri, M. R., Bhimala, K. R., & Mutheneni, S. R. (2025). Identification of malaria vulnerable zones in North East Region of India: Spatiotemporal assessment through geographical information system and self-organizing maps. Acta Tropica, 270, 107783. https://doi.org/10.1016/j.actatropica.2025.107783
7. NVBDCP. (2017). Epidemiological Situation Report of Mizoram 2017 (p. 21). Directorate of National Vector Borne Disease Control Programme.
8. NVBDCP. (2018). Epidemiological Situation Report of Mizoram 2018 (p. 21). Directorate of National Vector Borne Disease Control Programme.
9. NVBDCP. (2019). Epidemiological Situation Report of Mizoram 2019 (p. 23). Directorate of National Vector Borne Disease Control Programme.
10. NVBDCP. (2020). Epidemiological Situation Report of Mizoram 2020 (p. 23). Directorate of National Vector Borne Disease Control Programme.
11. NVBDCP. (2021). Epidemiological Situation Report of Mizoram 2021 (p. 25). Directorate of National Vector Borne Disease Control Programme.
12. NVBDCP. (2022). District Wise Malaria Epidemiological Situation Report Mizoram-2022 (p. 22). Directorate of National Vector Borne Disease Control Programme.
13. NVBDCP. (2023). District- Wise Malaria Annual Report, 2023 (p. 17). Directorate of National Vector Borne Disease Control Programme.
14. NVBDCP. (2024). Districtwise Annual Report 2024 (p. 7). Directorate of National Vector Borne Disease Control Programme.
15. Sarma, D. K., Mohapatra, P. K., Bhattacharyya, D. R., Chellappan, S., Karuppusamy, B., Barman, K., Senthil Kumar, N., Dash, A. P., Prakash, A., & Balabaskaran Nina, P. (2019). Malaria in North-East India: Importance and Implications in the Era of Elimination. Microorganisms, 7(12), 673. https://doi.org/10.3390/microorganisms7120673
16. Sharma, V. P., Dev, V., & Phookan, S. (2015). Neglected Plasmodium vivax malaria in northeastern States of India. The Indian Journal of Medical Research, 141(5), 546–555. https://doi.org/10.4103/0971-5916.159511
17. Vanlalhriata, C., Lalpianpuii,  null, Wankhar, P. T., Prakash, P. T., Amarthaluri, C., Pautu, L., Vanramliana,  null, Lalmalsawma, P., Kodali, P. B., Balasubramani, K., & Balabaskaran Nina, P. (2024). Assessment of knowledge, attitude, and practices toward malaria in the Lunglei district, Mizoram, North-East India. Malaria Journal, 23(1), 236. https://doi.org/10.1186/s12936-024-05058-y
18. WHO. (2018). Malaria surveillance, monitoring & evaluation: A reference manual (p. 196) [Manual]. World Health Organization.
19. WHO. (2023). World malaria report 2023 (p. 283). World Health Organization.
20. Zomuanpuii, R., Hmar, C. L., Lallawmzuala, K., Hlimpuia, L., Balabaskaran Nina, P., & Senthil Kumar, N. (2020). Epidemiology of malaria and chloroquine resistance in Mizoram, northeastern India, a malaria-endemic region bordering Myanmar. Malaria Journal, 19, 95. https://doi.org/10.1186/s12936-020-03170-3