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Researchers at the London School of Hygiene & Tropical Medicine (LSHTM) have been awarded £2.8m to study factors sustaining malaria transmission in an area of India where infections are evading detection.  

The team will investigate malaria in the eastern tribal state of Odisha, where asymptomatic infections and those that cannot be spotted through microscopic examination help maintain a reservoir of this parasitic disease.  

They will also evaluate biomarkers associated with malaria infections to inform the design and implementation of new interventions and diagnostic tools, furthering the goal of malaria elimination across India. 

Malaria in India has been declining since the early 2000s. Cases have gone down from 20 million in 2000 to 5.6 million in 2019, according to the . Despite this, the burden of malaria in Odisha has remained stubbornly high compared to other states in the country.  

In collaboration with the  and the , LSHTM researchers and partners will carry out a community-based study of 3,000 people to investigate why malaria-causing Plasmodium infections persist across three districts of Odisha, each of which has a distinct ecology and malaria transmission settings. 

The five-year project will focus on the prevalence and impact of submicroscopic and asymptomatic infections, understanding how infections are evading diagnosis, measuring human-to-mosquito transmission through antibody levels, monitoring non-Plasmodium falciparum species, and evaluating changes in mosquito vector dynamics and insecticide resistance. 

The U.S. National Institute of Allergy and Infectious Diseases (NIAID) is funding the project as part of its  (ICEMR) programme.  

Dr Sam Wassmer, co-director of the Malaria Centre at LSHTM and co-director of the new India ICEMR programme, said: "Previous research as part of this programme has generated extensive data showing there is a considerable burden of infections that are not detectable by microscopy, or do not lead to symptoms in malaria-endemic regions in India. These hidden reservoirs perpetuate malaria parasite transmission locally.”

“In addition, research from our team has shown a high occurrence of diagnostic escape in the region, when using rapid diagnostic tests. Malaria parasites have evolved to stop shedding the protein used to detect them in the blood of patients, jeopardising their chance of being diagnosed accurately and treated.

“Deciphering the factors driving the maintenance of malaria infections and reservoirs is key for designing innovative strategies tailored to different transmission settings and supporting malaria elimination efforts locally.

“The particular convergence of threats to malaria elimination is unique to Odisha within India but is highly relevant to other endemic countries facing similar challenges.”  

Dr Sanjib Mohanty, a senior physician based at the Community Welfare Society Hospital in Rourkela, and co-director of the programme, said: "This award will be crucial to better understanding how malaria parasites evade current elimination strategies in different settings in Odisha.

“Through our research projects and the training of a new generation of malaria scientists, the India ICEMR will support future steps in the fight against malaria in India.”

Read more about this programme research (NIH award number 1U19AI181587-01).