Beyond the bite: a 22‐year analysis of climate and social interventions in malaria reduction

Abstract This study aims to identify the relative impact of meteorological and socio-demographic variables on malaria incidence in India, as their combined role is crucial for achieving the 2030 elimination target. While climate change influences the spatial and temporal patterns of transmission, its exact effect varies due to development efforts and malaria control strategies, which have significantly reduced the incidence. Mapping the decline in incidence over two decades shows the persistence of hotspots (Central India, from the borders of Rajasthan and Gujarat to Odisha, Jharkhand, Chhattisgarh and eastern Madhya Pradesh, and North–East) and areas of significant reduction. Statistical models used in this study delineate the role of temperature and rainfall (annual, seasonal and variability). Exposure to a minimum rainfall (60–120 mm; IRR = 1.001) and warm temperature (IRR = 1.037) are necessary for transmission, but a 1 °C temperature increase during the summer months leads to a 13% reduction in cases. The variability of the long-term average in temperature contributes to the incidence (IRR = 1.3) but precipitation thwarts (IRR = 0.98). Integrating socioeconomic factors emphasises the vulnerability of historically marginalised social groups (scheduled tribe (ST) individuals) to malaria and an enhanced adaptive capacity due to improved water sources and female education. It curtails the odds of high malaria incidence by 5.6% and 4.7%, respectively. The role of last-mile health access is noted in better reporting. The classification and regression tree (CART) model also recognises ST population, proportion of educated females and access to sanitation as dominant and interacting predictors of malaria prevalence. With the success of micro-level strategies like the DAMaN and Malaria Elimination Demonstration Project, the persistence of (‘tribal’) malaria can be addressed with women’s capacity building, education, and integration with national nutrition schemes for equitable malaria elimination.