CDS (II) 2021 General Knowledge · Question 114 of 120

Correct — C, China. The World Health Organization certified China malaria-free on 30 June 2021, five months before this paper was set. The scale of what was undone is the striking part: China was reporting something like thirty million malaria cases a year in the 1940s, and it worked the number down over seven decades of sustained effort before recording its first year with no indigenous case. Certification is not awarded for low numbers. WHO grants it only when a country can prove that the chain of indigenous malaria transmission by Anopheles mosquitoes has been broken nationwide for at least the previous three consecutive years, and can also show it has the surveillance and response capacity to stop the disease being re-established. At the time of China's certification about forty countries and territories had reached that standard.

• (a)Pakistan — Malaria remains a live public health problem in Pakistan, with transmission continuing across large parts of the country. It has not been certified.
• (b)Bhutan — Bhutan has driven its case numbers down sharply and is among the countries working towards elimination in this region, but it had not been certified when this paper was set.
• (d)Nepal — Nepal likewise has an elimination programme and much-reduced transmission, and likewise had not received certification. The three wrong options are all South Asian neighbours, chosen so that a candidate who half-remembers regional progress on malaria will hesitate.

Malaria is caused by Plasmodium parasites and is passed to people by female Anopheles mosquitoes. Because the parasite must complete part of its life cycle inside the mosquito, control works on three fronts at once — killing or excluding the vector with nets and residual spraying, finding and treating human cases quickly so there is no reservoir for a mosquito to draw on, and keeping surveillance tight enough that an imported case does not restart local transmission.

The word to hold on to in this question is 'certification', which has a technical meaning and a specific test behind it. Elimination is what a country achieves; certification is what WHO confers after verifying it, and the three-consecutive-years rule is the part most often forgotten. The other useful frame is that certification is reversible in principle — a certified country that stops watching can see transmission re-established, which is why capacity to prevent resurgence is part of the test. Since 2021 further countries have been certified, so the figure of about forty is the count as it stood in the middle of that year rather than a current total, and India remains outside the group with its own elimination target.

• China was certified malaria-free by the World Health Organization on 30 June 2021.
• Certification requires proof that the chain of indigenous transmission by Anopheles mosquitoes has been interrupted nationwide for at least the past three consecutive years.
• The country must also demonstrate the capacity to prevent re-establishment of transmission.
• China reported roughly thirty million malaria cases a year in the 1940s and began its elimination effort in the 1950s.
• About forty countries and territories had been granted WHO malaria-free certification at the time of China's certification.

• Assuming a small country must be first; China is the largest country ever certified in its region.
• Treating certification as automatic once cases reach zero; the three-year rule and the resurgence-prevention test both have to be met.
• Confusing elimination in one country with global eradication, which has been achieved only for smallpox.

As a country-to-milestone item, or inside a statements question on what WHO certification requires.

• practice — not a real PYQ

  For WHO to certify a country malaria-free, indigenous transmission must have been interrupted nationwide for at least

  • (a)one year
  • (b)three consecutive years
  • (c)five consecutive years
  • (d)ten consecutive years

  Answer(b) three consecutive years — and the country must also show it can prevent the disease from being re-established.

• practice — not a real PYQ

  Malaria is transmitted to humans by which one of the following?

  • (a)Female Anopheles mosquito
  • (b)Male Aedes mosquito
  • (c)Female Culex mosquito
  • (d)Sandfly

  Answer(a) Female Anopheles mosquito — Aedes carries dengue and chikungunya, Culex carries Japanese encephalitis and filariasis, and the sandfly carries kala-azar.