(a) Under the National Framework for Malaria Elimination in India, what are the targets set for the years 2027 and 2030…

India’s malaria elimination strategy is staged by transmission intensity. Under the National Framework for Malaria Elimination, the 2027 target is elimination of malaria in Category 3 States and UTs, i.e. high-transmission areas with API >2 per 1,000 population at risk, after earlier targets for Category 1 and 2 (2020 and 2022). The 2030 target is malaria-free India, with national elimination and certification. For Category 3, intensified control means sustained IRS in high-risk foci, universal LLIN distribution, prompt diagnosis and ACT-AL/ACT-SP treatment, radical cure with primaquine (single dose 0.75 mg/kg for P. falciparum gametocytocidal effect where safe), and strengthened surveillance. Surveillance parameters include API, slide positivity rate, Plasmodium falciparum proportion, therapeutic efficacy studies, insecticide resistance monitoring, and case-based reporting through IHIP (Integrated Health Information Portal). API tracks incidence per 1,000 population at risk, SPR tracks positive slides per 1,000 blood examinations, and Pf proportion tracks species mix; together they enable early detection of resurgence, guide vector-control response, and support certification. Category 3 also requires active case detection, community engagement, and quality assurance of testing and treatment. IHIP provides real-time data for district-level action.

Contraceptive eligibility and IUCD care. WHO MEC classifies contraceptive methods for women with medical conditions into four categories: 1 no restriction; 2 advantages generally outweigh risks; 3 theoretical or usually serious risks, but advantages generally outweigh risks; 4 unacceptable health risk. It is a counselling tool for method selection, not a diagnosis. Category 3 requires careful counselling and follow-up. Examples include category 1 for conditions such as COPD where methods are broadly safe, category 3 for conditions needing caution such as migraine with aura where hormonal methods are restricted, and category 4 for unacceptable risks such as breast cancer with hormonal methods; for Cu-IUCD, active pelvic infection, pregnancy, or uterine perforation are category 4. IUCD complications are immediate (pain, vasovagal syncope, perforation), early (expulsion, PID, abnormal bleeding), and late (pregnancy with device, embedment, actinomycosis). Perforation may present with acute pain and absent threads, PID with fever and discharge, expulsion with visible threads, and embedment with pain or failed removal. A misplaced Cu-T is managed by first confirming location with ultrasound and, if needed, X-ray; if partially expelled or extrauterine, remove it, preferably hysteroscopically if embedded, and laparoscopically if perforated into the peritoneal cavity, with antibiotics if infection is suspected. If the device is intrauterine but malpositioned, remove and replace after excluding infection.

Cleft palate. Cleft palate results from failure of the palatal shelves to elevate, meet and fuse during the 8th–12th week of embryogenesis. The primary palate forms from medial palatine processes, while the secondary palate forms from the palatal shelves of the maxillary prominences; failure at the midline produces a cleft. The process is influenced by genetic factors such as IRF6 and MSX1 mutations, environmental factors such as maternal smoking and folate deficiency, and mechanical constraints. Clinically, cleft palate may be isolated or associated with cleft lip, and is classified by Veau according to extent: Veau I involves the soft palate, Veau II the hard and soft palate, Veau III unilateral complete cleft involving the alveolus, and Veau IV bilateral complete cleft. Features include nasal regurgitation, hypernasal speech, feeding difficulty, otitis media and hearing loss, dental malocclusion, and psychosocial effects. Management is multidisciplinary: safe feeding with appropriate bottles or nasogastric tube, speech therapy, orthodontic preparation and alveolar management, and staged surgical repair, usually palatoplasty at 9–18 months, with later velopharyngoplasty or orthognathic surgery if needed. Audiometry and nutrition support are essential. Speech therapy should begin before palatoplasty and continue after repair. Alveolar bone grafting may be needed later for dental development. The public-health implication is that malaria elimination, safe contraception and congenital anomaly care are linked through primary health care, surveillance and early intervention.