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

(a) National Framework for Malaria Elimination (NFME) 2016–2030

States and UTs are grouped by annual parasite incidence (API, cases per 1,000 population at risk): Category 0 (prevention of re-establishment) has zero indigenous cases; Category 1 (elimination phase) has API < 1 in the State and in all its districts; Category 2 (pre-elimination phase) has State API < 1 but some districts with API ≥ 1; and Category 3 (intensified control phase) has API ≥ 1.

Targets. The framework sets staged objectives: eliminate malaria (zero indigenous cases) in all Category 1 and 2 States/UTs by 2022, and bring every State/UT to API < 1 by 2024. By 2027, indigenous transmission is to be interrupted throughout the country, so that all States/UTs, including the Category 3 States, reach zero indigenous cases (Category 0). By 2030, malaria-free status is to be sustained and re-establishment prevented, allowing WHO certification of elimination; the National Strategic Plan 2023–27 retains these 2027 and 2030 goals.

Key interventions for Category 3 (intensified control). These States (largely Odisha, Chhattisgarh, Jharkhand, Meghalaya, Tripura, Mizoram and forested or tribal belts elsewhere) require aggressive scale-up:

• Case management: early diagnosis by RDT or microscopy at village level through ASHAs, and complete treatment (ACT-AL in the North-East and ACT-SP elsewhere for P. falciparum, a single dose of primaquine as a gametocytocide, and chloroquine plus 14-day primaquine for P. vivax radical cure).
• Vector control: two to three rounds of indoor residual spraying in high-risk foci and universal coverage with long-lasting insecticidal nets, with larval source management and biolarvicides in urban and project areas.
• Surveillance: active and passive case detection, mass or focal screening in hotspots, and case investigation.
• Special strategies: targeted action in hilly, tribal, forest and conflict-affected areas, epidemic preparedness, inter-sectoral convergence (tribal affairs, forest and mining departments), behaviour-change communication, and monitoring of drug and insecticide resistance.

Parameters for epidemiological surveillance.

• Annual Parasite Incidence (API): confirmed cases per 1,000 population per year, the main classification indicator.
• Annual Blood Examination Rate (ABER): percentage of the population examined per year (≥10% is the benchmark for adequate surveillance).
• Slide/Test Positivity Rate (SPR/TPR): positive tests per 100 examined.
• Slide falciparum rate / Pf proportion: share of P. falciparum among cases.
• Case-based indicators: 100% case notification, investigation and classification (indigenous or imported) within set timelines, and foci investigation; entomological surveillance (vector density, insecticide susceptibility) and therapeutic efficacy studies.
• Reporting: real-time data through the Integrated Health Information Platform (IHIP) for district-level action.

(b)(i) WHO Medical Eligibility Criteria (MEC)

WHO MEC classifies contraceptive methods for women with medical conditions into four categories: 1 no restriction; 2 advantages generally outweigh risks; 3 theoretical or proven risks usually outweigh the advantages; 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 combined oral contraceptives in a woman with adequately controlled hypertension or in a smoker aged ≥35 years smoking fewer than 15 cigarettes a day; and category 4 for unacceptable risks, such as combined hormonal contraceptives in migraine with aura, blood pressure ≥160/100 mmHg or less than 6 weeks postpartum while breastfeeding, and all hormonal methods in current breast cancer; for Cu-IUCD, active pelvic infection, pregnancy, or a distorted uterine cavity are category 4. In clinical practice categories 1–2 mean the method can be used, and 3–4 mean it should not be used when clinical judgement is limited.

(b)(ii) IUCD complications

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.

(b)(iii) Misplaced Cu-T

A misplaced Cu-T (threads not visible) is managed by excluding pregnancy, gently exploring the canal with a thread retriever, and confirming location with ultrasound and, if not seen in the uterus, a plain abdominal X-ray (a device absent on X-ray was expelled); 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. If a pregnancy coexists with an intrauterine device, remove it if threads are visible in the first trimester; ectopic pregnancy must be excluded. The woman is counselled on alternative contraception.

(c) 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 (the premaxilla in front of the incisive foramen) forms from the intermaxillary segment of the merged medial nasal prominences, 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. Associated syndromes, such as Pierre Robin sequence and 22q11.2 deletion, must be screened for.