Malaria is a major public health problem in India even though it is both preventable and treatable disease [
11]. Malaria presents a diagnostic challenge as
P. falciparum can present with a wide spectrum of signs, symptom and history from a fatal disease to an apparently asymptomatic infection, from a rapidly progressing fulminate illness to a chronic insult [
12]. Further, malaria produces anaemia by several mechanisms. Both acute
P. falciparum and chronic or recurrent low level parasitaemia can produce hemolysis [
13]. In forest villages where resources for malaria diagnosis are limited, malaria diagnosis is mostly made on the basis of clinical symptoms although this is alarmingly inaccurate [
14]. The detection of
P. falciparum/
P. vivax can be made on the spot by recently introduced rapid diagnostic tests in symptomatic patients with fairly high sensitivity and specificity [
15]. However, it is not always available in remote areas [
16]. Spleen enlargement, fever and anaemia are the three main signs characteristic of malaria infection. Children with malaria had a lower haematocrit than aparasitaemic children. Therefore, measure of haematocrit index for anaemia could also be useful in field along with surveillance of fever cases [
17,
18]. One of the most striking findings of the study was high SR and IPR in all the outbreak-affected areas indicating intense malaria transmission. Both the indices are of immense value in evaluating and assessing the malaria situation in an area. While the former is a crude method and reflects the endemicity of the area, the latter is an indicator of recent transmission of malaria. It is worthwhile to mention that surveillance data on epidemic is often not collected because epidemics may be over before health services have had time to intervene or because in severe situations, reporting procedures may breakdown. Further, once achieved, malaria control cannot be taken for granted and must be actively maintained. The rapid re-introduction of cases from neighbouring areas is very common. Both SR and IPR can quickly track the effects of intervention packages for malaria control as recorded earlier [
7,
8,
19]. They are of great diagnostic aid as these could serve to identify scattered endemic villages in hypo-endemic areas which maintain the parasite reservoir during the inter-epidemic periods and from which explosive epidemics may spread [
6]. These tools can also be applied in malaria control programmes, in advance elimination or even in the maintenance phase [
7,
8,
18]. In fact, the spleen examination was even applied in advanced malaria eradication programmes and in maintenance phase in different geographical location very efficiently [
20]. The enlarged spleen without much diminution in size, in most districts, is due to frequent recrudescence or relapses such as in Balaghat, Sidhi and Dindori. Further, Thomas et al [
21] found a positive correlation between seroepidemiological study and spleen results in aborigine children in Malaysia where both
P. vivax and
P. falciparum were prevalent.
The current global strategy for malaria elimination requires surveillance tools for the evaluation of accomplishment at the different geographical scales of the elimination goals [
22]. Indicators derived from surveillance tools need to be precise, accurate and representative of changes in transmission patterns at the population level [
23]. The utilization of the spleen examination and infant parasite rate as a tool of malaria evaluation is considered by the authors as one of the most valuable, practical, simple and economical method which yield immediate and practical results in several malarial outbreaks [
24,
25]. However, De et al [
4] detected splenomegaly in only 13% malaria patients which does not signify a positive correlation between splenomegaly and malaria, perhaps due to widespread use of anti-malarials.
The new methods of detection of low numbers of asexual and sexual stages of parasites by molecular techniques [
26,
27] and new approaches to serology [
28] could have an important role in surveillance. However, they are difficult to establish in rural/semi rural laboratories by inexperienced technicians. They are of tremendous value in research projects. [
20].