BackgroundIn India, malaria is not uniformly distributed. Chhattisgarh is a highly malarious state where both Plasmodium falciparum and Plasmodium vivax are prevalent with a preponderance of P. falciparum. Malaria in pregnancy (MIP), especially when caused by P. falciparum, poses substantial risk to the mother and foetus by increasing the risk of foetal death, prematurity, low birth weight (LBW), and maternal anaemia. These risks vary between areas with stable and unstable transmission. The specific objectives of this study were to determine the prevalence of malaria, its association with maternal and birth outcomes, and use of anti-malarial preventive measures for development of evidence based interventions to reduce the burden of MIP.MethodsA cross-sectional study of pregnant women presenting to antenatal clinics (ANC) or delivery units (DU), or hospitalized for non-obstetric illness was conducted over 12 months in high (Bastar) and low (Rajnandgaon) transmission districts in Chhattisgarh state. Intensity of transmission was defined on the basis of slide positivity rates with a high proportion due to P. falciparum. In each district, a rural and an urban health facility was selected.ResultsPrevalence of peripheral parasitaemia was low: 1.3% (35/2696) among women at ANCs and 1.9% at DUs (19/1025). Peripheral parasitaemia was significantly more common in Bastar (2.8%) than in Rajnandgaon (0.1%) (p < 0.0001). On multivariate analysis of ANC participants, residence in Bastar district (stable malaria transmission) was strongly associated with peripheral parasitaemia (adjusted OR [aOR] 43.4; 95% CI, 5.6-335.2). Additional covariates associated with parasitaemia were moderate anaemia (aOR 3.7; 95% CI 1.8-7.7), fever within the past week (aOR 3.2; 95% CI 1.2-8.6), and lack of formal education (aOR 4.6; 95% CI 2.0-10.7). Similarly, analysis of DU participants revealed that moderate anaemia (aOR 2.5; 95% CI 1.1-5.4) and fever within the past week (aOR 5.8; 95% CI 2.4-13.9) were strongly associated with peripheral and/or placental parasitaemia. Malaria-related admissions were more frequent among pregnant women in Bastar, the district with greater malaria prevalence (51% vs. 11%, p < 0.0001).ConclusionsGiven the overall low prevalence of malaria, a strategy of enhanced anti-vector measures coupled with intermittent screening and targeted treatment during pregnancy should be considered for preventing malaria-associated morbidity in central India.

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OBJECTIVE--To determine the prevalence of non-insulin-dependent diabetes mellitus (NIDDM), impaired glucose tolerance (IGT), and hypertension in a rural community of Bangladesh. RESEARCH DESIGN AND METHODS--A cluster sampling of 1,005 subjects > 15 years of age in the rural community of Dohar was investigated. Capillary blood glucose of fasting and 2 h after 75 g oral glucose (2hBG) were estimated. World Health Organization criteria were used for diagnosis of NIDDM and IGT. Blood pressure, height, and weight were also measured. RESULTS--The crude prevalence of NIDDM was 2.1% (men 3.1, women 1.3%) and IGT was 13.3% (men 14.4, women 12.4%). Age-adjusted (30-64 years of age) prevalence was 2.23% (95% confidence interval [CI] 1.01-3.45) for NIDDM and 15.67% (95% CI 12.59-18.75) for IGT. Prevalence of hypertension with systolic blood pressure (sBP) > or = 140 mmHg was 10.5% and with diastolic blood pressure (dBP) > 90 mmHg was 9.0%. Increased age was the risk factor for NIDDM, IGT, and hypertension; whereas increased BMI showed inconsistent association with them. Relative risk for sBP with higher BMI ( < 22.0 vs. > or = 22.1) was 1.94 with CI 1.55-2.43 and for dBP it was 2.2 with CI 1.40-3.46. Correlation of sBP was significant with age, BMI, and 2hBG. Similar correlation was also observed with dBP. CONCLUSIONS--High prevalences of NIDDM, IGT, and hypertension were observed among rural subjects. Increased age was shown to be an important risk factor for all these disorders, whereas BMI-associated risk was significant with NIDDM and hypertension but not with IGT.

BackgroundMalaria in pregnancy in India, as elsewhere, is responsible for maternal anemia and adverse pregnancy outcomes such as low birth weight and preterm birth.It is not known whether prevention and treatment strategies for malaria in pregnancy (case management, insecticide-treated bednets, intermittent preventive therapy) are widely utilized in India.MethodsThis cross-sectional study was conducted during 2006-2008 in two states of India, Jharkhand and Chhattisgarh, at 7 facilities representing a range of rural and urban populations and areas of more versus less stable malaria transmission. 280 antenatal visits (40/site) were observed by study personnel coupled with exit interviews of pregnant women to assess emphasis upon, availability and utilization of malaria prevention practices by health workers and pregnant women. The facilities were assessed for the availability of antimalarials, lab supplies and bednets.ResultsAll participating facilities were equipped to perform malaria blood smears; none used rapid diagnostic tests. Chloroquine, endorsed for chemoprophylaxis during pregnancy by the government at the time of the study, was stocked regularly at all facilities although the quantity stocked varied. Availability of alternative antimalarials for use in pregnancy was less consistent. In Jharkhand, no health worker recommended bednet use during the antenatal visit yet over 90% of pregnant women had bednets in their household. In Chhattisgarh, bednets were available at all facilities but only 14.4% of health workers recommended their use. 40% of the pregnant women interviewed had bednets in their household. Only 1.4% of all households owned an insecticide-treated bednet; yet 40% of all women reported their households had been sprayed with insecticide. Antimalarial chemoprophylaxis with chloroquine was prescribed in only 2 (0.7%) and intermittent preventive therapy prescribed in only one (0.4%) of the 280 observed visits.ConclusionsA disconnect remains between routine antenatal practices in India and known strategies to prevent and treat malaria in pregnancy. Prevention strategies, in particular the use of insecticide-treated bednets, are underutilized. Gaps highlighted by this study combined with recent estimates of the prevalence of malaria during pregnancy in these areas should be used to revise governmental policy and target increased educational efforts among health care workers and pregnant women.