Assessing afebrile malaria and bed-net use in a high-burden region of India: Findings from multiple rounds of mass screening

Abstract

A key obstacle in the fight against malaria is afebrile malaria. It remains undiagnosed and, therefore, is invisible to the health system. Apart from being a serious illness, it contributes to increased transmission. Existing studies in India have not adequately reported afebrile malaria and its determinants, including the use of long-lasting insecticide-treated nets (LLINs). This study used six waves of mass screening, which were conducted by the state government in the high-malaria-burden region of Chhattisgarh, a state in India, in 2020, 2021, and 2022. Each round of data collection included more than 15000 individuals. Descriptive statistics were used to analyse key indicators of malaria prevalence and LLIN use. Multivariate analyses were performed to identify the determinants of afebrile malaria and LLIN use. Malaria prevalence in the afebrile population varied from 0.6% to 1.4% across the different waves of mass screening. In comparison, malaria positivity among febrile individuals was greater than 33% in each wave. Afebrile malaria contributed to 19.6% to 47.2% of the overall malaria burden in the region. Indigenous communities (scheduled tribes) were more susceptible to malaria, including afebrile malaria. Individuals using LLINs were less likely to be affected by afebrile malaria. Overall, 77% of the individuals used LLINs in early monsoon season, and in winter the rate was lower at 55%. LLIN use was significantly associated with the number of LLINs the households received from the government. Although fever continues to be a primary symptom of malaria, afebrile malaria remains a significant contributor to the malaria burden in the region. The free distribution of LLINs should be expanded to include high-burden populations. Global policies must include strategies for surveillance and control of afebrile malaria in high-burden areas.

Long-Lasting Insecticidal Net Coverage and Utilization in Burla Town of Sambalpur District: A Cross-Sectional Study

“…While approximately 45.74% of respondents reported regular LLIN usage and stated that they slept under the nets on the previous night and similar results were obtained by Millat-Martínez et al [17]. However, higher usage from Chhattisgarh and West Bengal, and lower usage from Bihar were reported by other studies [13][14][15]. About 84% reported using the supplied bed nets at least once similar to the results reported by Millat-Martínez et al [17].…”

“…These results suggest that household characteristics, availability of nets, and maintenance practices play a vital role in determining LLIN usage. Other studies also depicted similar associations [4,13,17].…”

“…A study from the high-burden region in Chhattisgarh reported 86% coverage, whereas Bihar reported 81% coverage in another study [13,14]. A study from West Bengal reported 100% coverage of LLIN whereas another from Purulia reported 96% coverage [15,16].…”