Burden of Complicated Malaria in a Densely Forested Bastar Region of Chhattisgarh State (Central India)

Abstract

BackgroundA prospective study on severe and complicated malaria was undertaken in the tribal dominated area of Bastar division, Chhattisgarh (CG), Central India, with an objective to understand the clinical epidemiology of complicated malaria in patients attending at a referral hospital.MethodsBlood smears, collected from the general medicine and pediatric wards of a government tertiary health care facility located in Jagdalpur, CG, were microscopically examined for malaria parasite from July 2010 to December 2013. The Plasmodium falciparum positive malaria cases who met enrollment criteria and provided written informed consent were enrolled under different malaria categories following WHO guidelines. PCR was performed to reconfirm the presence of P.falciparum mono infection among enrolled cases. Univariate and multivariate logistic regression analysis was done to identify different risk factors using STATA 11.0.ResultsA total of 40,924 cases were screened for malaria. The prevalence of malaria and P.falciparum associated complicated malaria (severe and cerebral both) in the hospital was 6% and 0.81%, respectively. P.falciparum malaria prevalence, severity and associated mortality in this region peaked at the age of>4–5 years and declined with increasing age. P.falciparum malaria was significantly more prevalent in children than adults (P<0.00001). Among adults, males had significantly more P.falciparum malaria than females (P<0.00001). Case fatality rate due to cerebral malaria and severe malaria was, respectively, 32% and 9% among PCR confirmed mono P.falciparum cases. Coma was the only independent predictor of mortality in multivariate regression analysis. Mortality was significantly associated with multi-organ complication score (P = 0.0003).ConclusionThis study has revealed that the pattern of morbidity and mortality in this part of India is very different from earlier reported studies from India. We find that the peak morbidity and mortality in younger children regardless of seasonality. This suggests that this age group needs special care for control and clinical management.

Genetic diversity and antibody responses against Plasmodium falciparum vaccine candidate genes from Chhattisgarh, Central India: Implication for vaccine development

“…In the present investigation, we determined the IgG antibody response against synthetic peptides representing the conserved region of B cell & T cell of msp1, csp and B cell of msp2, glurp among patients infected with P . falciparum in Central India, where malaria is endemic [ 51 ]. In this study, majority of the plasma samples reacted against the B cell epitope of pfmsp1 and pfcsp despite its short amino acid sequence.…”

Prevalence of Malaria among Hospitalized Fever Cases of a Tribal District Tertiary Care Centre of South India

“…Moreover, treatment seeking behavior, occupational activities and socio-cultural barriers promote male to reach the higher health centers [12], [13] . Vidhan Jain et al observed male predominance in hospitalization pattern of malaria [1] . Pathak et al also had the similar opinion as Vidhan Jain [14] .…”

“…Majority of hospitalization of malaria due Falciparum is the main and most important finding of the study. In one of the study which was carried out by Vidhan Jain et al in highly tribal region of India namely Bastar District of Chhattisgarh in which tribal population is mainly involved in agriculture and forest, observed 9% slide positivity rate with almost 50% incidence of plasmodium falciparum [1] . They found 5 years as median age of malaria and associated morbidity in children.…”

“…It is mainly because of comparatively lower immunity in children and intensity of transmission. Hence this vulnerable age group needs more attention not only for the treatment but also in the policies framed for prevention and education regarding malaria prevention programs [1][9][10] [11] . Gender differences were observed in the present study.…”

“…India also contributes substantially to global malaria burden. In India it is widely prevalent specifically in rural and tribal regions and responsible for huge number of morbidity and also mortality as shown by number of studies which were conducted in various regions of India, namely few are Rourkela and Cuttack, Orissa, Bikaner, Rajasthan and Jabalpur [1], [2] . But the prevalence and incidence picture is different in all the regions.…”