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Burden of complicated malaria in a densely forested Bastar region of Chhattisgarh State (Central India).

Jain V, Basak S, Bhandari S, Bharti PK, Thomas T, Singh MP, Singh N - PLoS ONE (2014)

Bottom Line: Mortality was significantly associated with multi-organ complication score (P = 0.0003).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.

View Article: PubMed Central - PubMed

Affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.

ABSTRACT

Background: A 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.

Methods: Blood 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.

Results: A 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).

Conclusion: This 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.

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Related in: MedlinePlus

Map of study site.The map shows India (A), state of Madhya Pradesh, where RMRCT is located in Jabalpur (B), state of Chhattisgarh (C). Malaria clinic of RMRCT at Maharani Hospital and associated Medical college Jagdalpur is shows in Bastar region in Chhattisgarh.
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pone-0115266-g001: Map of study site.The map shows India (A), state of Madhya Pradesh, where RMRCT is located in Jabalpur (B), state of Chhattisgarh (C). Malaria clinic of RMRCT at Maharani Hospital and associated Medical college Jagdalpur is shows in Bastar region in Chhattisgarh.

Mentions: A malaria clinic of the Regional Medical Research Centre for Tribal (RMRCT) was established in a 600 bedded Maharani Hospital, which is part of the Medical College in Jagdalpur, CG, India (Coordinates 19.07°N and 82.03°E) in the year 2010 (Fig. 1, A–C). This is the only tertiary health care facility in Bastar division, for seven districts i.e., Kanker, Kondagaon, Jagdalpur, Dantewada, Bijapur, Narayanpur and Sukma. This tertiary health care centre is situated in a remote area of Bastar having thick dense forest (45% of the geographical area under forest) and tribal settlement (75% tribal population). South Bastar of CG is a high-prevalence malaria region, which contributed 24% (30,193/124,006) malaria and 27% (24/90) malaria related deaths in the state in 2012. The Annual Parasite Incidence (API) was 17.5 (P. falciparum percentage of 85% (NVBDCP, unpublished report) and Slide Positivity Rate (SPR) of 9%. Average annual rainfall in this region is around 1400–1500 mm. The economy of the villagers residing in this tribal district is mainly agricultural and forest based.


Burden of complicated malaria in a densely forested Bastar region of Chhattisgarh State (Central India).

Jain V, Basak S, Bhandari S, Bharti PK, Thomas T, Singh MP, Singh N - PLoS ONE (2014)

Map of study site.The map shows India (A), state of Madhya Pradesh, where RMRCT is located in Jabalpur (B), state of Chhattisgarh (C). Malaria clinic of RMRCT at Maharani Hospital and associated Medical college Jagdalpur is shows in Bastar region in Chhattisgarh.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4274025&req=5

pone-0115266-g001: Map of study site.The map shows India (A), state of Madhya Pradesh, where RMRCT is located in Jabalpur (B), state of Chhattisgarh (C). Malaria clinic of RMRCT at Maharani Hospital and associated Medical college Jagdalpur is shows in Bastar region in Chhattisgarh.
Mentions: A malaria clinic of the Regional Medical Research Centre for Tribal (RMRCT) was established in a 600 bedded Maharani Hospital, which is part of the Medical College in Jagdalpur, CG, India (Coordinates 19.07°N and 82.03°E) in the year 2010 (Fig. 1, A–C). This is the only tertiary health care facility in Bastar division, for seven districts i.e., Kanker, Kondagaon, Jagdalpur, Dantewada, Bijapur, Narayanpur and Sukma. This tertiary health care centre is situated in a remote area of Bastar having thick dense forest (45% of the geographical area under forest) and tribal settlement (75% tribal population). South Bastar of CG is a high-prevalence malaria region, which contributed 24% (30,193/124,006) malaria and 27% (24/90) malaria related deaths in the state in 2012. The Annual Parasite Incidence (API) was 17.5 (P. falciparum percentage of 85% (NVBDCP, unpublished report) and Slide Positivity Rate (SPR) of 9%. Average annual rainfall in this region is around 1400–1500 mm. The economy of the villagers residing in this tribal district is mainly agricultural and forest based.

Bottom Line: Mortality was significantly associated with multi-organ complication score (P = 0.0003).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.

View Article: PubMed Central - PubMed

Affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.

ABSTRACT

Background: A 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.

Methods: Blood 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.

Results: A 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).

Conclusion: This 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.

Show MeSH
Related in: MedlinePlus