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.
Highlights
Malaria is a global public health problem and India contributes substantially to global malaria incidence [1]
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
Further age group wise (,15 years & $15 years) and sex wise analysis revealed that malaria and P. falciparum malaria in particular, was significantly more associated with children [7.9% (689/8,685) & 7.0% (610/8,685)] than adults [5.5% (1,761/32,218) & 4.7% (1,500/32,218)] (x2574.0; p,0.00001 and x2578.4; p,0.00001 respectively)
Summary
Malaria is a global public health problem and India contributes substantially to global malaria incidence [1]. In India, major studies conducted so far on severe and complicated malaria are from Rourkela and Cuttack, Orissa, East India [3], [4], [5], Bikaner, Rajasthan, Western India [6] and Jabalpur, Central India [7] All of these studies have been carried out in tertiary level hospitals with very different malaria endemicity and ecosystems. While Jabalpur, a meso-endemic area, showed mortality up to 21% in all age groups including young children [7] In all of these studies, P. vivax and P. falciparum were found as mono infections and these studies did not clearly define the clinical picture of CM from other severe forms of malaria (SM). Complicated malaria included 168 CM and 54 SM (non cerebral) cases with known outcomes
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