Abstract
The aetiology of non-malaria vector-borne diseases in malaria-endemic, forested, rural, and tribal-dominated areas of Dhalai, Tripura, in north-east India, was studied for the first time in the samples collected from malaria Rapid Diagnostic Kit negative febrile patients by door-to-door visits in the villages and primary health centres. Two hundred and sixty serum samples were tested for the Dengue NS1 antigen and the IgM antibodies of Dengue, Chikungunya, Scrub Typhus (ST), and Japanese Encephalitis (JE) during April 2019–March 2020. Fifteen Dengue, six JE, twelve Chikungunya, nine ST and three Leptospirosis, and mixed infections of three JE + Chikungunya, four Dengue + Chikungunya, three Dengue + JE + Chikungunya, one Dengue + Chikungunya + ST, and one Dengue + ST were found positive by IgM ELISA tests, and four for the Dengue NS1 antigen, all without any travel history. True prevalence values estimated for infections detected by Dengue IgM were 0.134 (95% CI: 0.08–0.2), Chikungunya were 0.084 (95% CI: 0.05–0.13), Scrub were 0.043 (95% CI: 0.01–0.09), and Japanese Encephalitis were 0.045 (95% CI: 0.02–0.09). Dengue and Chikungunya were associated significantly more with a younger age. There was a lack of a defined set of symptoms for any of the Dengue, Chikungunya, JE or ST infections, as indicated by the k-modes cluster analysis. Interestingly, most of these symptoms have an overlapping set with malaria; thereby, it becomes imperative that malaria and these non-malaria vector-borne disease diagnoses are made in a coordinated manner. Findings from this study call for advances in routine diagnostic procedures and the development of a protocol that can accommodate, currently, in practicing the rapid diagnosis of malaria and other vector-borne diseases, which is doable even in the resource-poor settings of rural hospitals and during community fever surveillance.
Highlights
Infectious diseases are a significant public health burden in India, causing morbidity and mortality [1], with fever being the most common clinical symptom
The records of fevers and malaria infections in Ambassa Primary Health Centre (PHC) from April 2019 to March 2020, and Gurudhanpara and Shikaribari sub-centres (SCs) are given in Tables 1 and 2, respectively. These data show that many fever cases are reported annually, with a high number of fever cases being reported to ASHAs, health volunteers, or Sub Centres (SCs) MPWs
A high number of malaria cases are reported with the malaria Annual Parasite Incidence (API) for the study year, being ~10 for Ambassa PHC and 122 for Gurudhanpara SC and ~57 for Shikaribari SC
Summary
Infectious diseases are a significant public health burden in India, causing morbidity and mortality [1], with fever being the most common clinical symptom. Malaria is one of those diseases that cause fever and is endemic in many parts of developing countries, including India. These areas are often rural, especially in north-east (NE) India, and include tribal populations living in forest-fringes, where forest-dwelling disease-carrying mosquito vectors are common [3]. The availability of sensitive Rapid Diagnostic Kits (RDTs) for malaria diagnosis, either by the regular active door-to-door community-level fever surveillance, at village health camps, or by passive surveillance at the health care facilities serving several villages, has allowed population-level malaria testing in endemic areas. The importance of non-malaria fevers (NMFs) is severely undermined due to under-diagnosis, especially in peri/semi-urban or rural areas, where diagnostic facilities are not available [5,6,7]. VRDLs mainly cater to severe referral AFIs, samples from outbreak investigations and patients from respective city catchment areas
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