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Abstract
BackgroundSubclinical (asymptomatic) cases of malaria could be a major barrier to the success of malaria elimination programs. This study has evaluated the impact of long-lasting insecticidal nets (LLINs) on the prevalence of subclinical malaria in the presence of pyrethroid resistance in the main malaria vector Anopheles culicifacies on malaria transmission among a cohort of children in villages of the Keshkal sub-district in Chhattisgarh state. MethodsA cohort of 6582 children ages less than 14 years was enrolled from 80 study clusters. Post monsoon survey was carried out at baseline before LLIN distribution, and 5862 children were followed up in the subsequent year. Study outcomes included assessment of subclinical malarial infections and use of LLINs among the study cohort in the presence of varied levels of pyrethroid resistance. FindingsIn the baseline survey, the proportion of subclinical malaria was 6·1%. LLIN use during the previous night was 94·8%. Overall, prevalence of subclinical malaria was significantly reduced to 1% (p<0·001) in the second survey. LLIN users were protected from malaria (OR: 0·25, 95% CI=0·12–0·52, p<0.001) and subclinical malaria (OR: 0·25, 95% CI=0·11–0·58, p=0·001) despite the presence of pyrethroid resistance in the study area. InterpretationIn this low transmission area, sleeping under LLINs significantly reduced the burden of malaria among children. In the presence of pyrethroid resistant malaria vector, a high LLIN use of 94·5% was observed to have significantly brought down the proportion of subclinical malaria among the cohort children.
Highlights
IntroductionSubclinical (asymptomatic) cases of malaria could be a major barrier to the success of malaria elimination programs
Subclinical cases of malaria could be a major barrier to the success of malaria elimination programs
A basic health care facility is available through one Community Health Centre (CHC) situated at block headquarter Keshkal, as well as four Primary Health Centres (PHCs), each catering to a population of about 20000–25000
Summary
Subclinical (asymptomatic) cases of malaria could be a major barrier to the success of malaria elimination programs. This study has evaluated the impact of long-lasting insecticidal nets (LLINs) on the prevalence of subclinical malaria in the presence of pyrethroid resistance in the main malaria vector Anopheles culicifacies on malaria transmission among a cohort of children in villages of the Keshkal sub-district in Chhattisgarh state. Malaria morbidity has been reduced by 45% from an estimated two million reported malaria cases in year 2000 to 1Á1 million cases in 2015 due to sustained control efforts.[2] Of the remaining malaria cases, more than 80% are contributed by tribal forested areas of ten states including Chhattisgarh.[3]. A sizeable proportion of the population has been observed to harbour malaria parasites without presentation of any symptom Such cases are not captured through the routine surveillance system. They pose a serious challenge to efforts towards malaria elimination.[8,9]
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