ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
Research Note

Prevalence of malaria infection among under five year tribal children residing in malaria endemic forest villages

[version 1; peer review: peer review discontinued]
PUBLISHED 20 Nov 2014
Author details Author details
OPEN PEER REVIEW
PEER REVIEW DISCONTINUED

This article is included in the Médecins Sans Frontières gateway.

This article is included in the Médecins Sans Frontières: Research on F1000 collection.

Abstract

Malaria is a life-threatening protozoal infection and India has the highest malaria burden in South East Asia. The objective of this communication is to assess the prevalence of malaria infection amongst forest dwelling tribal children under the age of five residing in malaria endemic regions of the Andhra Pradesh and Chhattisgarh states of India. A total of 5,801 children attended seven outpatient mobile clinics in 2012. Of them, 2,123 children had a history of fever and were screened for malaria with a Rapid Diagnostic Test (RDT). About 37% of children had a history of fever. Of them, 34% children were diagnosed with malaria. The majority (66%) of children with a positive RDT had a mixed malaria infection of both Plasmodium falciparum and P. vivax, followed by single infections of P. falciparum (18.9%) and P. vivax (14.2%). Malaria infection is a major public health concern amongst the tribal children residing in these malaria endemic forest villages. Therefore, region specific sustainable intervention measures need to be initiated for the prevention and control of malaria and malaria related deaths in this region.

Keywords

malaria, under five tribal children, P.falciparum

Introduction

The World Health Organization reported 219 million cases of malaria with an estimated 660,000 deaths. South East Asia is the second most affected region in the world after Africa, and India has the highest (61%) malaria burden in the region with an estimated 24 million cases per year. Plasmodium falciparum malaria continues to be a major public health threat in India, with nearly half (273 million) of the high risk population outside Africa residing in India1. India contributes over one fifth (22.6%) of clinical episodes of P. falciparum globally2. About 80% of malaria cases reported in the country is confined to areas consisting of 20% of the total population, who reside in tribal, hilly, difficult and inaccessible areas3. In India, malaria is predominantly reported among the tribal population owing to about 80% of malaria cases and overall 97% of deaths4. Keeping in view the magnitude of malaria burden among the forest dwelling tribal population in India, this communication was prepared with the objective to assess the prevalence of malaria among forest dwelling tribal children under the age of five residing in northern Andhra Pradesh and the southern part of Chhattisgarh states. This region is a remote hilly and forested area inhabited by various Naxalite (communist guerrilla) groups and there is a constant conflict with local governments leading to security restrictions. Primary health centres (PHCs) are sparsely located in forest villages. To avail the health care services, they need to travel on foot for long distances as there is no proper transport infrastructure. The tribal population of this region have poor access to modern health care and are vulnerable to under-nutrition, malaria and other communicable diseases. Medecins Sans Frontieres (MSF) has been providing primary health care and emergency services to the tribal population through mobile health clinics.

About Medecins Sans Frontieres (MSF) India

MSF India’s teams make available basic healthcare, antenatal and postnatal care, vaccinations and treatment for diarrhoea, tuberculosis, and malaria to tribal populations residing in adjoining tribal forest villages of northern part of Andhra Pradesh and southern part of Chhattisgarh states5.

Methods

Retrospective secondary data collected by MSF on malaria during January 2012 to December 2012 from seven mobile clinics (Table 1) was utilized for this communication. A total of 5,801 children under the age of 5 attended as out-patients at mobile health clinics during 2011–12. All children with history of fever were screened for malaria infection with a finger prick Rapid Diagnostic Test (RDT) kit (SD 05FK60 RDT). A three day course of anti-malarial treatment with the combination of Artemether + Lumefrantine based on body weight was initiated for children who tested positive. Data was analysed using SPSS version 196. Descriptive statistics were calculated to assess the prevalence malaria infection in different clinic areas. Therefore, to study the difference in the prevalence of malaria infection between clinic areas generalised estimable equation was applied. A p-value of <0.05 was considered statistically significant.

Table 1. Data of under 5 year children with suspected malaria fever and positive RDT†.

Clinic AreaConsultations
(<5 Years)
Malaria infection
(Suspects)
Malaria Positives
(Positive RDT)
NnPercentnPercent
Maita33011835.84033.9
Mallampeta102634533.611733.9
Dharmannapeta89831935.510532.9
Pusuguppa76732942.911535.0
Tippapuram66420831.36531.3
Yampuram122342134.413732.5
Puttapalli89338342.914437.6
Total5801212336.672334.1

†Rapid diagnostic test. p<0.001

Results

A total of 5,801 under five year children attended the outpatient mobile clinics. Of them, 36.6% of children had history of fever. Based on the RDT data, the prevalence of malaria was 34.1% among children suffering from fever, and significant differences were observed in prevalence of malaria infection between the mobile clinics (p<0.001) (Table 1).

Among the children with positive RDT, about 66.8% were diagnosed with mixed malaria infection indicating the presence of both P. falciparum and P. vivax malaria, while the proportion of children with P. falciparum and P. vivax malaria infection was 18.9% and 14.2%, respectively. Thus, about 85% of children with malaria were infected with P. falciparum, which ranged from 67.7% in the Tippapuram mobile clinic to 92.2% in Pusuguppa. However, a higher prevalence of P. vivax (95.4%) was reported among the children of Tippapuram (Table 2).

Table 2. Distribution (%) of children under the age of five by type of malaria and area.

Clinic AreaMalaria Positive (RDT Positive)Type of Malaria
NP. falciparum Percent (n)P. vivax Percent (n)Mixed Percent (n)
Maita4020.0 (8)15.0 (6)65.0 (26)
Mallampeta11717.9 (21)17.9 (21)64.1 (75)
Dharmannapeta10527.6 (29)10.5 (11)61.9 (65)
Pusuguppa11516.5 (19)7.8 (9)75.7 (87)
Tippapuram654.6 (3)32.3 (21)63.1 (41)
Yampuram13721.2 (29)12.4 (17)66.4 (91)
Puttapalli14419.4 (28)12.5 (18)68.1 (98)
Total72318.9 (137)14.2 (103)66.8 (483)

Figures in the parenthesis are numbers.

Discussion

The prevalence of malaria infection is a major problem of public health significance among the tribal children residing in these hilly and remote forest villages where malaria is endemic. Qureshi et al. have previously reported high prevalence of malaria among pregnant women in this study area7. In general, a majority (85%) of children with malaria infection were infected with P. falciparum. Similar findings were reported by Sahu et al. among tribes of the Koraput district of Odisha State, India (89% in 1–14yr, and >14 age categories)8, and Gahutu et al. in Rwanda (15–21% in under five year olds)9. As reported by the National Vector Borne Disease Control Programme (NVBDCP), around 50% of total malaria cases reported was due to P. falciparum3 in India. Similarly, as per the Strategic Action Plan for Malaria Control in India 2007–2012, the prevalence of P. falciparum has gradually increased from 38.8% in 1995 to 50% in 200810. The NVBDCP Epidemiological report of 2013–14 was also reported the prevalence of P. falciparum infection in Andhra Pradesh as 68.85% in 2013 and 74.60% by September, 2014, while the corresponding figures for the neighbouring state of Chhattisgarh were 78.80% and 84.26%, respectively11. One of the reasons attributed to the rise in proportion of P. falciparum cases is resistance to chloroquine, which was used for a long time as the first line of treatment in malaria cases1.

The prevalence of malaria among the children of under the age of five was high in this present study. Similar, findings were reported among children under the age of five in Angola1 and Rwanda9. The prevalence of malaria infection among the children under the age of five is around 20% in Angola and 16.7% in Rwanda. The NVBDCP has undertaken appropriate intervention measures such as introduction of artemisinin combination therapy (ACT) and long lasting insecticidal nets (LLINs) across India including malaria endemic forest areas. In spite of RDT and introduction of ACT, insecticide treated nets (ITNs) and LLINs in 2010, the prevalence of P. falciparum malaria continues to be very high in this study area. The WHO has categorised India under the countries where malaria is in the ‘under control’ phase, while neighbouring Sri Lanka is categorised in countries in the ‘under elimination’ phase1. Thus, India needs to do lot to reach at least the elimination phase, let alone the eradication of malaria.

Malaria infection is a significant public health concern among the tribal under five year olds residing in malaria endemic forest villages of the northern part of Andhra Pradesh and southern part of Chhattisgarh states. Therefore, it is imperative to initiate appropriate area specific and sustainable intervention measures including early diagnosis and treatment of all individuals with suspected malaria fever, interruption of malaria transmission in the community and prevention of drug resistance by rational use of anti-malarial drugs. More specifically, RDT coverage should be expanded to all the malaria endemic areas for early detection of cases, improve the effectiveness of Indoor Residual Spray (IRS) and use of ACT for all P. falciparum cases throughout the country and increase the human resources at all levels for better surveillance of the disease. It is also important that the community needs to be involved through inclusion of grass root health workers such as Accredited social health activists (ASHAs) and community health workers12. Health education through IEC (Information, Education and Communication) activities and behavioural change communication (BCC) are also very important intervention measures aimed at improvement of environmental sanitation and personal protection from mosquito bites for the elimination of malaria in the endemic areas as well as in the whole country.

Limitation of the study

This manuscript is prepared utilizing retrospective secondary mobile clinic based data. As demographic information, such as gender and age of the subjects is not available, we could not analyze the data to study possible associations.

Ethical considerations

Ethical clearance was not obtained as this communication is based on (secondary) data from a mobile clinic out-patient database. We thank MSF for providing such data.

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 20 Nov 2014
Comment
Author details Author details
Competing interests
Grant information
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
- -
Citations
CITE
how to cite this article
Qureshi I, Qureshi MA, Gudepu RK and Arlappa N. Prevalence of malaria infection among under five year tribal children residing in malaria endemic forest villages [version 1; peer review: peer review discontinued]. F1000Research 2014, 3:286 (https://doi.org/10.12688/f1000research.5632.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Peer review discontinued

Peer review at F1000Research is author-driven. Currently no reviewers are being invited. What does this mean?

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 20 Nov 2014
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
Sign In
If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

The email address should be the one you originally registered with F1000.

Email address not valid, please try again

You registered with F1000 via Google, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Google account password, please click here.

You registered with F1000 via Facebook, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Facebook account password, please click here.

Code not correct, please try again
Email us for further assistance.
Server error, please try again.