Four decades of epidemiological data reveal trajectories towards malaria elimination in Kheda district (Gujarat), western part of India

BackgroundMalaria is a main public health problem in India and was so particularly in the state of Gujarat in the western part of the country. This study assesses the effects of various interventions on malaria cases using data from the last 33 years (1987–2019).MethodsHere we have analysed 33 years of malaria epidemiological data from a malaria clinic in Kheda district in Gujarat. The data were digitised yearly and monthly, age-wise and gender-wise, and descriptive analysis was performed to assess the effects of several interventions on malaria burden.ResultsDuring 1987–2019, our clinic diagnosed 5466 Plasmodium vivax and 4732 P. falciparum malaria cases. Overall, there was a declining trend in malaria cases except for the years 1991, 1994, 2004 and 2005. The year 2004 especially witnessed an epidemic in Kheda as well as throughout Gujarat. Malaria infections were most common (40%) among the 21–40 years age group. Fever was the most common symptom in all age groups.InterpretationIntroduction of revised drug policy and improved surveillance technique (rapid diagnosis kits) have strengthened the diagnosis and treatment of malaria in the district. Use of pyrethroid in indoor residual insecticide spray has also strengthened vector control. Among the various interventions used, long-lasting insecticide nets and introduction of artemisinin-based combination therapy have played significant roles in controlling malaria cases. A more drastic decline in P. falciparum cases versus P. vivax is evident, but the latter persists in high proportions and therefore new tools for malaria control will be needed for elimination.

Malaria en route to elimination in two endemic coastal environments of southern India: an eco-epidemiological analysis from 2004 to 2019

Background Coastal environment and climatic condition are more suitable in propagation of mosquito vectors, and malaria parasite transmission throughout the year. In the present investigation, malaria prevalence in two endemic coastal localities of India viz., Besant Nagar (Chennai district) and Pamban (Rameshwaram district) were analysed from 2004 to 2019. Methods Malaria surveillance data and entomological data from malaria clinic were used to investigate epidemiological parameters. The annual malaria cases were correlated with highest maximum temperature. Results The analysis showed that the malaria case (P.v. and P.f.) report were directly proportional to the temperature increase. Malaria cases were remarkably increased from 2004 to 2011 and subsequently, both P.v. and P.f. cases were drastically reduced till 2019. P. vivax was higher than P. falciparum and male population was found to be more affected. Mixed infection of P.v. & P.f. was observed only in Besant Nagar site (0.3%). The most affected age group was adult age group (15 years and above) in both Besant Nagar (76.1%) and Pamban (69.5%). Conclusions Improved surveillance, complete treatment and integrated vector control activities showed declining trend of malaria cases in both the coastal sites towards malaria elimination.

The Evolution of the Malaria Clinic: The Cornerstone of Malaria Elimination in Thailand

Background: Malaria Clinics (MCs) have served communities in Thailand since 1965 and are still playing a critical role in providing early diagnosis and effective treatment of malaria. Methods: We reviewed six decades of published manuscripts, articles, strategies, and plans regarding MC operations in Thailand;,and analyzed national program surveillance data in both malaria control and malaria elimination phases. Results: MCs accounted for 39.8% of malaria tests and 54.8% of positive cases by the end of the 1980s. The highest number of MCs established was 544 in 1997. MCs contributed to 6.7% of all tests and 30% of all positive cases over the 2015–2017 period. Between 2017 and June 2019, during the malaria elimination phase, MCs continued to test an average of 67% of all persons tested for malaria, and confirmed 38.3% of all positive cases detected in the country. Conclusions: Testing and positive rates of MCs are on a gradual decline as the overall burden of malaria declines annually, which may reflect decreasing transmission intensity. Although the number of MCs in the last three years has been stable (n = 240), the attrition of MC staff poses a real challenge to the longevity of MCs in the absence of a human resource plan to support the elimination phase. It is necessary to identify and support capacity gaps and needs as MCs are absorbed into an integrated and decentralized program, while ensuring that the Division of Vector Borne Diseases (DVBD) maintains its necessary technical and advisory role.

Situation Analysis of Malaria in Surat: A Hospital Based Study

Background: Recent challenges in dealing with prevention of malaria are urbanization and migration, construction activity, insecticide resistance, inadequate health and sanitation infrastructure, poor community participation and public private partnership. Surat city experienced the worst phase of malaria between 1987 to 1992. Methods: Cross-sectional study was carried out from December 2006 to March 2007 in malaria clinic in New Civil Hospital, Surat. On an average daily 8-10 patients for whom blood was collected were asked to come again after one week to collect the report of malaria. Study was included 500 participants in which 287 male and 213 female. Results: Most of male participants were student (24.4%), labor (23.7%) and factory worker (20.2) and most of female participants were house wife (50.7%), student (21.1%) and labor (7.5%). Almost 50.5% male participants got information regarding Malaria from poster, handball, hoarding and 50.2% female participants from TV, cinema slide, radio. Conclusions: Changing staff, including resident doctors and other staff needs to be oriented with the national guidelines regarding control of malaria and especially anti-malarial prescription. Malaria clinic can be an important place to educate the people regarding malaria control. Educating patients can go a long way for malaria control in urban area.

Simple In Vitro Assay for Determining the Sensitivity of Plasmodium vivax Isolates from Fresh Human Blood to Antimalarials in Areas where P. vivax Is Endemic

ABSTRACT The aim of this study was to develop a simple, field-practical, and effective in vitro method for determining the sensitivity of fresh erythrocytic Plasmodium vivax isolates to a range of antimalarials. The method used is a modification of the standard World Health Organization (WHO) microtest for determination of P. falciparum drug sensitivity. The WHO method was modified by removing leukocytes and using a growth medium supplemented with AB+ serum. We successfully carried out 34 in vitro drug assays on 39 P. vivax isolates collected from the Mae Sod malaria clinic, Tak Province, Thailand. The mean percentage of parasites maturing to schizonts (six or more merozoites) in control wells was 66.5% ± 5.9% (standard deviation). This level of growth in the control wells enabled rapid microscopic determination (5 min per isolate per drug) of the MICs of chloroquine, dihydroartemisinin, WR238605 (tafenoquine), and sulfadoxine. P. vivax was relatively sensitive to chloroquine (MIC = 160 ng/ml, 50% inhibitory concentration [IC50] = 49.8 ng/ml) and dihydroartemisinin (MIC = 0.5 ng/ml, IC50 = 0.47 ng/ml). The poor response of P. vivax to both tafenoquine (MIC = 14,000 ng/ml, IC50 = 9,739 ng/ml) and sulfadoxine (MIC = 500,000 ng/ml, IC50 = 249,000 ng/ml) was due to the slow action of these drugs and the innate resistance of P. vivax to sulfadoxine. The in vitro assay developed in our study should be useful both for assessing the antimalarial sensitivity of P. vivax populations and for screening new antimalarials in the absence of long-term P. vivax cultures.