|Year : 2015 | Volume
| Issue : 2 | Page : 91-94
Malarial trend in Dakshina Kannada, Karnataka: An epidemiological assessment from 2004 to 2013
Shivakumar1, BV Rajesh2, Arun Kumar3, Muktha Achari3, Suman Deepa2, Navya Vyas2
1 District Health and Family Welfare Office, Dakshina Kannada, Karnataka, India
2 District Surveillance Unit, Dakshina Kannada, Karnataka, India
3 District Vector Borne Disease Control Programme Office, Dakshina Kannada, Karnataka, India
|Date of Web Publication||17-Jan-2016|
District Epidemiologist, District Surveillance Unit, Dakshina Kannada, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Malaria is one of the main causes for morbidity in India and many of the tropical countries. Dakshina Kannada in Karnataka is one of the Malaria endemic districts. Various efforts to contain the transmission of this deadly disease by National Vector Borne Disease Control Program (NVBDCP) has been effective up to an extent.
Methods: A retrospective report based study over a period of ten years was conducted in Dakshina Kannada district. The community based data of confirmed cases of malaria was collected and analysed.
Results: Highest cases of Malaria were recorded in 2005 (16,154) . The incidence of Malaria ranged from 26% to 85% in the last ten years. The magnitude of Plasmodium falciparum %(Pf%) ranged from 6.8%-30.9%.
Conclusion: Prevalence of malaria has been on a declining trend but some of the malariometric indices have been on a fluctuating trend. This is indicative of a multidisciplinary approach to curb the disease.
Keywords: Endemic, malarial transmission, malariometric indices
|How to cite this article:|
Shivakumar, Rajesh B V, Kumar A, Achari M, Deepa S, Vyas N. Malarial trend in Dakshina Kannada, Karnataka: An epidemiological assessment from 2004 to 2013. Indian J Health Sci Biomed Res 2015;8:91-4
|How to cite this URL:|
Shivakumar, Rajesh B V, Kumar A, Achari M, Deepa S, Vyas N. Malarial trend in Dakshina Kannada, Karnataka: An epidemiological assessment from 2004 to 2013. Indian J Health Sci Biomed Res [serial online] 2015 [cited 2019 May 19];8:91-4. Available from: http://www.ijournalhs.org/text.asp?2015/8/2/91/174235
| Introduction|| |
Mosquitoes are insects of public health importance because it causes many deaths every year due to a wide range of parasitic diseases. These include malaria, chikungunya, dengue, and Japanese encephalitis. Among these vector-borne diseases, malaria contributes a significant chapter in the archives of biological parasitism. Hence, it is a grave health problem that has tormented mankind for countless generations. Due to this reason, combating malaria has been included as one of the millennium development goals. Worldwide, annually 8,81,000 deaths are related to malaria alone and in this, India contributes a major share of the incidence.  According to World Health Organisation, in South East Asia Region, 70% of malaria cases were from India.  Global estimate shows developing countries report a maximum number of cases of malaria with the majority of infected people living in urban India. To combat the problem of vector-borne diseases in India, National Vector Borne Disease Control Program (NVBDCP) (a national program) came into existence in 2005. The program covers the formulation of policies and guidelines; and monitoring and evaluation of vector-borne diseases in the country. In 2009, 1.6 million cases and 1100 deaths were reported due to Malaria alone by NVBDCP. 
Karnataka constitutes of 28 districts, out of which Dakshina Kannada contributes almost 50% of the cases to the state malaria profile.  The main objective of this study is to present an overview of the malarial scenario in Dakshina Kannada in the last 10 years.
| Subjects and Methods|| |
Dakshina Kannada is the Southern coastal district of Karnataka State with an area of 4866 sq. km. The population being 21 lakhs. The district constitutes of five talukas (a subdivision of a revenue district). A retrospective record based study over a period of 10 years was carried out in the District Malaria Office, Dakshina Kannada and Malaria Cell, Mangalore City Corporation. The community-based data for Malaria, Primary Health Center wise and wardwise in Dakshina Kannada was obtained from the former and latter, respectively. The study included confirmed cases of malaria from January 2004 to December 2013.
| Case Definition || |
A case of malaria is considered when a patient presents with fever accompanied with headache, backache, chills, rigors, sweating, myalgia, nausea and vomiting splenomegaly and anemia, generalized convulsions, coma, shock, spontaneous bleeding, pulmonary edema, renal failure, and death (untreated falciparum infection). 
A confirmed case of malaria is defined as a suspect case with malarial parasites in the blood film.
A confirmed complicated/severe malaria is defined as a confirmed case with symptoms/signs of complicated/severe malaria (prostration, impaired consciousness, respiratory distress (acidotic breathing), multiple convulsions, circulatory collapse, pulmonary edema (radiological), abnormal bleeding, jaundice, hemoglobinuria, severe anemia, etc.).
| Results|| |
The analysis of the epidemiological data from 2004 to 2013 [Figure 1] revealed that the total confirmed cases of malaria was recorded highest in 2005 that is 16, 154 cases with a steep decline in the number of cases in the consecutive years [Table 1]. The incidence of malaria in Dakshina Kannada had ranged from as low as 26% to as high as 85% in the last 10 years [Figure 2]. The cases reported due to Plasmodium vivax (Pv) was found to be more than the cases due to Plasmodium falciparum (Pf).The annual blood examination rate (ABER) throughout the years was high ranging from 12.94% to 16.7%, which is considerably good. The annual parasite incidence (API) has been found to be less than 2 cases per 1000 population, 2-5 cases per 1000 population and more than 5 cases per 1000 population since 2004. The slide positivity rate (SPR) which gives information on the parasitic load in the region has been in the range of 1.85-4.9% in the last 10 years. The magnitude of Plasmodium falciparum percentage (Pf%) has ranged from 6.8% to 30.9%. It is quite credible that in this part of Karnataka Pf% has been well within the normal limits which show that interventional measures to curb the transmission of the parasite has been successful up to an extent.
|Table 1: Epidemiological data of malaria in Dakshina Kannada (2004 - 2013)|
Click here to view
| Discussion|| |
Multitude of problems need to be addressed to battle Malaria in Dakshina Kannada like rapid urbanization, humidity and temperature, problems in tracing and detection of malaria cases in construction sites, lack of usage of personal protective measures, lack of legislative measures to enforce screening in construction workers, lack of compliance to the course of treatment of malaria and increased migration to this region from different parts of India and Karnataka. There have been a lot of efforts to contain the spread of the disease; in spite of all the efforts Malaria still continues to be a public health problem in this part of Karnataka. This region calls for the more intensive administration of drug and vector control measures to contain the disease.
However, the silver lining among these challenges is that malaria surveillance has been good for the past 10 years which is evident from ABER. According to National Malaria Guidelines, the ideal magnitude of ABER must be less than 10% every year.  Similar findings were found in the malaria surveillance in the public health centers in Sahibganj district of Jharkhand, which helped in getting a clear scenario of malaria in the region.  The incidence of malaria had been reduced from 85.5% to 26% in last 10 years due to good control measures. This may be due to continues malaria campaign with house-house survey and activities of vector control including bed-net distribution and indoor residual spray by special group constituted by District Malaria Office, Dakshina Kanna. Apart from this, multipurpose workers have been visiting unoccupied houses for source reduction of mosquito in the urban areas. A similar decreasing trend in incidence was observed in a study in Solomon Islands where there was a reduction by 86.5%.  Through malaria surveillance, it was found that the 81.4% of the cases reported were due to Pv, whereas only 18.6% of cases were reported due to Pf in this part of Karnataka. Pf species can be more easily controlled and the compliance rate for the treatment is also more, but it is more deadlier than the Pv species. Whereas in Henan Province Pf cases were dominant (78.2%) followed by Pv (9.1%) and other strains constituted 12.7% of the cases.  The Pf species is considered to be one of the deadliest species of Malaria. Pf% in Dakshina Kannada had shown a fluctuating trend since 2004. Pf% had declined after the introduction of artemisinin-based combination therapy in 2009. However in the last 10 years, the magnitude of Pf% has always been less than 50%.  Orissa is a state which contributes a significant proportion of malaria cases to the national average. In a district in Orissa, Pf% was reported to be 81%. 
The API in this district has been more than 2/1000 population, with a fluctuating trend seen throughout these 10 years which implies a need for vector control coverage, with the ideal magnitude being less than 2/1000 population for at least 3 years before vector control measures are withdrawn.  This figure implies that malaria had been a vital health issue since 2004. Similar fluctuating trends of API were observed in a district in Uttar Pradesh in the past 10 years which is indicative of an impending outbreak.  The magnitude of SPR in Dakshina Kannada, which is < 5%, which being the ideal magnitude indicates that the control measures to contain the deadly disease have been effective up to an extent.  However in another study, SPR was found to be 24.4% in Balsore district of Orissa where Malaria was nonendemic.  In the present study, since ABER was satisfactory API becomes the most important criterion to assess the prevalence of malaria in the region, which indicates a declining trend. SPR becomes important if ABER IS low but in this case ABER is quite good.
| Conclusion|| |
In India, Karnataka contributes only a small proportion to the national burden of malaria, but it has a potential risk to national health security. The prevalence of malaria had declined from 85% to 26% in the last 10 years which is a credible achievement. On the other hand, API had been on a fluctuating trend which implies a need for more intensive vector coverage. The proportion of Pv cases accounted for about 81.4% which was much more than the proportion of Pf cases (18.6%) reported. However, malaria is not a problem of health sector alone. A multidisciplinary response with development and implementation of public health policies that provide a favorable setting and guaranteed community participation are vital.
Now with enhanced level of knowledge, lessons learnt from the earlier period, with the availability of technology and manpower, malaria could undoubtedly be contained in Dakshina Kannada.
We would like to thank Dr. Nilesh Yadav and Mr. Sonal Sekhar for their valuable suggestions. We also thank Mr. Bhaskar Rao for technical assistance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]