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Brief Reports

Indian Pediatrics 1999; 36:579-580 

Prevalence of Malaria in East Delhi - A Hospital Based Study


Sunil Gomber
Lalitha Kabilan

 From the Department of Pediatrics, University  College of Medical Sciences and Guru Teg Bahadur Hospital and Malaria Research Centre, Indian Council of Medical Research, Delhi, India.

Reprint requests: Dr. Sunil Gomber, F-4, Vijay Nagar, Delhi-llOOO9, India.

Manuscript Received: September 22, 1998; Initial review completed: October 7, 1998;
Revision Accepted: December 14, 1998.

Malaria has re-emerged as one of main public health problems leading to increased morbidity and mortality. It is a serious problem in the poor countries. Thirty six per cent of world's total population is exposed to risk of malaria( 1). In India, malaria peaked in 1976 following which the Government of India launched a modified plan of operation in 1977 to reduce its incidence. The problem was brought under control and malaria cases had been static till 1993. Since 1994 focal I outbreaks have been reported from various parts of the country with occurrence of increased proportion of cases of Plasmodium falciparum (Pf)(2). Keeping this in mind a ! hospital based study on prevalence of malaria I in children (1-12 years) coming from urban I and peri urban areas of East Delhi was carried out.

Subjects and Methods

A sample of population of children (1-12 yr) was examined by enrolling children attending the Out-Patient Department of the hospital for any reason. Children were recruited keeping in mind the overall distribution at various ages. The prevalence of malaria was found out by detecting parasites in their blood. Gimesa' s staining method was used for detecting slide positivity for malarial parasite. A total of 9442 blood smears were examined at the Malaria Clinic established in the Department during November 1994 to October 1995.

Results

Males and females comprised 59.7% and 40.3% of the sample, respectively. Children between the ages of 1-3 yrs, 4-6 yrs, 7-9 yrs and 10-12 yrs, represented 32.9%, 28.4%, 19.5% and 19.2% of the sample respectively. The slide positivity rate was 1.05% (number of positive slides = 99, Plasmodium vivax (Pv) = 83; 0.88%; Pf = 16; 0.17%). P. vivax was the predominant species among the positive cases. Differences in seasonal parasite rates were significant. P. vivax infections increased gradually from March and reached the peak of transmission by September-October and thereafter showed a gradual decline. However, Pf infections started in September and reached a peak 'in October and declined thereafter. The number of malaria positive cases at various ages were: 8 (1-3 yrs), 25 (4- 6 yrs), 38 (7-9 yrs) and 28 (10-12 yrs), respectively. The number of positive cases represented as proportion of positive slides and the total blood smears tested is shown in Table I. Examination of 9442 blood smears revealed a total of 62 out of83 (males - 36, females - 26) infections with P. vivax gametocytes and 13/16 with P. falciparum (males - 10, females - 3) gametocytes. Although gametocytes of both the species were prevalent in all the age groups, a higher positivity for gametocytes was seen in the age group 7-9 years.
 


TABLE I

Positive Cases Represented as Positive Slides at Various Ages
 

Age group (yr) Cases examined Positive slides (%)
1-3 3106 0.21
4-6 2682 0.93
7-9 1841 2.06
10-12 1813 1.05

           Slide positivity rate was significantly lower in 1-3 year age group (p <0.01).

Discussion

The results reveal that prevalence of malaria in East Delhi is low but malaria due to Plasmodium falciparum has been occurring in a significant proportion of cases. The trend is in concordance with the national scenario(3). Occurrence of Plasmodium falciparum malaria in increased proportions (16/99; 16.2%) may complicate the disease epidemiology as rising trends of resistant Plasmodium falciparum malaria are being noticed. Occurrence of low immunity in the community results in the presence of cases throughout the childhood(4) as shown in the present study. However, there was significant decrease in the proportion of positive cases below 3 years which could be explained due to the fact that younger children mainly stay indoors and also remain fully clothed. The difference in seasonal parasite rates of Pv and Pf is due mainly to two reasons: (a) occurrence of Pv in the earlier part of transmission (March-June) is usually due to relapse cases because of lack of radical treatment given by malaria workers to affected patients (GS Sonal, Deputy Director, National Malaria Eradication Program, Personal Communication); and (b) The difference in the extrinsic incubatiofl period which is 16 days in Pv and as long as 22 days in Pf.

The problem of increased occurrence of Pf needs to be monitored on a regular basis and containment measures should be immediately taken as there is increased cost of its treatment and moreover morbidity and mortality increases manifolds with Plasmodium falciparum malaria.
 

 References


1. Kondrachine A V, Trigg PI. Overview of malaria. Indian J Med Res 1997; 106: 39-52.

2. Lal S, Dhillion GPS, Sonal GS, Arora U, Nandi J. Drug Resistance and Chemotherapy of Malaria in India; An Update. Delhi, National Malaria Eradication Programme 1997; p I.

3. Sharma VP. Emerging problems in malaria control. Indian J Clin Biochem 1997; 12: 4.

4. McGregor IA. Epidemiology and control of Malaria. In: Epidemiology and the Community Control of Disease in Warm Climate Countries, 2nd edn. Robinson D. Edinburgh, Churchill Livingstone 1985; pp 413-429.

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