Epidemiology of Malaria in India Assignment Sample

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Epideomiolgy of Malaria in India

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EPIDEOMIOLGY OF MALARIA IN INDIA

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TABLE OF CONTENTS

INTRODUCTION .......................................................................................................................... 1

CONTEXT: DEMOGRAPHY/DISEASE PREVALENCE/EPIDEMIOLOGY............................ 1

Prevalence................................................................................................................................... 1

Demography................................................................................................................................ 2

Epidemiology.............................................................................................................................. 3

METHOD/ SOURCE DATA ......................................................................................................... 5

DISCUSSION................................................................................................................................. 6

REFERENCES ............................................................................................................................... 9

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LIST OF FIGURES AND TABLES

Figure 1Trend of malaria in India................................................................................................... 2

Figure 3 Graph drawn on basis of number of species of Anopheles .............................................. 5

Figure 5 Age standardized mortality............................................................................................... 6

Table 1 Country wide epidemiological situation (1995-2010)....................................................... 2

Table 2 Distribution of species of vectors in India......................................................................... 4





INTRODUCTION

Malaria has been defined as a mosquito borne disease, which is caused because of a

parasite known as plasmodium. It is known to be transmitted from the bite of infected

mosquitoes. The disease begins due to a bite of an infected female mosquito known as

Anopheles through which plasmodium or protists enters into the circulatory system. Then, in

blood, the protists travel towards the liver where it matures and reproduces to increase in

number. The main symptoms of this disease include fever, vomiting and headache and this

usually appears after 10-15 days of the bite of mosquito (Nosten and White, 2007).

There are five species of Plasmodium, which can infect and get transmitted through

humans. Its species P. falciparum and P. vivax are mainly responsible for causing a majority of

deaths and therefore, the two are considered to be the most fatal. The other two are P. malariae

and P. ovale, which are not fatal and are mild (Ollhoff, 2010).

Malaria is considered to be as one of the largest infections of micro parasite leading to

millions of deaths and especially children in each year. According to WHO (World Health

Organization), this disease has been declared as a highly endemic one in 109 countries of the

world in the year 2008. It is spreading rapidly in various countries of the world and especially the

tropical countries of central and South America, Africa and Asia. It is so because in these areas

warm temperatures, high rainfall along with stagnant water provides ideal habitat for the growth

of mosquitoes. Though various programmes for the prevention of the disease have been initiated

but still the number of deaths due to this is increasing (Malaria, 2013).

CONTEXT: DEMOGRAPHY/DISEASE PREVALENCE/EPIDEMIOLOGY

Prevalence

According to the National Ministry of Health and Family Welfare in India, malaria is

known to be one of the major causes of deaths and especially among children. According to

WHO, malaria has lead to approximately 15000 deaths per year in the country among which

5000 is among children and 10,000 thereafter. It has lowered the physical and social standards

and economic progress of the entire nation. WHO has reported that from 1990s till data the

number of cases reported are approximately 15 million with average 19500 to 20000 deaths per

year. The expansive geography and diverse climate are the factors which provides an ideal





climate due to which growth of malarial parasites and their vectors is supported (World Malaria

Report 2009, 2010).

Demography

Figure 1Trend of malaria in India

(Source: National Vector Borne Disease Control Programme, 2013)

Table 1 Country wide epidemiological situation (1995-2010)

Year Population (in

‘000)

Total Malaria

Cases (million)

P.falciparum Pf % API Deaths due

to malaria

1151

1010

879

664

1048

932

cases (million)

1.14

1.18

1.01

1.03

1.14

1.05

1.01

0.90

1995

1996

1997

1998

1999

2000

2001

2002

888143

872906

884719

910884

948656

970275

984579

1013942

2.93

3.04

2.66

2.22

2.28

2.03

2.09

1.84

38.84

38.86

37.87

46.35

49.96

51.54

48.20

48.74

3.29

3.48

3.01

2.44

2.41

2.09

2.12

1.82

1005

973






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Epidemiology

The fact that malaria in India has a diverse epidemiology is shown by the presence of

different species of vectors of the disease. The most geographically vector is Anopheles

culicifacies which further consists of its siblings namely, A, B, C, D, and E. Though these

species do not differ physically from one another but variations do occur in physiological terms

on basis of their capacity to cause infection. Among the sibling species, A is the one which is

most susceptible to infection while species B is least susceptible. Other malarial vectors include

Anopheles fluviatilis, Anopheles minimu and many more. All these are prevalent in the country

causing infection. The common parasites of the disease are plasmodium vivax which is most

commonly found in India. Then next is plasmodium falciparum which is the only one

responsible for death. Others which are not found in India are plasmodium malariae and ovale

(Malaria in India, 2004).

Table 2 Distribution of species of vectors in India

Primary vectors No of sibling No of sibling Members in India Ecological

distribution

Rural/peri urban

species species in India

An. culcifacies

An. minimus

5

3

5

1

A,B,C,D,E

An. minimus, An.

minimus s.s.

S,T,U,V

North eastern

states

An. fluvatis

An. sundaicus

4

3

4

1

Foothills/forest

Andaman Nicobar

islands

New cytotype D

An. dirus 7 2 An. baimali, An. North

states

eastern

elegans

(Source: Malaria in India: The Center for the Study of Complex Malaria in India, 2012)





8

7

6

5

4

3

2

1

0

No of sibling species in

India

No of sibling species

An. An. An. An. An. dirus

culcifacies minimus fluvatis sundaicus

Figure 2 Graph drawn on basis of number of species of Anopheles

METHOD/ SOURCE DATA

The hypothesis which is taken is that whether there is a difference in the prevalence of

malarial deaths related to age or not. The main aim is to find the possible range of age of

mortality rate in India due to malaria. As a source of primary data, published survey in journal of

US National Library of Medicine was referred in which study is done to find out the adult and

child mortality in India. For this, families and other respondents were interviewed and asked

about each of the deaths which occurred because of the disease. The deaths attributed to malaria

were found to be correlated geographically with local malaria transmission rates which were

derived independently from malaria control programme. It was found that 205,000 malaria

deaths per year occur before 70 years of age. The figure is approximately 55000 in early

childhood, 30,000 at ages 5-14 and 1, 20,000 at the age of 15-69 years of age (Dhingra and et.

al., 2010).

For secondary sources, data provided by World Health Organization and National Vector

Disease Control Programme by National Institute of Health and Family Welfare are taken.

RESULTS

Figure1





This table shows the geographic variation occurring among few states of India in the

Million Death Study (MDS). The study depicts the deaths due to malaria at ages 0-69 years and

also by National Vector-Borne Disease Control Programme (NVBDCP).

Figure 2

Figure 3 Age standardized mortality

The above figure shows the geographic distribution of mortality due to malaria in India.

States which have high mortality rates includes Orissa, Chhattisgarh, and Jharkhand. It also

includes north eastern states except Sikkim.

DISCUSSION

Key findings

In order to find an association of death rate and age it was found that there exists that a

significant difference between the two or not. From figure 1, it was seen that although the death

rate attributed to malaria was found to be high among young children but the rate became

comparably high in later middle age. The rates indicate an overall probability of 1·8% of dying

from malaria before 70 years of age in the absence of other causes. Also, it was found that about

half of the 205,000 malaria-attributed deaths that occurred before the age of 70 years occurred

only in a few high-malaria states. This was highest in Orissa which accounted for over 50,000





deaths. The study is based purely on random variation confidence interval of 99% for the total

number of deaths before the age 70. The confidence interval means a type of estimation of an

interval within a parameter of population. With help of this, reliability of an estimate is indicated

(Kumar and et. al., 2007).

A range of values exist within the confidence interval and is considered to be a good

estimate of the parameter of the population under study. This value is represented by percentage

and with help of this significant level is also reflected. A 95% confidence level indicates a

significance level of 0.05 which is used to test a hypothesis. This confidence interval is

determined by the researcher. Confidence intervals are shown at either 95% or 99%. Here, in this

study, a confidence interval of 99% shows a significant difference of 0.05 (Sample Size

Calculator, 2012).

To reach the final results, four correlations were made that were then supported by

applying values of correlation to find the level of association. Firstly, from table 1, the

proportional distribution of malarial deaths across the major states was found to be similar to that

of the national malaria control program for the few positive slides which were then clinically

confirmed. A total of only 5647 deaths occurred at all ages during 2000-2005. Secondly, the

occurrence of deaths varied seasonally, that is, it was higher some time after the wet season

began although perhaps it was not as extreme as was expected for P. falciparum malaria (Snow

and et. al., 2005).

Thirdly, a geographical correlation was made with the district-level P. falciparum

transmission rates which were indicated independently by the Indian malaria control programme

as shown in figure 2 with rates of fever that were reported by researchers by conducting

nationwide surveys at district-level of 700,000 households. Another hypothesis which was

assumed to be null was that there was no significant difference between the rates of death

indicated by the Indian malaria control programme and the survey conducted independently. The

alternative hypothesis is that there is a significant difference between the two. It came out to be,

r = 0.59 and p<0.0001.

The value of correlation lies between the ranges of -1.00 to +1.00. It shows a negative

and positive probability between the variables. A positive value suggests that they are linked and

a negative value gives that variables are not correlated. The value of p implies the probability of

obtaining whether the hypothesis is to be accepted or not. If value of p is less than 0.01 or 0.05





may happen that some kind of biasness may arise among interviewers while taking the response

from the people (Dev, Ansari, Hira, and Barman, 2001).

The strengths of information taken from National Vector Disease Control Programme

which is a unit of National Institute of Health and Family Welfare in India is that the data taken

for reference is taken at the national level covering each area and can be relied upon.

The limitation can be that sometimes it may not be possible for the authorities to collect

the entire data and the process can become cumbersome sometimes (Das and et. al., 2011).

Conclusion

According to me, the epidemiology of malaria in India is known to exist since many

years but still not many preventive measures are provided for entirely curing it. Apart from this,

level of awareness among people related to this disease is not much and that is why public is

easily prone to this. Rural people, especially, more endangered to the disease because less level

of cleanliness in maintained in the rural areas. If in any area, water or garbage is collected for a

number of days then this will encourage the growth of mosquitoes which obviously is not a good

sign. So, the government should increase the awareness level and educate people on how they

can prevent malaria in their households (Mendis, Sina and Marchesini, 2001).

While conducting a survey, it should be kept in mind that data and information provided

is taken from reliable sources so that study or evaluation can be done in the correct manner.






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REFERENCES

Books and Journals

Breman, J.G., 2001. The ears of the hippopotamus: manifestations, determinants and estimation of the malaria burden. Am J Trop Med Hyg. 64(1). pp.1–11.

Chaturvedi, H.K., Mahanta, J., and Pandey, A., 2009. Treatment-seeking for febrile illness in north-east India: an epidemiological study in the malaria endemic zone. Malar Journal. 8. p.301.

Das, A. and et. al., 2011. Malaria in India: The Center for the Study of Complex Malaria in India. Acta Tropica. 121(2012). pp.267-273.

Dev, V., Ansari, M.A., Hira, C.R., and Barman, K., 2001. An outbreak of Plasmodium falciparummalaria due to Anopheles minimus in Central Assam, India. Indian J Malariol. 2001 (38). pp.32–38.

Dhingra N. and et. al., 2010. Adult and child malaria mortality in India. PubMed Central. 376(9754). pp.1768-1774.

Kumar, A. and et. al., 2007. Burden of malaria in India: retrospective and prospective view. PubMed Central. 77 (6). pp.69–78

Marcus, B., 2009. Malaria. Infobase Publishing.

Mendis, K., Sina, B.J. and Marchesini, P., 2001. The neglected burden of Plasmodium vivax malaria. Am J Trop Med Hyg. 64. pp.97–106.

Nandy, A., and et. al., 2003. Monitoring the chloroquine sensitivity of Plasmodium vivax from Calcutta and Orissa, India. Ann Trop Med Parasitol. 97. pp. 215–20.

Nosten, F., and White, N.J., 2007. Artemisinin-based combination treatment of falciparum malaria. PubMed Central. 77(2). pp.181–192.

Ollhoff, J., 2010. Malaria. ABDO.

Singh, R.K., 2000. Emergence of chloroquine-resistant vivax malaria in South Bihar (India). Trans R Soc Trop Med Hyg. 2000 (94). p. 327.

Snow, R.W., and et. al., 2005. The global distribution of clinical episodes of Plasmodium falciparum malaria. Nature. 434. pp.214–7.

Subbarao, S.K., 2004. Malarial morbidity in tribal communities living in the forest and plain ecotypes of Orissa, India. Ann Trop Med Parasitol. 98. pp.459–68.

Zwi, A., Brugha, A. and Smith, E., 2001. Private health care in developing countries. British Med Journal. 323. pp.463–4.





Online

Malaria in India. 2004. [Online]. Available through:

<http://www.malariasite.com/malaria/MalariaInIndia.htm > [Accessed on 6th April 2013].

Malaria. 2013. [Online]. Available through: < http://www.who.int/topics/malaria/en/ > [Accessed on 6th April 2013].

Correlation. 2013. [Online]. Available through:

<http://www.investopedia.com/terms/c/correlation.asp > [Accessed on 6th April 2013].

Sample Size Calculator. 2012. [Online]. Available through:

<http://www.surveysystem.com/sscalc.htm > [Accessed on 6th April 2013].

World Malaria Report 2009. 2010. [pdf]. Available through:

<http://whqlibdoc.who.int/publications/2009/9789241563901_eng.PDF > [Accessed on 6th April 2013].

National Anti-Malaria Programme. 2009. [Online]. Available through:

<http://www.nihfw.org/NDC/DocumentationServices/NationalHealthProgramme/NATIO NALANTI-MALARIAPROGRAMME.html > [Accessed on 6th April 2013].

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Epidemiology of Malaria in India Assignment Sample