1
|
Garg S, Gupta V, Patel K, Dewangan M, Nanda P, Sridhar R, Singh G. Assessing afebrile malaria and bed-net use in a high-burden region of India: Findings from multiple rounds of mass screening. PLoS One 2023; 18:e0287667. [PMID: 37467182 DOI: 10.1371/journal.pone.0287667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
A key obstacle in the fight against malaria is afebrile malaria. It remains undiagnosed and, therefore, is invisible to the health system. Apart from being a serious illness, it contributes to increased transmission. Existing studies in India have not adequately reported afebrile malaria and its determinants, including the use of long-lasting insecticide-treated nets (LLINs). This study used six waves of mass screening, which were conducted by the state government in the high-malaria-burden region of Chhattisgarh, a state in India, in 2020, 2021, and 2022. Each round of data collection included more than 15000 individuals. Descriptive statistics were used to analyse key indicators of malaria prevalence and LLIN use. Multivariate analyses were performed to identify the determinants of afebrile malaria and LLIN use. Malaria prevalence in the afebrile population varied from 0.6% to 1.4% across the different waves of mass screening. In comparison, malaria positivity among febrile individuals was greater than 33% in each wave. Afebrile malaria contributed to 19.6% to 47.2% of the overall malaria burden in the region. Indigenous communities (scheduled tribes) were more susceptible to malaria, including afebrile malaria. Individuals using LLINs were less likely to be affected by afebrile malaria. Overall, 77% of the individuals used LLINs in early monsoon season, and in winter the rate was lower at 55%. LLIN use was significantly associated with the number of LLINs the households received from the government. Although fever continues to be a primary symptom of malaria, afebrile malaria remains a significant contributor to the malaria burden in the region. The free distribution of LLINs should be expanded to include high-burden populations. Global policies must include strategies for surveillance and control of afebrile malaria in high-burden areas.
Collapse
Affiliation(s)
- Samir Garg
- Division of Health Systems, State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Vishnu Gupta
- Division of Health Systems, State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Kavita Patel
- Division of Health Systems, State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Mukesh Dewangan
- Division of Health Systems, State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Prabodh Nanda
- Division of Health Systems, State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Ryavanki Sridhar
- Health Section, UNICEF, Chhattisgarh Field Office, Raipur, India
| | - Gajendra Singh
- Health Section, UNICEF, Chhattisgarh Field Office, Raipur, India
| |
Collapse
|
2
|
Singh A, Rajvanshi H, Singh MP, Bhandari S, Nisar S, Poriya R, Telasey V, Jayswar H, Mishra AK, Das A, Kaur H, Lal AA, Bharti PK. Mass screening and treatment (MSaT) for identifying and treating asymptomatic cases of malaria-malaria elimination demonstration project (MEDP), Mandla, Madhya Pradesh. Malar J 2022; 21:395. [PMID: 36575544 PMCID: PMC9793628 DOI: 10.1186/s12936-022-04423-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Mass screening and treatment (MSaT) aims at reducing the spread of malaria in communities by identifying and treating infected persons regardless of the symptoms. This study was conducted to identify and treat asymptomatic cases using MSaT approaches in the community. METHODS Three rounds of MSaT using cluster combination approaches were carried out during September 2018 to December 2019 to identify and treat asymptomatic malaria cases in the community. All individuals who were present in the household were screened using RDT irrespective of malaria related symptoms. Simultaneously thick and thin blood smear and blood spot were collected for further analysis using microscopy and diagnostic PCR done in a subset of the samples. RESULTS Logistic regression analysis revealed that asymptomatic malaria cases significantly less among the older age groups compared with < 5 years children (OR ranged between 0.52 and 0.61; p < 0.05), lowest in cluster 4 (OR = 0.01; p < 0.0001); during third round of MSaT survey (OR = 0.11; p < 0.0001) and significantly higher in moderate to high endemic areas (OR = 88.30; p < 0.0001). CONCLUSION Over the three rounds of MSaT, the number of asymptomatic cases were significantly less in the older age groups, and during third round. Similarly, the asymptomatic cases were significantly less in the low endemic area with API < 1 (cluster four). Therefore, the malaria elimination programme may consider the MSaT strategy to identify asymptomatic cases that would be otherwise missed by routine fever based surveillance. This MSaT strategy would help accomplish the malaria elimination goal in an expedited manner.
Collapse
Affiliation(s)
- Akansha Singh
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India ,grid.419641.f0000 0000 9285 6594Indian Council of Medical Research - National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| | - Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Asia Pacific Leaders Malaria Alliance (APLMA), Singapore, Singapore
| | | | - Sneha Bhandari
- grid.19096.370000 0004 1767 225XIndian Council of Medical Research - National Institute of Research in Environment Health (ICMR-NIREH), Bhopal, Madhya Pradesh India
| | - Sekh Nisar
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Present Address: Department of Health and Family Welfare, NHM Raigarh, Raigarh, Chattisgarh India
| | - Rajan Poriya
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Vinay Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India
| | - Himanshu Jayswar
- Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India
| | - Ashok K. Mishra
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Aparup Das
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India
| | - Harpreet Kaur
- grid.19096.370000 0004 1767 225XDepartment of Health Research, Ministry of Health and Family Welfare, Indian Council of Medical Research, New Delhi, India
| | - Altaf A. Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh India ,Foundation for Disease Elimination and Control of India, Mumbai, 482003 Maharashtra India
| | - Praveen K. Bharti
- grid.452686.b0000 0004 1767 2217Indian Council of Medical Research - National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh India ,grid.419641.f0000 0000 9285 6594Indian Council of Medical Research - National Institute of Malaria Research (ICMR-NIMR), New Delhi, India
| |
Collapse
|
3
|
Singh A, Singh MP, Bhandari S, Rajvanshi H, Nisar S, Telasey V, Jayswar H, Mishra AK, Das A, Kaur H, Lal AA, Bharti PK. Significance of nested PCR testing for the detection of low-density malaria infection amongst febrile patients from the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh, India. Malar J 2022; 21:341. [PMCID: PMC9669540 DOI: 10.1186/s12936-022-04355-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Low-density malaria infections (LDMI) are defined as infections that are missed by the rapid diagnostic test (RDT) and/or microscopy which can lead to continued transmission and poses a challenge in malaria elimination efforts. This study was conducted to investigate the prevalence of LDMI in febrile cases using species-specific nested Polymerase Chain Reaction (PCR) tests in the Malaria Elimination Demonstration Project, where routine diagnosis was conducted using RDT.
Methods
Every 10th fever case from a cross-sectional community based fever surveillance was tested with RDT, microscopy and nested PCR. Parasite DNA was isolated from the filter paper using Chelex based method. Molecular diagnosis by nested PCR was performed targeting 18SrRNA gene for Plasmodium species.
Results
The prevalence of malaria was 2.50% (436/17405) diagnosed by PCR, 1.13% (196/17405) by RDT, and 0.68% (118/ 17,405) by microscopy. Amongst 17,405 febrile samples, the prevalence of LDMI was 1.51% (263/17405) (95% CI 1.33–1.70), which were missed by conventional methods. Logistic regression analysis revealed that illness during summer season [OR = 1.90 (p < 0.05)] and cases screened within three days of febrile illness [OR = 5.27 (p < 0.001)] were the statistically significant predictors of LDMI.
Conclusion
The prevalence of malaria among febrile cases using PCR was 2.50% (436/17405) as compared to 1.13% (196/17405) by RDT. Higher number of the LDMI cases were found in subjects with ≤ 3 days mean duration of reported fever, which was statistically significant (p < 0.001). This observation suggests that an early detection of malaria with a more sensitive diagnostic method or repeat testing of the all negative cases may be useful for curtailing malaria transmission. Therefore, malaria elimination programme would benefit from using more sensitive and specific diagnostic methods, such as PCR.
Collapse
|
4
|
Deora N, Yadav C, Pande V, Sinha A. A systematic review and meta-analysis on sub-microscopic Plasmodium infections in India: Different perspectives and global challenges. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 2:100012. [PMID: 37383294 PMCID: PMC10305983 DOI: 10.1016/j.lansea.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background The long-term maintenance of parasite biomass below the detection threshold of microscopy may stymie malaria elimination. Variation in microscopists' competencies to detect and correctly identify parasite species reflect in microscopy sensitivity, resulting in incorrect species-specific burden. Methods The study estimated Plasmodium SMI pooled burden from published reports using a random effect model & identifies their hotspots in India. The study applied a prediction model for the first time on Indian data, emphasizing the importance of such models that can predict PCR-prevalence from slide- prevalence. Findings A total of 17,449 samples from 39 districts were examined for Plasmodium by microscopy and PCR. The overall heterogeneity in clinic-based and community-based studies was 91% and 96%, respectively, with the pooled prevalence of 3.63%. The SMI prevalence in individual studies ranged from 38.4% to 0.4%. Sensitivity of microscopy for mono-P. vivax (91%) was found to be better than mono-P. falciparum (82 %). But surprisingly, it was much lower for mixed PfPv (45%). Interpretation Primary regional data in the form of SMIs hot spots should be generated from countries on the verge of malaria elimination, and genetic monitoring should be integrated into national programs, particularly in key areas for successful malaria elimination. Funding Not applicable.
Collapse
Affiliation(s)
- Nimita Deora
- ICMR-National Institute of Malaria Research, New Delhi, India
- Department of Biotechnology, Kumaun University, Nainital, Uttarakhand, India
| | - C.P. Yadav
- ICMR-National Institute of Malaria Research, New Delhi, India
| | - Veena Pande
- Department of Biotechnology, Kumaun University, Nainital, Uttarakhand, India
| | - Abhinav Sinha
- ICMR-National Institute of Malaria Research, New Delhi, India
| |
Collapse
|
5
|
Abagero BR, Kepple D, Pestana K, Witherspoon L, Hordofa A, Adane A, Baharu F, Hansel S, Lopez K, Janies DA, Lo E, Yewhalaw D. Low Density Plasmodium Infections and G6PD Deficiency Among Malaria Suspected Febrile Individuals in Ethiopia. FRONTIERS IN TROPICAL DISEASES 2022; 3:966930. [PMID: 36619004 PMCID: PMC9815519 DOI: 10.3389/fitd.2022.966930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The identification and management of low parasitemia infections have become increasingly challenging for malaria control and elimination. Submicroscopic Plasmodium infections and G6PD deficiency among febrile patients require more sensitive diagnostic methods to improve detection and careful treatment regime of these infections. In Ethiopia, information on the low density submicroscopic malarial infections and frequency of G6PD deficiency (G6PDd) is scarce. In this study, 297 malaria suspected febrile patient samples were collected from health facilities of Bonga town in southwestern Ethiopia. The positivity rates of Plasmodium infection were determined by microscopy and quantitative PCR. G6PD activity level was determined by careSTART™ G6PD biosensor and the frequency of three common variants: G6PD*A (A376G), G6PD*A- (G202A) and Mediterranean (C563T) were investigated. G6PD gene sequencing was performed to detect mutations in exons 2-11 for both G6PD normal and deficient samples based on the phenotypic assay. More than twice Plasmodium infected samples was detected by qPCR (52/297; 17.4%) than microscopy (21/297; 7.0%). About 31 (10%) of the infections were submicroscopic. Bednet usage and age had a significant association with Plasmodium infection. Of the 271 participants who were tested for G6PD phenotype, 19 (7.0%) had low G6PD level. No mutations were observed in A376G, G202A, and C563T in the G6PDd samples, but three novel non-synonymous mutations in exon 2 including a C to T transition at position ChrX:6504 (Arg to Thr), G to T at ChrX:6369 (Ser to IIe), and G to C at ChrX:6664 (Gln to His) were detected. A high number of submicroscopic Plasmodium infections observed in this study pose a challenge for accurate and timely diagnosis, which could hinder malaria control efforts. G6PD deficiency in malaria patients pose danger when treating patients with primaquine. The three novel mutations detected in exon 2 of the G6PD gene merit further investigation on the hemolytic risk when exposed to oxidative antimalarials, their prevalence, and clinical significance.
Collapse
Affiliation(s)
- Beka R. Abagero
- Department of Biological Sciences, University of North Carolina at Charlotte, USA,Tropical Infectious Disease Research Center, Jimma University, Ethiopia
| | - Daniel Kepple
- Department of Biological Sciences, University of North Carolina at Charlotte, USA
| | - Kareen Pestana
- Department of Biological Sciences, University of North Carolina at Charlotte, USA
| | - Logan Witherspoon
- Department of Biological Sciences, University of North Carolina at Charlotte, USA
| | - Abdisa Hordofa
- Tropical Infectious Disease Research Center, Jimma University, Ethiopia
| | - Abinet Adane
- Tropical Infectious Disease Research Center, Jimma University, Ethiopia
| | - Fetiya Baharu
- Tropical Infectious Disease Research Center, Jimma University, Ethiopia
| | - Shantoy Hansel
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, USA
| | - Karen Lopez
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, USA
| | - Daniel A. Janies
- Department of Bioinformatics and Genomics, University of North Carolina at Charlotte, USA
| | - Eugenia Lo
- Department of Biological Sciences, University of North Carolina at Charlotte, USA,School of Data Science, University of North Carolina, Charlotte, USA,Correspondence: Eugenia Lo, Department of Biological Sciences, University of North Carolina at Charlotte; Delenasaw Yewhalaw, Tropical Infectious Disease Research Center, Jimma University, Ethiopia, ,
| | - Delenasaw Yewhalaw
- Tropical Infectious Disease Research Center, Jimma University, Ethiopia,Correspondence: Eugenia Lo, Department of Biological Sciences, University of North Carolina at Charlotte; Delenasaw Yewhalaw, Tropical Infectious Disease Research Center, Jimma University, Ethiopia, ,
| |
Collapse
|
6
|
Sarkar R, Kessler A, Mawkhlieng B, Sullivan SA, Wilson ML, Carlton JM, Albert S. Household and individual level risk factors associated with declining malaria incidence in Meghalaya, India: implications for malaria elimination in low-endemic settings. Malar J 2021; 20:460. [PMID: 34895233 PMCID: PMC8665616 DOI: 10.1186/s12936-021-03982-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/12/2021] [Indexed: 01/02/2023] Open
Abstract
Background A detailed analysis of household and individual level Plasmodium infection patterns in two low-endemic districts of Meghalaya was undertaken to better understand the epidemiology of malaria in northeast India. Methods Socio-demographic and behavioural information from residents (aged 1–69 years) of households were collected through pre-tested, questionnaire conducted in 2018 and 2019. Blood samples collected from participants were tested for Plasmodium falciparum and/or Plasmodium vivax infection using rapid diagnostic test, microscopy and PCR. Plasma samples from a subset of participants were analysed for antibodies against thirteen P. falciparum and four P. vivax antigens. Associations between household and individual level risk factors, and Plasmodium infections were evaluated using multilevel logistic regression models. Results A total of 2753 individuals from 827 households were enrolled in 2018, and 834 individuals from 222 households were enrolled in 2019. Of them, 33 (1.2%) were positive by PCR for P. falciparum in 2018 and none were positive for P. vivax. In 2019, no PCR-positive individuals were detected. All, but one, infections were asymptomatic; all 33 infections were sub-microscopic. Reported history of malaria in the past 12 months (OR = 8.84) and history of travel in the past 14 days (OR = 10.06) were significantly associated with Plasmodium infection. A significant trend of increased seropositivity with age was noted for all 17 antigens. Although adults (≥ 18 years) consistently had the highest seropositivity rates, a sizeable proportion of under-five children were also found to be seropositive. Almost all individuals (99.4%) reported sleeping under an insecticide-treated bed-net, and household indoor residual spray coverage in the 12 months preceding the survey was low (23%). Most participants correctly identified common signs and symptoms of malaria, i.e., fever (96.4%), headache (71.2%), chills (83.2%) and body-ache (61.8%). Almost all participants (94.3%) used government-provided services for treatment of malaria. Conclusion This study explored the epidemiology of malaria in two communities in Meghalaya, India, in the context of declining transmission. The presence of widespread asymptomatic infections and seropositivity among under-five children suggest that low-level Plasmodium transmission persists in this region. Implications of the study findings for malaria elimination efforts in low-transmission settings are discussed.
Collapse
Affiliation(s)
- Rajiv Sarkar
- Indian Institute of Public Health - Shillong, Shillong, Meghalaya, 793001, India. .,Martin Luther Christian University, Shillong, Meghalaya, 793006, India.
| | - Anne Kessler
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | | | - Steven A Sullivan
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jane M Carlton
- Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA.,Department of Epidemiology, School of Global Public Health, New York University, New York, NY, 10003, USA
| | - Sandra Albert
- Indian Institute of Public Health - Shillong, Shillong, Meghalaya, 793001, India.,Martin Luther Christian University, Shillong, Meghalaya, 793006, India
| |
Collapse
|
7
|
Application of dried blood spot sample pooling strategies for Plasmodium 18S rRNA biomarker testing to facilitate identification of infected persons in large-scale epidemiological studies. Malar J 2021; 20:391. [PMID: 34620192 PMCID: PMC8499573 DOI: 10.1186/s12936-021-03907-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background Plasmodium 18S rRNA is a sensitive biomarker for detecting Plasmodium infection in human blood. Dried blood spots (DBS) are a practical sample type for malaria field studies to collect, store, and transport large quantities of blood samples for diagnostic testing. Pooled testing is a common way to reduce reagent costs and labour. This study examined performance of the Plasmodium 18S rRNA biomarker assay for DBS, improved assay sensitivity for pooled samples, and created graphical user interface (GUI) programmes for facilitating optimal pooling. Methods DBS samples of varied parasite densities from clinical specimens, Plasmodium falciparum in vitro culture, and P. falciparum Armored RNA® were tested using the Plasmodium 18S rRNA quantitative triplex reverse transcription polymerase chain reaction (qRT-PCR) assay and a simplified duplex assay. DBS sample precision, linearity, limit of detection (LoD) and stability at varied storage temperatures were evaluated. Novel GUIs were created to model two-stage hierarchy, square matrix, and three-stage hierarchy pooling strategies with samples of varying positivity rates and estimated test counts. Seventy-eight DBS samples from persons residing in endemic regions with sub-patent infections were tested in pools and deconvoluted to identify positive cases. Results Assay performance showed linearity for DBS from 4 × 107 to 5 × 102 parasites/mL with strong correlation to liquid blood samples (r2 > 0.96). There was a minor quantitative reduction in DBS rRNA copies/mL compared to liquid blood samples. Analytical sensitivity for DBS was estimated 5.3 log copies 18S rRNA/mL blood (28 estimated parasites/mL). Properly preserved DBS demonstrated minimal degradation of 18S rRNA when stored at ambient temperatures for one month. A simplified duplex qRT-PCR assay omitting the human mRNA target showed improved analytical sensitivity, 1 parasite/mL blood, and was optimized for pooling. Optimal pooling sizes varied depending on prevalence. A pilot DBS study of the two-stage hierarchy pooling scheme corroborated results previously determined by testing individual DBS. Conclusions The Plasmodium 18S rRNA biomarker assay can be applied to DBS collected in field studies. The simplified Plasmodium qRT-PCR assay and GUIs have been established to provide efficient means to test large quantities of DBS samples. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03907-8.
Collapse
|
8
|
Kaur J, Kaura T, Sharma A, Kumar A, Pangotra MK, Upadhyay AK, Anvikar A, Grover GS, Chaturvedi HK, Sharma SK. Surveillance-based estimation of the malaria disease burden in a low endemic state of Punjab, India, targeted for malaria elimination. Trans R Soc Trop Med Hyg 2021; 115:512-519. [PMID: 33539517 DOI: 10.1093/trstmh/trab005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/10/2020] [Accepted: 01/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The state of Punjab in India qualifies for malaria elimination because the number of cases reported through routine surveillance is in decline. However, surveillance system prevalence mainly provides malaria trends. Therefore, a prospective epidemiological study was designed to estimate the malaria burden in the state. METHODS District-wise annual parasite incidence (API) was used for identification of three strata, representing high, moderate and low API zones. A total of 0.9 million people from nine districts was under malaria surveillance for 1 y. The weighted estimates of API for the three regions was calculated and combined to give an estimate of API for the total population of the state. RESULTS Based upon the primary data generated, malaria cases from high, moderate and low malaria-endemic areas were estimated to be 3727, 904 and 106, respectively. Further, the total number of malaria cases in the state was estimated to be 4737 (95% CI 4006 to 5469) cases per annum. CONCLUSION Actual burden of malaria in the state of Punjab, India, is about seven to eight times higher than that reported by routine surveillance activities. However, the state still qualifies for malaria elimination but needs vigorous efforts to strengthen the active surveillance and reporting system along with implementation of effective control strategies to achieve malaria elimination.
Collapse
Affiliation(s)
- Jaspreet Kaur
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Taruna Kaura
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Ayush Sharma
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Ashish Kumar
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - M K Pangotra
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - A K Upadhyay
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| | - Anupkumar Anvikar
- ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, India
| | - Gagandeep S Grover
- Directorate of Health Services, Government of Punjab, Parivar Kalyan Bhavan, Sector-34, Chandigarh, India
| | - H K Chaturvedi
- ICMR-National Institute of Medical Statistics, Ansari Nagar, New Delhi, India
| | - Surya K Sharma
- ICMR-National Institute of Malaria Research, Field site, CHC Dhakoli, Zirakpur, Punjab, India
| |
Collapse
|
9
|
Shankar H, Singh MP, Phookan S, Singh K, Mishra N. Diagnostic performance of rapid diagnostic test, light microscopy and polymerase chain reaction during mass survey conducted in low and high malaria-endemic areas from two North-Eastern states of India. Parasitol Res 2021; 120:2251-2261. [PMID: 33772349 PMCID: PMC7997798 DOI: 10.1007/s00436-021-07125-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022]
Abstract
An early and accurate diagnosis followed by prompt treatment is pre-requisite for the management of any disease. Malaria diagnosis is routinely performed by microscopy and rapid diagnostic tests (RDTs) in the field settings; however, their performance may vary across regions, age and asymptomatic status. Owing to this, we assessed the diagnostic performance of conventional and advanced molecular tools for malaria detection in low and high malaria-endemic settings. We performed mass blood surveys in low and high endemic regions of two North-Eastern districts from the states of Assam and Meghalaya. A total of 3322 individuals were screened for malaria using RDT, microscopy and PCR and measures of diagnostic accuracy were estimated. Out of 3322 individuals, 649 (19.5%) were detected with malaria parasite. Asymptomatic were 86.4% (2872/3322), of which 19.4% (557/2872) had Plasmodium infection. The sensitivity and specificity of microscopy were 42.7% and 99.3%, and RDT showed 49.9% and 90.4%, respectively, considering PCR as standard. RDT (AUC: 0.65 vs 0.74; p = 0.001) and microscopy (AUC: 0.64 vs 0.76; p < 0.0001) performances were significantly lower in low compared to high endemic areas. True positive rate was lower in asymptomatics but true negative rate was found similar to symptomatic individuals. The conventional diagnostic tools (RDT and microscopy) had detected malaria in children with nearly twofold greater sensitivity than in the adults (p < 0.05). To conclude, asymptomatics, adults and low malaria-endemic regions require major attention due to mediocre performance of conventional diagnostic tools in malaria detection.
Collapse
Affiliation(s)
- Hari Shankar
- Parasite-Host Biology Group, ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, 110077, India
| | - Mrigendra Pal Singh
- Parasite-Host Biology Group, ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, 110077, India
| | - Sobhan Phookan
- ICMR-National Institute of Malaria Research Field Unit, Guwahati, Assam, 781022, India
| | - Kuldeep Singh
- ICMR-National Institute of Malaria Research Field Unit, Guwahati, Assam, 781022, India
| | - Neelima Mishra
- Parasite-Host Biology Group, ICMR-National Institute of Malaria Research, Sector-8, Dwarka, New Delhi, 110077, India.
| |
Collapse
|
10
|
Alkan ML. The Importance of Submicroscopic Diagnosis of Malaria. Clin Infect Dis 2019; 71:175-176. [DOI: 10.1093/cid/ciz752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Michael L Alkan
- Medical School for International Health, Ben Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|