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Table of Contents
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 31-35

Outcome of malaria cases in a tertiary care hospital with predominantly tribal population


1 Associate Professor, Department of Medicine, Late BRK Memorial Medical College, Jagdalpur, Chattisgarh, India
2 Professor, Department of Medicine, Late BRK Memorial Medical College, Jagdalpur, Chattisgarh, India

Date of Web Publication31-Aug-2018

Correspondence Address:
N K Dulhani
Associate Professor, Department of Medicine, Late BRK Memorial Medical College, Jagdalpur, Chattisgarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240242

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  Abstract 

Introduction:
The study was aimed to study the outcome of Malaria cases admitted in the medicine department of the tertiary care hospital at Late Brk Memorial Medical College Jagdalpur (C.G), India. and also to see the response of treatment. The cases were attended from Jagdalpur city and nearby districts and villages.
Methodology:
This was an observational study, which was conducted at LATE B R K MEMORIAL MEDICAL COLLEGE, Jagdalpur, which is a tribal state. The study was carried out from January 2017 to 30th september 2017 for a period of 9 months. Total cases were 362 confirmed cases of malaria admitted in medicine department. Confirmation was done by peripheral smear, RDT and parasite quality buffy coat (MP-QBC).
Result:
In our study, subjects enrolled were 362 cases of confirmed Malaria. Age group included were from 15 to 80 years. The mean age of the patients was 49.05 (±14.35) years. The percentage of male were 66.02% (n=239) and female were 33.97% (n=123).Complicated malaria was demonstrated in 260 (71.8%) and uncomplicated malaria in 108 (29.8%). Out of these tribal population comprised of 195 (53.8%) rural 97 (26.7%) and urban population was 70 (19.33%).The mortality reported after treatment in complicated malaria was 74 (20.4%) and no mortality was reported in uncomplicated malaria.
Conclusion:
In this tribal region of Chhattisgarh, current study depicted that, in spite of patients receiving adequate treatment the mortality was high in complicated malaria and population living in tribal area as compared to uncomplicated malaria. Complicated malaria is a poor prognostic factor.

Keywords: complicated malaria, malaria, treatment outcome, falciparum malaria, vivax malaria


How to cite this article:
Dulhani N K, Khan Y. Outcome of malaria cases in a tertiary care hospital with predominantly tribal population. J Integr Health Sci 2017;5:31-5

How to cite this URL:
Dulhani N K, Khan Y. Outcome of malaria cases in a tertiary care hospital with predominantly tribal population. J Integr Health Sci [serial online] 2017 [cited 2019 Aug 19];5:31-5. Available from: http://www.jihs.in/text.asp?2017/5/2/31/240242




  Introduction Top


Malaria despite being treatable and preventable, is still a public health hazard in india.. WHO in its report in 2012 estimated that 207 million cases of malaria occurred worldwide (uncertain range 135-287 million) and 6,27,000 deaths (uncertain range 4,73,000- 7,89,000); about 13 % cases were diagnosed in place of established in South East Asia Region (SEAR) and about 80% in African countries.[1] India accounts for 61 percent of malaria cases and 41 per cent of malaria deaths in SEAR countries.[2] In India, about 539 million people exist in high transmission areas, i.e. defined as more than one case per 1000 population.[3]

Malaria is major health problem in many parts of India, specially in tribal/rural population of chhattisgarh and also in eastern, central (9 states) north eastern states (7 states), as per NVBDCP REPORT 2010-2014.[4]

The tribal population living in distinct geographical condition because of forest, valleys, perennial streams[5] condition are hard to reach because of the climatic condition favours intensification and proliferation of the parasite and vector and therefore human inhabitants have resulted in high malaria transmission[5] health services accessibility is poor with lack of qualified doctors, poor or no roads, no or very less awareness about the disease and orthodox belief.

Chattisgarh is a high malaria prevalence state accounting to 12% of malaria cases and highest ratio of deaths due to malaria in the country which is about 17%[6]. All four species of malaria parasites are found in CG [7] There are a very few studies on hospital based situation in state of Chhattisgarh, hence the study was taken.


  Methodology Top


This was an observational study conducted on confirmed cases of admitted patients, carried out from 1st January 2017 to 30th september 2017. Cases satisfying WHO criteria of severe malaria were included in the study. Patients with fever and smear negative as well as empirically treated fever mimicking malaria and leptospirosis were excluded from the study.

The record was prepared with data in the form of name, age, sex, symptoms clinical features, laboratory investigations and test done for confirmation, form of malaria, comorbid condition, treatment given, the record was later analysed.

The test for confirmation was microscopy/rapid diagnostic test RDT and malaria parasite quantitative buffy coat (MP QBC). Centre for disease control and prevention guidelines were adopted to classify malaria into complicated and uncomplicated. Urban, rural and tribal population was included in the study. The study had approval of college ethical committee.


  Result Top


Studied population comprised of 362 cases of confirmed malaria. 66.02% (n=239) were male and 33.97% (123) were female [Figure 1]. The mean age was 49.05(14.3) years. The maximum number of patients was between 30-49 years. Majority of the patients belonged to tribal population 60.7% (n=195) followed by rural 26.7% (n=97) and 19.33% (n=70) were from urban population [Figure 2]. Approximately half of the population was illiterate 48.89% (n=177), co morbidity was observed in the form of diabetes mellitus 8 (0.02%), hypertension 4 (.01%) and pulmonary tuberculosis was in 2 (n=.005) cases. Presenting complaints were fever with chills and rigor 306 (84.5%), vomiting 61 (17%) headache 60(17%) loose motion 54 (14.9%) jaundice 43 (11.8%),cough 22 (6.07%), pain in abdomen 11 (3.03%), altered sensorium 55 (15.1%), black urine 12 (3.3%) and spontaneous bleeding in 5(1%) patients [Figure 3].
Figure 1: Demographic profile of malaria patients.

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Figure 2: Distribution of population

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Figure 3: Symptomatology

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Plasmodium falciparum (Pf) was reported in 66.02% (240) cases followed by plasmodium vivax (Pv) in 27.6% (100) and mixed variety (Pf+Pv) in 6.2% (22). Out of these 79.1% were confirmed by microscopy, 15.3% cases by RDT and 5.6% cases by MP QBC. The percentage in which Malaria parasite was diagnosed by RDT and microscopy comprised of 2.4% cases. Of the study population 71.8% (260) suffered complicated malaria and 29.8% (108) were uncomplicated malaria cases [Table 2].
Table 2: Distribution of malaria cases according to complications

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Among the complicated malaria patients, hepatopathy was noted in 15.1% (n=55), cerebral malaria in 11.04% (n=40) cases, acute renal failure in 9.7% (n=35) cases, and sever anaemia in 43.09% (n=156), hepatic failure 5.52% (n=20), Acute Respiratory Distress Syndrome 4.14% (n=15) shock 4.9% (n=18) and respiratory failure in 4.97% (n=18) cases. Platelets was found ≤20000 in 8.5% (n=20), Leucocytosis was reported in 34.5% (n=125), leucopenia 9.3% (n=70) [Figure 4]. Fatality in complicated malaria was 20.4% (n=74) out of which in tribal population it was 60.81% (n=45), rural 36.49% (27), and urban 2.70% (2) [Table 1]. Patients having uncomplicated malaria no death was reported. Out of the patient who died of complicated malaria had cerebral malaria 27% (n=20), acute renal failure 33.7% (n=25),hepatic failure 27% (n=20) and ARDS in 20.27% (n=15), 24.32% (n=18) patients required ventrilatory support.10% (n=26) patients received blood transfusion, and platelet transfusion in 7.7% (n=20) patients. The treatment administered falciparum positive patients was in the form of parentral chloroquine, quinine and artisunate and artisunate plus clindamycine, and to vivax positive was in the form of parentral chloroquine and artisunate. Other symptomatic and supportive treatment was also administered.
Table 1: Mortality as per distribution of population

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  Discussion Top


Total subjects included in the study were 362 out of which 66.02% were male and 33.97% female. We observed in our study male preponderance. The patients between the age of 15 to 80 years. The incidence was high in the age group of 30 to 49 years. Gender dissimilarity as male preponderance was observed this is consistent with the study of Jain et al[8] and Pathak et al[9] who observed male preponderance in hospitalisation pattern of malaria[9]. Male predominance might be due to working pattern, men being exposed to mosquito bite outdoor, also treatment seeking behaviour, social culture barrier in rural and tribal area.

In our study plasmodium falciparum was noted in 41.98% which is consistent to study carried out by vidhan jain et al[8],in highly tribal region of bastar district, involved in agriculture and forest, who noted 50% of plasmodium falciparum and 9% of slide positivity.

Symptoms analysis shows fever as the major complaint followed by vomiting (17.12%) and headache in (17%),jaundice (11.8%) renal failure (9.7%) and this is similar to other studies conducted by mishra et al[10] in rourkela[10] .In our study, outcome in the form of fatality in complicated malaria residing in rural and tribal area wasv20.4%(n=74). Mortality rate was more or less similar compared to study conducted by mishra et al10,in odisha being 23% and also similar to study conducted by murty et al11 who recorded 20%of mortality.[11]


  Conclusion Top


The percentage of falciparum malaria was higher than vivax and mixed variety. The incidence was high in tribal and rural population. In spite of adequate treatment the mortality was high in complicated malaria residing in tribal area as compared to rural area this could be due to distinctive geographical situation usually due to forest, hills, valleys, less excess to health services, lack of awareness about the disease. Complicated malaria is poor prognostic factor. To prevent the mortality, early diagnosis and timely treatment of the complicated cases, awareness and education programme regarding prevention should be contemplated. To reduce the mortality, larger sample size study is needed for changing trends in treatment and to observe clinical outcome.



 
  References Top

1.
WHO. World malaria report 2013. Geneva: World Health Organization; 2013. Available from: www.who.int/iris/bitstream/10665/97008/1/9789241564694_eng.pdf, (accessed on July, 2015).  Back to cited text no. 1
    
2.
WHO. World malaria report 2011. Geneva: World Health Organization. Available from: http://www.who.int/malaria/world_malaria _report_2011/9789241564403_eng.pdf, (accessed on September 11, 2015)  Back to cited text no. 2
    
3.
WHO. World malaria report 2013. Geneva: World Health Organization; 2013. Available from:www.who.int/iris/bitstream/10665/97008/1/9789241564694_eng.pdf, (accessed on June, 2015.)  Back to cited text no. 3
    
4.
National Vector Borne Disease Control Programme, (2010- 3. 2014). Malaria situation in India. Available from: http://www.nvbdcp.gov.in/Doc/malaria-mishra et al[10],in odisha being 23% and also similar to study conducted by murty et al” who recorded 20%of mortality.  Back to cited text no. 4
    
5.
Sundararajan R, Kalkonde Y, Gokhale C, Greenough PG. Bang A. Barriers to malaria control among marginalized tribal communities: a qualitative study. PLoS One 2013; 8:e81966.  Back to cited text no. 5
    
6.
NVBDCP (2012) Malaria situation. Available at: http://nvbdcp.gov.in/Doc/mal_situation_July2014.pdf (access on 7 September, 2015).  Back to cited text no. 6
    
7.
Singh R, Jain V, Singh PP, Bharti PK, Thomas T. First report of detection and molecular confirmation of Plasmodium ovale from severe malaria cases in central India. Trop Med Int Health 2013;18:1416-20.  Back to cited text no. 7
    
8.
Jain V, Basak S, Bhandari S, Bharti PK, Thomas T, Singh MP, Singh N. Burden of Complicated Malaria in a Densely Forested Bastar Region of Chhattisgarh State (Central India). PLoS One. 2014;9(12): e115266.  Back to cited text no. 8
    
9.
Pathak S, Rege M, Gogtay NJ, Aigal U, Sharma SK, Valecha N, Bhanot G, Kshirsagar NA, Sharma S. Age-dependent sex bias in clinical malarial disease in hypoendemic regions. PLoS One. 2012;7(4):e35592.  Back to cited text no. 9
    
10.
Mishra SK, Mohanty S, Satpathy SK, Mohapatra DN. Cerebral malaria in adults: A description of 526 cases admitted to Ispat General Hospital in Rourkela, India. Ann Trop Med Parasitol 2007;101(3):187-93.  Back to cited text no. 10
    
11.
Murthy GL, Sahay RK, Srinivasan VR, Upadhaya AC, Shantaram V, Gayatri K. Clinical profile of Plasmodium falciparum malaria in a tertiary care hospital. J Indian Med Assoc 2000;9S(4):160-2.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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