Burden of Complicated Malaria in a Densely Forested Bastar Region of Chhattisgarh State (Central India)

Background: A prospective study on severe and complicated malaria was undertaken in the tribal dominated area of Bastar division, Chhattisgarh (CG), Central India, with an objective to understand the clinical epidemiology of complicated malaria in patients attending at a referral hospital. Methods: Blood smears, collected from the general medicine and pediatric wards of a government tertiary health care facility located in Jagdalpur, CG, were microscopically examined for malaria parasite from July 2010 to December 2013. The Plasmodium falciparum positive malaria cases who met enrollment criteria and provided written informed consent were enrolled under different malaria categories following WHO guidelines. PCR was performed to reconfirm the presence of P. falciparum mono infection among enrolled cases. Univariate and multivariate logistic regression analysis was done to identify different risk factors using STATA 11.0. Results: A total of 40,924 cases were screened for malaria. The prevalence of malaria and P. falciparum associated complicated malaria (severe and cerebral both) in the hospital was 6% and 0.81%, respectively. P. falciparum malaria prevalence, severity and associated mortality in this region peaked at the age of>4-5 years and declined with increasing age. P. falciparum malaria was significantly more prevalent in children than adults (P<0.00001). Among adults, males had significantly more P. falciparum malaria than females (P<0.00001). Case fatality rate due to cerebral malaria and severe malaria was, respectively, 32% and 9% among PCR confirmed mono P. falciparum cases. Coma was the only independent predictor of mortality in multivariate regression analysis. Mortality was significantly associated with multi-organ complication score (P=0.0003). Conclusion: This study has revealed that the pattern of morbidity and mortality in this part of India is very different from earlier reported studies from India. We find that the peak morbidity and mortality in younger children regardless of seasonality. This suggests that this age group needs special care for control and clinical management.