Trends in Malaria in Odisha, India—An Analysis of the 2003–2013 Time-Series Data from the National Vector Borne Disease Control Program

Abstract

BackgroundAlthough Odisha is the largest contributor to the malaria burden in India, no systematic study has examined its malaria trends. Hence, the spatio-temporal trends in malaria in Odisha were assessed against the backdrop of the various anti-malaria strategies implemented in the state.MethodsUsing the district-wise malaria incidence and blood examination data (2003–2013) from the National Vector Borne Disease Control Program, blood examination-adjusted time-trends in malaria incidence were estimated and predicted for 2003–2013 and 2014–2016, respectively. An interrupted time series analysis using segmented regression was conducted to compare the disease trends between the pre (2003–2007) and post-intensification (2009–2013) periods. Key-informant interviews of state stakeholders were used to collect the information on the various anti-malaria strategies adopted in the state.ResultsThe state annual malaria incidence declined from 10.82/1000 to 5.28/1000 during 2003–2013 (adjusted annual decline: -0.54/1000, 95% CI: -0.78 to -0.30). However, the annual blood examination rate remained almost unchanged from 11.25% to 11.77%. The keyinformants revealed that intensification of anti-malaria activities in 2008 led to a more rapid decline in malaria incidence during 2009–2013 as compared to that in 2003–2007 [adjusted decline: -0.83 (-1.30 to -0.37) and -0.27 (-0.41 to -0.13), respectively]. There was a significant difference in the two temporal slopes, i.e., -0.054 (-0.10 to -0.002, p = 0.04) per 1000 population per month, between these two periods, indicating almost a 200% greater decline in the post-intensification period. Although, the seven southern high-burden districts registered the highest decline, they continued to remain in that zone, thereby, making the achievement of malaria elimination (incidence <1/1000) unlikely by 2017.ConclusionThe anti-malaria strategies in Odisha, especially their intensification since 2008, have helped improve its malaria situation in recent years. These successful measures need to be sustained and perhaps intensified further for eliminating malaria from Odisha.

Comparative assessment on the prevalence of mutations in the Plasmodium falciparum drug-resistant genes in two different ecotypes of Odisha state, India

“…India is endemic to malaria and accounts for about 52% of the total malaria morbidity in Southeast Asia (Pradhan et al, 2016). Interestingly, majority of the malaria morbidity (about 26.9%) and mortality (about 17.6%) is contributed by Odisha state alone, although it comprises about 3% of Indian population (including some aboriginal tribes) (Pradhan et al, 2016).…”

“…Interestingly, majority of the malaria morbidity (about 26.9%) and mortality (about 17.6%) is contributed by Odisha state alone, although it comprises about 3% of Indian population (including some aboriginal tribes) (Pradhan et al, 2016). Intense and stable malaria has been reported from tribal areas of Odisha and neighbouring states (http://www.malariasite.com/tag/orissa/)(Das et al, 2012; Kumar et al, 2012; Kumar et al, 2007; Nanda et al, 2000).…”

“…Deogarh surrounded by Keonjhar, Sundergarh, Anugul and Sambalpur) and the South-Western (comprising of seven districts, viz . Koraput, surrounded by Malkangiri, Nawarangpur, Kalahandi, Raygada, Nuapada, and Kandhamal (Mohanty et al, 2009; Pradhan et al, 2016; Rao et al, 2015; Sahu et al, 2013), although other districts too contribute to the total malaria cases. Interestingly, the districts in both the clusters are rich in hills and forests and home for aboriginal tribes (Pradhan et al, 2016; Ramar et al, 2014; Sahu et al, 2013).…”

“…Koraput, surrounded by Malkangiri, Nawarangpur, Kalahandi, Raygada, Nuapada, and Kandhamal (Mohanty et al, 2009; Pradhan et al, 2016; Rao et al, 2015; Sahu et al, 2013), although other districts too contribute to the total malaria cases. Interestingly, the districts in both the clusters are rich in hills and forests and home for aboriginal tribes (Pradhan et al, 2016; Ramar et al, 2014; Sahu et al, 2013). The Deogarh district is one of the epicentres of high malaria endemicity (Pradhan et al, 2016); comprising of two distinct ecotypes [Hilly-Forested (HF) and Riverine-Plain (RP)], and therefore can serve as a model to understand the influence of micro eco-typical habitats on malaria epidemiological outcome (in this case mutational pattern in different genes conferring drug resistance in the malaria parasite, P. falciparum ).…”

Active v. passive surveillance for malaria in remote tribal belt of Central India: Implications for malaria elimination

“…7,12 With a year-round presence in some parts of the country, it exacts an unacceptable toll on the health of the people of all ages. 13 Moreover, population movement in and out of the forest was common and there was no mechanism in place to check these movements. 14 Extending effective and appropriate care in such sparsely community, live among them, and are always available, which is another reason for their preference of the community.…”