title: Burden of complicated malaria in a densely forested Bastar region of Chhattisgarh State (Central India).
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.
authors.forename: Vidhan
authors.initials: V
authors.lastname: Jain
authors.affiliation: District Malaria Office, Maharani Hospital and associated Medical College Jagdalpur, Chhattisgarh, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Basak
authors.affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.
authors.forename: Sneha
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.
authors.forename: Praveen K
authors.initials: PK
authors.lastname: Bharti
authors.affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.
authors.forename: Trilok
authors.initials: T
authors.lastname: Thomas
authors.affiliation: National Institute of Malaria Research, Field Unit, Jabalpur, Madhya Pradesh, India.
authors.forename: Mrigendra P
authors.initials: MP
authors.lastname: Singh
authors.affiliation: Regional Medical Research Centre for Tribals (RMRCT), ICMR, Garha, Jabalpur, Madhya Pradesh, India.
authors.forename: Neeru
authors.initials: N
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016054:DNA, Protozoan / Q000032:analysis; D003710:Demography; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000235:genetics; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan