Jane M Carlton1,2, Sandra Albert3,4, Anne Kessler5, Badondor Shylla6,7, Upasana Shyamsunder Singh8, Rilynti Lyngdoh9, Bandapkupar Mawkhlieng6, Anna Maria van Eijk5, Steven A Sullivan5, Aparup Das10, Catherine Walton8, Mark L Wilson11. 1. Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA. jane.carlton@nyu.edu. 2. Department of Epidemiology, College of Global Public Health, New York University, New York, NY, 10012, USA. jane.carlton@nyu.edu. 3. Indian Institute of Public Health-Shillong, Shillong, Meghalaya, 793001, India. sandra.albert@phfi.org. 4. Martin Luther Christian University, Shillong, Meghalaya, 793006, India. sandra.albert@phfi.org. 5. Center for Genomics and Systems Biology, Department of Biology, New York University, New York, NY, 10003, USA. 6. Indian Institute of Public Health-Shillong, Shillong, Meghalaya, 793001, India. 7. Martin Luther Christian University, Shillong, Meghalaya, 793006, India. 8. Department of Earth and Environmental Sciences, School of Natural Sciences, University of Manchester, Manchester, M13 9PT, UK. 9. Department of Health Services (Malaria), National Vector Borne Disease Programme, Lawmali, Pasteur Hill, Shillong, Meghalaya, 793001, India. 10. ICMR-National Institute of Research in Tribal Health, Jabalpur, Madhya Pradesh, 482003, India. 11. Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA.
Abstract
BACKGROUND: Despite declining incidence over the past decade, malaria remains an important health burden in India. This study aimed to assess the village-level temporal patterns of Plasmodium infection in two districts of the north-eastern state of Meghalaya and evaluate risk factors that might explain these patterns. METHODS: Primary Health Centre passive malaria case data from 2014 to 2018 were analysed to characterize village-specific annual incidence and temporal trends. Active malaria case detection was undertaken in 2018 and 2019 to detect Plasmodium infections using PCR. A questionnaire collected socio-demographic, environmental, and behavioural data, and households were spatially mapped via GPS. Adult mosquitoes were sampled at a subset of subjects' houses, and Anopheles were identified by PCR and sequencing. Risk factors for Plasmodium infection were evaluated using bivariate and multivariate logistic regression analysis, and spatial cluster analysis was undertaken. RESULTS: The annual malaria incidence from PHC-based passive surveillance datasets in 2014-2018 was heterogenous but declining across villages in both districts. Active surveillance in 2018 enrolled 1468 individuals from 468 households (West Jaintia Hills) and 1274 individuals from 359 households (West Khasi Hills). Plasmodium falciparum prevalence per 100 people varied from 0 to 4.1% in the nine villages of West Jaintia Hills, and from 0 to 10.6% in the 12 villages of West Khasi Hills. Significant clustering of P. falciparum infections [observed = 11, expected = 2.15, Relative Risk (RR) = 12.65; p < 0.001] was observed in West Khasi Hills. A total of 13 Anopheles species were found at 53 houses in five villages, with Anopheles jeyporiensis being the most abundant. Risk of infection increased with presence of mosquitoes and electricity in the households [Odds Ratio (OR) = 1.19 and 1.11], respectively. Households with reported animals had reduced infection risk (OR = 0.91). CONCLUSION: Malaria incidence during 2014-2018 declined in all study villages covered by the passive surveillance data, a period that includes the first widespread insecticide-treated net campaign. The survey data from 2018 revealed a significant association between Plasmodium infection and certain household characteristics. Since species of Plasmodium-competent mosquito vectors continue to be abundant, malaria resurgence remains a threat, and control efforts should continue.
BACKGROUND: Despite declining incidence over the past decade, malaria remains an important health burden in India. This study aimed to assess the village-level temporal patterns of Plasmodium infection in two districts of the north-eastern state of Meghalaya and evaluate risk factors that might explain these patterns. METHODS: Primary Health Centre passive malaria case data from 2014 to 2018 were analysed to characterize village-specific annual incidence and temporal trends. Active malaria case detection was undertaken in 2018 and 2019 to detect Plasmodium infections using PCR. A questionnaire collected socio-demographic, environmental, and behavioural data, and households were spatially mapped via GPS. Adult mosquitoes were sampled at a subset of subjects' houses, and Anopheles were identified by PCR and sequencing. Risk factors for Plasmodium infection were evaluated using bivariate and multivariate logistic regression analysis, and spatial cluster analysis was undertaken. RESULTS: The annual malaria incidence from PHC-based passive surveillance datasets in 2014-2018 was heterogenous but declining across villages in both districts. Active surveillance in 2018 enrolled 1468 individuals from 468 households (West Jaintia Hills) and 1274 individuals from 359 households (West Khasi Hills). Plasmodium falciparum prevalence per 100 people varied from 0 to 4.1% in the nine villages of West Jaintia Hills, and from 0 to 10.6% in the 12 villages of West Khasi Hills. Significant clustering of P. falciparum infections [observed = 11, expected = 2.15, Relative Risk (RR) = 12.65; p < 0.001] was observed in West Khasi Hills. A total of 13 Anopheles species were found at 53 houses in five villages, with Anopheles jeyporiensis being the most abundant. Risk of infection increased with presence of mosquitoes and electricity in the households [Odds Ratio (OR) = 1.19 and 1.11], respectively. Households with reported animals had reduced infection risk (OR = 0.91). CONCLUSION: Malaria incidence during 2014-2018 declined in all study villages covered by the passive surveillance data, a period that includes the first widespread insecticide-treated net campaign. The survey data from 2018 revealed a significant association between Plasmodium infection and certain household characteristics. Since species of Plasmodium-competent mosquito vectors continue to be abundant, malaria resurgence remains a threat, and control efforts should continue.
Authors: Lucy C Okell; Teun Bousema; Jamie T Griffin; André Lin Ouédraogo; Azra C Ghani; Chris J Drakeley Journal: Nat Commun Date: 2012 Impact factor: 14.919
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