Mangaluru (formerly Mangalore) is a picturesque city in Southern India, on the shore of the Arabian Sea. It is the headquarters of Dakshina Kannada district with a population of 4,55,217 (2001 Census). Known for hundreds of rivers and rivulets and plenty of coconut and areca nut gardens and paddy fields, the district is home for many world-known educational and financial institutions. The people of the district are generally considered as intelligent, educated and peace loving. The district has been witnessing a great spurt in construction activities in the recent years, owing to rapid industrialization. And this has brought the dreaded disease, malaria, to this peaceful land. A disease that was unknown in Mangaluru until 1990 has already killed more than 300 people in the district in the past 15 years. And it has now spread, not only to all the villages of this district, but also to the neighbouring districts of Udupi and Kasaragod (in the state of Kerala).
Incidence of Malaria in India, Karnataka State and Mangalore
Annual Incidence of Malaria in Mangalore (1990-2014)
|Year||P. vivax||P. falciparum||Total||Deaths|
|2013||4351||363||4714||0 (>20 #)|
[Table legend: *New CHO appointed, New NVBDCP Officer appointed; Data tweaked by stopping collection from private hospitals; #Official figures show no deaths, but >14 deaths in 2012 and >20 deaths in 2013 have been reported to NVBDCP, Mangalore.]
In the year 2006, a total of 62864 cases of malaria were reported from Karnataka state and Mangaluru accounted for 15664 (24%) of these cases. Of the 16446 cases of P. falciparum malaria reported from Karnataka in the same year, 4903 (29%) cases were from Mangaluru. And among 29 malaria related deaths from Karnataka, 11 were from Mangaluru. Whereas the incidence of malaria is showing a downward trend in Karnataka, it is continuing in Mangaluru, and in 2013, of the 13302 cases reported from Karnataka, 4714 (35%) were from Mangaluru and in 2014, of the 12335 cases from Karnataka, 7360 (59%) were from Mangaluru. Although only 2 deaths have been officially reported, the actual number of deaths may be 8-10 times more as all the cases are not reported and even among the reported deaths, all cannot be confirmed for want of evidence in the form of a preserved blood smear of the victim. Alarmed by this trend, the Karnataka State Government has intensified the malaria control drive in Mangaluru.
There was a sudden rise in the cases of P. falciparum in the year 1995-96 that resulted in more than 100 deaths due to malaria (26 in 1995 as per official figures). The high mortality was probably related to delayed diagnosis and treatment due to lack of awareness among the general public as well as doctors. Alarmed by these events, a voluntary initiative for malaria control was started by private medical practitioners in association with the local medical college, Mangaluru City Corporation (MCC) and District Administration; Malaria Control Action Committee (MCAC) was thus constituted. Due to the concerted efforts and also decline in the construction activities, the annual incidence declined by the year 2000, with only 1798 cases reported. However, by 2001 the incidence again showed an upward trend. Despite strengthening the anti-malaria drive under MCAC, the cases have continued to rise, largely due to resurgence in construction activities.
In June 2003, a Malaria Cell was started with financial aid from the city based Corporation Bank. It has a co-ordinator, a computer operator and more than 30 field staff, including supervisors, ANMs, spray workers and Guppy distributors divided into six teams. Logistical support is provided by the MCC and DHO. These teams are carrying out active surveillance with special emphasis on migrant workers, construction workers, hotel workers and inmates of orphanages. The teams also carry out door-to-door surveys, IEC activities, source reduction, anti larval and anti adult spray operations, fogging, distribution of Guppy fish besides administering treatment to positive cases. [See Malaria Control in Mangaluru]
Monthwise Incidence of Malaria in Mangalore (Jan 2003-Dec 2007)
|Month||P. vivax||P. falciparum||Total|
The teams of Malaria Cell visit construction sites, hotels, orphanages, apartments and other high risk areas on a regular basis. Active surveillance and treatment of migrant workers staying in open areas is regularly conducted during early hours of the morning and evenings.
Active Surveillance among high risk population in Mangalore
|Risk Group||2004||2005 (Up to March)||Total|
|Orphanages, hostel inmates||720||50||10||60||54||6||3||9||774||69||8.91|
Monthwise Adult Anopheles Mosquito Density, Larval Density and Malaria Cases
|Month||Adult Mosquito Density||Larval Density||Total Cases|
Mangaluru is identified to have chloroquine resistance in P. falciparum. Accordingly, Mangaluru was one of the first cities in India to have switched over to artemisinin based combination for the treatment of P. falciparum malaria. Resistance to other antimalarial drugs is not known. NVBDCP now recommends Artesunate Plus Pyrimethamine-sulfadoxine for the treatment of all cases of P. falciparum in Mangaluru. P. vivax remains sensitive to chloroquine and therefore must be treated with chloroquine alone.
Mangaluru has now become endemic for malaria and as the figures above clearly indicate, nearly 10% of cases of malaria are caused by P. falciparum infection. And, resistance to chloroquine, of various degrees, has been noticed in Mangalore. Therefore, all travelers planning to visit Mangaluru are recommended the following chemoprophylaxis regimen:
Tablet Doxycycline 100 mg once daily (1.5mg/kg body weight for children above 8 years), (start 2 days before, continue during the stay at Mangaluru and for 4 weeks thereafter); alternatively, Tablet Mefloquine can be used at a dose of 250mg (5mg/kg body weight) weekly, starting 2 weeks before travel, continued during and for 4 weeks after travel.
For further details and dosage in children, see Chemoprophylaxis
©malariasite.com ©BS Kakkilaya | Last Updated: Apr 28, 2015