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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 Mangalore 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).
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Incidence of Malaria in India, Karnataka State and
Mangalore |
|
Year |
All India |
Karnataka |
Mangalore |
|
1990 |
2.02 million |
|
19 |
|
1991 |
2.12 million |
|
198 |
|
1992 |
2.13 million |
|
707 |
|
1993 |
2.21 million |
|
3907 |
| 1994 |
2.51 million |
266682 |
3131 |
| 1995 |
2.93
million |
285883 |
5245 |
| 1996 |
3.04
million |
219198 |
9874 |
| 1997 |
2.66
million |
181447 |
7862 |
| 1998 |
2.22
million |
118685 |
6475 |
|
1999 |
2.28
million |
96156 |
3415 |
|
2000 |
2.03
million |
107999 |
1798 |
|
2001 |
2.09
million |
196306 |
3309 |
|
2002 |
1.84
million |
132609 |
3739 |
|
2003 |
1.87
million |
100218 |
9138 |
|
2004 |
1.92
million |
81314 |
16321 |
|
2005 |
1.82
million |
83181 |
20083 |
|
2006 |
1.79
million |
62864 |
15664 |
|
2007 |
1.51
million |
49355 |
10930 |
|
2008 |
1.53
million |
47344 |
5915 |
|
2009 |
1.56
million |
36559 |
5154 |
|
2010 |
1.49 million |
44122 |
6335 |
|
In
the year 2006, a total of 62864 cases of malaria were reported from
Karnataka state and Mangalore 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 Mangalore. And among 29 malaria
related deaths from Karnataka, 11 were from Mangalore.
From the year 2007, there has been a marginal decline in the total
number of cases. However, there have been 8 deaths confirmed by the
health authorities. The actual number of deaths may be 5-6 times the
official figure as all 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 Mangalore. [See]
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Annual Incidence of Malaria In Mangalore (1990-2007)
| Year |
P. vivax |
P. falci |
Total |
Deaths |
1990 |
19 |
0 |
19 |
0 |
1991 |
195 |
3 |
198 |
0 |
1992 |
692 |
15 |
707 |
0 |
1993 |
3896 |
11 |
3907 |
0 |
1994 |
3124 |
7 |
3131 |
0 |
1995 |
4374 |
871 |
5245 |
26 |
1996 |
8324 |
1550 |
9874 |
5 |
1997 |
7001 |
861 |
7862 |
4 |
1998 |
5896 |
579 |
6475 |
1 |
1999 |
3146 |
269 |
3415 |
1 |
2000 |
1712 |
86 |
1798 |
0 |
2001 |
2965 |
344 |
3309 |
2 |
2002 |
2962 |
777 |
3739 |
5 |
2003 |
7189 |
1949 |
9138 |
2 |
2004 |
12110 |
4211 |
16321 |
3 |
|
2005 |
14016 |
6067 |
20083 |
4 |
|
2006 |
10761 |
4903 |
15664 |
11 |
|
2007 |
8626 |
2304 |
10930 |
8 |
|
2008 |
5255 |
660 |
5915 |
0 |
|
2009 |
4511 |
643 |
5154 |
1 |
|
2010 |
5384 |
951 |
6335 |
0 |
|
 |
Malaria in
Mangalore (1990-2007) |
|
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, Mangalore
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.
See Malaria
control in Mangalore - A voluntary initiative
See Malaria Control
Activities in Mangalore
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.
Monthwise
Incidence of Malaria In Mangalore (Jan 2003-Dec 2007)
|
Month |
P. vivax |
P. falci |
Total |
|
Jan03 |
451 |
108 |
559 |
|
Feb03 |
262 |
71 |
333 |
|
Mar03 |
344 |
80 |
424 |
|
Apr03 |
270 |
67 |
337 |
|
May03 |
318 |
49 |
367 |
|
Jun03 |
500 |
69 |
569 |
|
Jul03 |
793 |
162 |
955 |
|
Aug03 |
1046 |
292 |
1338 |
|
Sep03 |
856 |
242 |
1098 |
|
Oct03 |
724 |
317 |
1041 |
|
Nov03 |
835 |
259 |
1094 |
|
Dec03 |
790 |
233 |
1023 |
|
Jan04 |
581 |
172 |
753 |
|
Feb04 |
355 |
95 |
450 |
|
Mar04 |
486 |
141 |
627 |
|
Apr04 |
665 |
134 |
799 |
|
May04 |
796 |
157 |
953 |
|
Jun04 |
1460 |
449 |
1909 |
|
Jul04 |
1628 |
613 |
2241 |
|
Aug04 |
1171 |
564 |
1735 |
|
Sep04 |
1224 |
497 |
1721 |
|
Oct04 |
1227 |
442 |
1669 |
|
Nov04 |
1146 |
466 |
1612 |
|
Dec04 |
1371 |
481 |
1852 |
|
Jan05 |
817 |
287 |
1104 |
|
Feb05 |
855 |
253 |
1108 |
|
Mar05 |
714 |
221 |
935 |
|
Apr05 |
740 |
259 |
999 |
|
May05 |
1061 |
335 |
1396 |
|
Jun05 |
1529 |
442 |
1971 |
|
Jul05 |
2022 |
698 |
2720 |
|
Aug05 |
1456 |
726 |
2182 |
|
Sep05 |
1231 |
809 |
2040 |
|
Oct05 |
1272 |
765 |
2037 |
|
Nov05 |
1255 |
770 |
2025 |
|
Dec05 |
1064 |
502 |
1566 |
|
Jan06 |
923 |
404 |
1327 |
|
Feb06 |
647 |
220 |
867 |
|
Mar06 |
513 |
203 |
716 |
|
Apr06 |
526 |
245 |
771 |
|
May06 |
764 |
417 |
1181 |
|
Jun06 |
939 |
391 |
1330 |
|
Jul06 |
1085 |
566 |
1651 |
|
Aug06 |
1306 |
610 |
1916 |
|
Sep06 |
1155 |
573 |
1728 |
|
Oct06 |
891 |
304 |
1195 |
|
Nov06 |
1048 |
470 |
1518 |
|
Dec06 |
964 |
500 |
1464 |
|
Jan07 |
796 |
296 |
1092 |
|
Feb07 |
479 |
112 |
591 |
|
Mar07 |
367 |
95 |
462 |
|
Apr07 |
332 |
66 |
398 |
|
May07 |
490 |
99 |
589 |
|
Jun07 |
905 |
139 |
1044 |
|
Jul07 |
1229 |
281 |
1510 |
|
Aug07 |
1119 |
338 |
1457 |
|
Sep07 |
859 |
236 |
1095 |
|
Oct07 |
819 |
274 |
1093 |
|
Nov07 |
635 |
238 |
873 |
|
Dec07 |
590 |
130 |
720 |
|
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Monthwise
Malaria Cases in Mangalore |
| |
|
|
|
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.
|
|
| Water logging in
construction sites is a major source for Anopheles breeding |
 |
|
|
 |
|
|
|
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Active
Surveillance among high risk population in Mangalore
| Risk Group |
2004 |
2005 (Up to March) |
Total |
| Smears |
Vivax |
Falci |
Total |
Smears |
Vivax |
Falci |
Total |
Smears |
Total |
SPR |
| Moving
labourers |
4127 |
57 |
7 |
64 |
907 |
16 |
3 |
19 |
5032 |
83 |
1.64 |
| Construction
workers |
825 |
178 |
19 |
197 |
485 |
100 |
35 |
135 |
1310 |
332 |
25.34 |
| Orphanages,
hostel inmates |
720 |
50 |
10 |
60 |
54 |
6 |
3 |
9 |
774 |
69 |
8.91 |
| Hotel workers |
580 |
75 |
15 |
90 |
69 |
18 |
7 |
25 |
649 |
115 |
17.71 |
| Total |
6252 |
360 |
51 |
411 |
1515 |
140 |
48 |
188 |
7765 |
599 |
7.71 |
Monthwise Adult
Anopheles Mosquito Density (AMD, per man hour density), Anopheles
Larval Density (LD, per dip) and Malaria Cases
| Month |
AMD |
LD |
Cases |
| Jan03 |
2.3 |
3 |
559 |
| Feb03 |
2.2 |
2.6 |
333 |
| Mar03 |
2 |
2.6 |
424 |
| Apr03 |
2 |
2.5 |
337 |
| May03 |
3 |
4 |
367 |
| Jun03 |
4 |
6 |
569 |
| Jul03 |
4.2 |
6.4 |
955 |
| Aug03 |
4 |
6.7 |
1338 |
| Sep03 |
3.2 |
6 |
1098 |
| Oct03 |
3 |
5 |
1041 |
| Nov03 |
3 |
4 |
1094 |
| Dec03 |
2.8 |
3 |
1023 |
| Jan04 |
2.4 |
2.6 |
753 |
| Feb04 |
2.2 |
2.6 |
450 |
| Mar04 |
2.2 |
2.3 |
627 |
| Apr04 |
2 |
2.4 |
799 |
| May04 |
2.6 |
3.8 |
953 |
| Jun04 |
4 |
5.8 |
1909 |
| Jul04 |
4.1 |
6.2 |
2241 |
| Aug04 |
3.9 |
6.5 |
1735 |
| Sep04 |
3.1 |
5.8 |
1721 |
| Oct04 |
3 |
5 |
1669 |
| Nov04 |
2.6 |
4 |
1612 |
| Dec04 |
2.5 |
3.1 |
1852 |
|
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Monthwise
Adult Mosquito Density and Malaria Cases (2003-2004) |
|
 |
Monthwise
Adult Mosquito Density and Malaria Cases (2003-2004) |
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See Guidelines for management of malaria in Mangalore
Drug
resistance pattern in Mangalore
While large sized studies have not been
done on the drug sensitivity pattern for P. falciparum malaria in Mangalore, it
is our general experience that mild to moderate degree of resistance (RI to RII) to
chloroquine is fairly common in Mangalore. RIII resistance has also been observed in some
cases. 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 Mangalore..
Travel
to Mangalore- Recommendations for chemoprophylaxis
Mangalore has now become endemic for
malaria and as the figures above clearly indicate, nearly 40% 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
Mangalore 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 Mangalore 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)
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