Malaria in Mangaluru

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. The population of Mangalore City Corporation is recorded as 4,99,487 in the 2011 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. Since early 1990s, the district has been witnessing a great spurt in construction activities, owing to rapid industrialization, construction of highways, railways, urban housing and other constructions. And this has brought the dreaded disease, malaria, to this peaceful land. A disease that was rare in Mangaluru until 1990 killed more than 300 people in the district since 1995. And it also 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).

However, concerted and sustained efforts to control the disease appear to have given results. Malaria cases in Mangaluru have decreased from 4,741 in 2018 to 689 in 2022; till April only 18 cases have been reported in 2023. Malaria cases have been on a gradual decline since 2018, from 4,741 to 3,897 in 2019, 2,797 in 2020 and 1,397 in 2021. [Sustained blood smear tests keep malaria under double digit figure in Dakshina Kannada: See]

See Malaria in India, Karnataka and Dakshina Kannada

Malaria in India, Karnataka and Mangaluru 1990-2022

YearAll IndiaKarnataka StateMangalore
19902.02 million7401219
19912.12 million44565198
19922.13 million81057707
19932.21 million1964663907
19942.51 million2666823131
19952.93 million2858835245
19963.04 million2191989874
19972.66 million1814477862
19982.22 million1186856475
19992.28 million961563415
20002.03 million1079991798
20012.09 million1963063309
20021.84 million1326093739
20031.87 million1002189138
20041.92 million8131416321
20051.82 million8318120083
20061.79 million6286415664
20071.51 million4935510930
20081.53 million473445915
20091.56 million365595154
20101.49 million441226335
20111.31 million242375724
20121.06 million164665327
20130.881 million133024714
20141.10 million19148*11714*
20151.16 million16385*11021*
20161.09 million15816*11037*
20170.844 million11312*8075*

[Source: Mangaluru City Corporation, District Malaria Office, NVBDCP]
[*Numbers include cases diagnosed by QBC and malaria RDT, as well as peripheral smear; NVBDCP data cites only the cases diagnosed with peripheral smear, and omits QBC and mRDT.]

Malaria in Mangaluru 1990-2022

YearP. vivaxP. falciparumTotal Deaths
2012496436353270 (>14#)
2013435136347140 (>20 #)

[Source: Mangaluru City Corporation and District Malaria Office]
[*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
$Inclusive of all cases, diagnosed with peripheral smear, QBC and mRDT.]

Between 1940s and 1970s, when malaria was prevalent in the region, most of the cases occurred in the rural areas of Dakshina Kannada district. Since 1990, with the urbanisation boom, the infection has remained mostly localised to Mangaluru city, with almost 90-95% of the cases reported from the district belonging to the city limits, and even among the cases reported from the rural parts, majority are acquired from the city.

In the year 1990, a total of 74012 cases of malaria were reported from Karnataka state and Mangaluru accounted for 19 (0.03%) of these cases. In 2006, 66339 cases were reported from Karnataka, and Mangaluru accounted for 15664 cases (23.6%). 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 continues to remain high in Mangaluru, and in 2017, of the 11312 cases reported from Karnataka, 8075 (71.4%) were from 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, which has later been funded by the City Corporation itself. It has a co-ordinator, a computer operator and more than 30 field staff, including supervisors, ANMs, spray workers and Guppy distributors. The teams of Malaria Cell visit construction sites, hotels, orphanages, apartments and other high risk areas on a regular basis. 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]

See Published research regarding malaria in Mangaluru

See Guide to malaria treatment in Mangaluru

Drug Resistance Pattern in Mangaluru

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.

Travel to Mangaluru- Recommendations for Chemoprophylaxis

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.

CDC recommends the above, or, atovaquone or primaquine or tafenoquine See CDC

For further details and dosage in children, see Chemoprophylaxis

© ©BS Kakkilaya | Last Updated: May 25, 2023

Comments are closed.