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 has already killed more than 300 people in the district since 1995. 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).
Malaria in India, Karnataka and Mangaluru
|Year||All India||Karnataka State||Mangalore|
[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 1990-2018
|Year||P. vivax||P. falciparum||Total||Deaths|
|2013||4351||363||4714||0 (>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]
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: Feb 26, 2019