Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India.

Malaria is a major public health problem in African countries and South East Asia Region (SEAR) countries1. Malaria epidemiology and its control are complicated by poverty as it is a dominant disease in poverty stricken societies2. In India, two-third of all malaria cases are reported from six states - Odisha, Jharkhand, Chhattisgarh, Madhya Pradesh (MP), West Bengal and the states in North East3. Predominantly, these are the states having large populations of ethnic tribes where malaria is an enormous health and development problem and all five species of malaria are found4,5. Malaria in MP is caused by Plasmodium vivax and P.falciparum and these parasites are highly seasonal in their distribution, P.vivax during summer and monsoon and P. falciparum during post-monsoon and autumn. P. malariae is also found occasionally6. Peoples from all age groups are affected by both the parasites7. Malaria in most parts of MP is mainly transmitted by two efficient vectors, viz. Anopheles culicifacies and An.fluviatilis7,8. Malaria control is mainly based on two tools, i.e. vector control by indoor residual spray, two rounds of DDT /synthetic pyrethroids annually along with insecticide treated bed nets (ITNs) or long lasting insecticide treated nets (LLINs) and chemotherapy using chloroquine (CQ) /artemisinin based combination therapy (ACT) for treatment of malaria cases9. One of the difficulties associated with achieving a reduction in the malaria incidence is that a combination of many diverse factors contributes to the maintenance of its transmission compounded by socio-demographic and socio-economic factors relating to malaria. Housing condition and environmental factors significantly contribute to the variations in malaria incidence. In Sri Lanka10 a strong association was found between malaria incidence and the type of housing construction. Similarly, in Ethiopia household factors such as earth, roof, sharing the house with livestock, presence of windows and open eaves were significantly associated with malaria incidence11. Many studies have been conducted to investigate risk factors of malaria10,11,12,13,14, however, very few have examined household and socio-economic factors affecting malaria incidence particularly in India15. Therefore, the present study was undertaken in certain tribal areas of Jabalpur, MP, India, to assess the socio-demographic, socio-economic and household behavioural factors that play a role in malaria incidence in rural and tribal settings.