Situation of P. vivax malaria in Ahmedabad city: A study in purview of national guidelines

Introduction: Malaria is still the most important cause of morbidity-mortality in India. National vector borne disease control program (NVBDCP) in urban areas is implemented through UHCs. In Gujarat, 89,764 malaria cases were reported in 2011 with 127 deaths, with 17.9% of them being the vivax cases. Ahmedabad is at the receiving end of malaria menace due to its rapid growth. Compared to 2011, significant rise in number of Plasmodium vivax (Pv) cases has been observed in Ahmedabad in 2012. Aims and Objectives: The study was carried out to assess the Pv malaria detection modalities, relevant indices, existing radical treatment strategies, and adherence to national guidelines in the urban areas of Ahmedabad. Materials and Methods: Data of all 9 UHCs of south zone, catering total population of approximately 1 million and showing significant rise in Pv cases, were verified clubbed with field analysis, for the corresponding quarters of March, April, and May of two consecutive years-2011-2012. Concerned healthcare staff was interviewed. Guidelines and definitions of national anti-malarial guidelines and operational manual were followed. Process indicators for surveillance, case finding, and disease burden were considered. Results: Out of total blood smears examined, Pv cases raised from 97 (2011) to 382 (2012). Statistically significant rise of Pv % was 0.35% and 2.79% in active and passive slide collection, respectively. 71% slides were actively collected in both years. Quarterly Blood Examination Rate (QBER) rose from 1.50% to 2.41%. Quarterly Parasite Index (QPI) rose from 0.12 to 0.39. Successful Radical Treatment of Pv Malaria (RT) completion decreased from 59.8% to 29.1%. Knowledge regarding national-anti-malarial-guidelines was satisfactory in more than 70% of healthcare functionaries. Interpretations: Number of cases significantly increased in two years, Pv -positivity rise being 1.04%. Active slide collection is static. Rise in Pv -positivity should trigger improvement in the same. Average QBER and QPI rose in two years. QBER never reached prescribed levels. Successful RT-completion is the key towards drug-resistance and relapse prevention. Adherence to national-anti-malarial-guideline is imperative.