Malaria parasite burden and treatment seeking behavior in ethnic communities of Assam, Northeastern India

Objectives: The objectives of the study were to define the infectious reservoir of malaria with particular reference to transmission dynamics of Plasmodium falciparum, and to ascertain the disease trends in view of the existing containment practices and treatment seeking behavior in malaria endemic communities of Assam, India. Methods: Cross-sectional surveys were conducted in population groups of malaria endemic districts of the state to determine parasite prevalence, and data were analysed retrospectively for the years 1991-2003 to ascertain the disease trends. Structured questionnaire based surveys were conducted to study the treatment seeking behavior and practices of healthcare providers. Results: P. falciparum and P. vivax were the only two parasite species encountered, the former being in the majority (> 60%). Malaria transmission was persistent, and a seasonal peak of P. falciparum was consistently observed during the months of heavy rainfall (April to September). Among children (5-15 years) there was a significantly higher malaria parasite rate as compared to the < 5 years age group and adults (> 15 years). There was a decline in parasite rates for all age groups over the years of the study that could not be attributed to vector control intervention intensities and/or meteorological factors. Conclusions: The persistence of P. falciparum is attributed to the emergence of drug resistant varieties, inadequate interventions and treatment seeking patterns, and for its containment focused intervention measures are advocated in partnership with the communities. (c) 2005 The British Infection Society. Published by Elsevier Ltd. All rights reserved.