Malaria situation in India with special reference to tribal areas.

Background & objectives: In India, malaria is a major public health problem in states having predominantly tribal population. The objective of this analysis was to find out the incidence of malaria in various states/districts having varied proportions of tribal population using National Vector Borne Disease Control Programme (NVBDCP) data. Methods: States and districts were classified into three categories based on proportions of Scheduled Tribes (ST) population as <10, 10-29.9 and 30 per cent + ST population. Five year average (2008-2012) of all important malaria indicators collected by NVBDCP was taken to normalize the effect of annual fluctuations in malaria incidence. Results: State level analysis revealed that ten states/UTs with 30 per cent or more tribal population comprising only three per cent of total population, contributed 14 per cent of total malaria, 21 per cent Plasmodium falciparum and 29 per cent of deaths due to malaria. Similarly, district level analysis showed that districts with 30 per cent or more tribal population comprising about eight per cent country’s population contributed to 46 per cent of total malaria cases, 70 per cent P. falciparum and 47 per cent malarial deaths in the country. Interpretation & conclusions: our analysis showed that the neglect of the ethnic communities in tribal areas would be detrimental to the overall reduction of morbidity and mortality due to malaria. The fight against the increasing burden of malaria in tribal belt requires adoption of multiple approaches and socio-economic development of the tribal communities.

Laboratory diagnosis of malaria.

Malaria particularly falciparum malaria is a major public health problem in India. Its correct and early diagnosis is very important for prompt treatment as a preventive and control measure. Microscopy is the traditional method for laboratory diagnosis of malaria, which is used widely. However, it is time consuming, needs expertism and the detection limit is 10-20 parasites/ml blood in thick film and 100 parasites/ml blood in thin film. Quantitative buffy coat technique (QBC) is highly sensitive method but expensive equipment is needed for this test. The serological methods involving antibody detection give information regarding exposure to malaria but do not differentiate between present and past infections. Genetic probes and PCR are highly sensitive methods but require expensive equipments. Parasite antigen detection tests are useful in field and PHC level for rapid diagnosis of P falciparum malaria.LDH based test for diagnosing malaria is sensitive but can not differentiate between species. For monitoring of drug resistance or follow-up of patients, methods which can quantify parasitaemia are needed. Simply microscopy is the best solution at present.

Impact assessment of school-based sex education program amongst adolescents.

This was a cross-sectional, interview-based study to assess the impact of sex education on the students and the feasibility of such a program. Study sample consisted of 189 students from two secondary schools of Surat city. Impact was assessed by "before and after" administration of questionnaires. Statistical analysis was done by Z tests for difference of means and proportions. Sex education influenced the need perception and the knowledge of the students. After the training, the preferred mean age to start sex education in the two sexes converged to be 15-16 years. Doctors remained the first choice to impart the sex education, followed by school teachers. Knowledge about the STDs and the method(s) of prevention improved significantly (more in boys). Optimum days for conception became known to more students after the training and the gain was more in girls. Increased awareness about the contraceptives (condoms) use was evident in boys and (oral pills and condoms) in girls. The training improved the participation of girls in the post-evaluation program. A positive attitudinal change was observed after the training, towards extra-marital sex. It also removed the myths associated with masturbation. All students were satisfied with the programme, however, two-third of boys considered the duration insufficient.