Risk factors for malaria deaths in Jalpaiguri district, West Bengal, India: evidence for further action

BACKGROUND: In 2006, a cluster of malaria deaths in the highly endemic Jalpaiguri district, West Bengal, India, led to assignment of additional resources. Malaria deaths decreased, but continued to occur. A study was conducted to identify the risk factors for residual malaria deaths. METHODS: Malaria death was defined as a death from fever with microscopically confirmed Plasmodium falciparum among residents of Jalpaiguri during 2007–2008. For each case, three age-, sex- and locality-matched controls were recruited among microscopically confirmed falciparum malaria patients cured during the same period. Clinical and treatment information was abstracted from records. Information about knowledge about malaria, presence of bed nets and DDT spraying was collected through interviews of the close relatives of study subjects. Odds ratio (OR) were calculated using multivariate methods. RESULTS: 51 malaria deaths were matched with 153 controls, which did not differ by age (median: 35 versus 36 years) and proportion of males (63% versus 63%). On multiple logistic regression analysis, compared with survivors, malaria deaths were more likely to have been admitted with already existing complications [OR = 4.1, 95% confidence interval (CI) = 1.6–10)], treated at a private facility (OR = 3.7, 95% CI = 1.2–12), received treatment after 48 hours of fever onset (OR = 14, 95% CI = 2.9–64), received chloroquine (OR = 13.3, 95% CI = 3.7–47). Households of the deceased were also more likely to miss bed nets (OR = 6.3, 95% CI = 1.9–24) and DDT spraying (OR = 9.2, 95% CI = 2.8–31). CONCLUSION: Elimination of malaria deaths will require education of providers for prompt referral before complications, engagement of the private sector, community awareness for early treatment as well as scaled-up use of bed nets use and DDT. Use of newer generation anti-malarials must to be generalized

Incidence, management, and reporting of severe and fatal Plasmodium falciparum malaria in secondary and tertiary health facilities of Alipurduar, India in 2009

Background & objectives: The proportion of malaria cases that are complicated and fatal are not well describedin India. Alipurduar sub-division of Jalpaiguri district in West Bengal is highly endemic for malaria. We constructeda retrospective cohort of severe malaria patients admitted in the secondary and tertiary care facilities in Alipurduarto determine the incidence, assess the management, and evaluate the reporting of severe and fatal malaria.Methods: We reviewed routine surveillance data and the case records of all the malaria patients admitted in allsecondary and tertiary care facilities, both public and private. We defined severe malaria cases as Plasmodiumfalciparum infection with clinical signs and symptoms of organ involvement in a resident of Alipurduar admittedduring January to December 2009. We compared clinical and demographic characteristics of severe malariacases that died with those who survived. We also reviewed human resources and laboratory facilities availablefor the treatment of severe malaria in these health facilities.Results: During 2009, 6191 cases of P. falciparum in Alipurduar were reported to the malaria surveillancesystem. We identified 336 (5.4%) cases of severe malaria among which 33 (9.8%) patients died. Four malariadeaths were also recorded from primary health centres. Only 17 of the 37 (46%) total deaths recorded werereported to the routine surveillance system. Most severe cases were males (65%), aged >15 years (72%), andnearly half were admitted to secondary care hospitals (48%). In multivariate analysis, the risk factors associatedwith death included increased delay fever onset and hospitalization, treatment in a secondary level hospital,younger age, and multi-organ involvement. The secondary level public hospital had too few physicians andnurses for supporting severe malaria patients as well as inadequate laboratory facilities for monitoring suchpatients.Conclusions: Severe and fatal malaria continue to burden Alipurduar and record keeping in health facilities waspoor. Many malaria deaths were not routinely reported even in the public sector. Improved surveillance andincreased human and laboratory resources are needed to reduce malaria mortalit

Reducing Malaria Transmission: The Epidemiology and Treatment of Plasmodium falciparum Gametocytemia

Gametocytes are the sexual stage of the Plasmodia life cycle which render malaria cases infectious to mosquitoes. The proportion of P. falciparum malaria cases with gametocytemia and the duration of gametocytemia are varied. Interventions for detecting and treating gametocytemia also differ from those used against asexual parasitemia. In areas of low transmission, such as most of India, the size of the infectious reservoir drives transmission. The purpose of this dissertation was to 1) determine the epidemiology and risk factors for gametocytemia in order to better target interventions, and 2) estimate the effect of primaquine in addition to artesunate+sulphadoxine-pyrimethamine (AS+SP) to guide policy for reducing post-treatment malaria transmission. Using data from therapeutic efficacy studies conducted through the National Antimalarial Drug Resistance Monitoring System from 2009 to 2010, we measured the prevalence of gametocytemia in relation to various clinical and demographic factors. We found that all age groups, including adults, contribute substantially to the reservoir for potential transmission. We identified four risk factors - younger age group, previous antimalarial drug intake, sex, and region - from which we created a clinical algorithm for predicting gametocytemia. The predictive power of the model was low, suggesting the need for a universal approach for anti-gametocyte interventions. We compared trial sites which used primaquine to sites which did not to estimate the additional effect of primaquine. AS+SP with primaquine increased the rate of gametocyte clearance, prevented the development of new gametocytemia, and reduced the area under the gametocyte density over time curve over the study follow-up compared to AS+SP alone. Primaquine was well tolerated and no serious adverse events were reported. Adding primaquine to AS+SP for the treatment of P. falciparum infection in India would decrease the potential for post-treatment malaria transmission.Doctor of Philosoph

The impact of globalisation on curating contemporary art in India, 1990-2012

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Gurus and Media: Sound, image, machine, text and the digital

Gurus and Media is the first book dedicated to media and mediation in domains of public guruship and devotion. Illuminating the mediatisation of guruship and the guru-isation of media, it bridges the gap between scholarship on gurus and the disciplines of media and visual culture studies. It investigates guru iconographies in and across various time periods and also the distinctive ways in which diverse gurus engage with and inhabit different forms of media: statuary, games, print publications, photographs, portraiture, films, machines, social media, bodies, words, graffiti, dolls, sound, verse, tombs and more. The book’s interdisciplinary chapters advance, both conceptually and ethnographically, our understanding of the function of media in the dramatic production of guruship, and reflect on the corporate branding of gurus and on mediated guruship as a series of aesthetic traps for the captivation of devotees and others. They show how different media can further enliven the complex plurality of guruship, for instance in instantiating notions of ‘absent-present’ guruship and demonstrating the mutual mediation of gurus, caste and Hindutva. Throughout, the book foregrounds contested visions of the guru in the development of devotional publics and pluriform guruship across time and space. Thinking through the guru’s many media entanglements in a single place, the book contributes new insights to the study of South Asian religions and to the study of mediation more broadly

LIPIcs, Volume 251, ITCS 2023, Complete Volume

LIPIcs, Volume 251, ITCS 2023, Complete Volum

Massachusetts Domestic and Foreign Corporations Subject to an Excise: For the Use of Assessors (2004)

International audienc