Epidemiology of malaria during pregnancy in Mangaluru city in the southwestern coastal region of India

Dakshina Kannada district in the Southwestern region of Karnataka State in India is endemic to malaria for the last three decades. About 80% of malaria infections in Mangaluru and its surrounding areas are caused by Plasmodium vivax (Pv) and the remainder are due to Plasmodium falciparum (Pf). Malarial infections during pregnancy led to pregnancy-associated malaria (PAM), which are also being reported commonly in this region. The PAM could lead to serious clinical complications to both the mother and fetus resulting in morbidity and mortality. Despite high endemicity, todate, very little has been reported on the epidemiology and burden of PAM in this area. Keeping in view of this, we conducted a systematic longitudinal study during 2015 across four malaria active hotspot areas in Mangalore city and recruited both long-time residents and immigrant laborers (temporary residents) to find out the actual burden of PAM. Data on socio-demographic, literacy, knowledge of malaria and treatment-seeking behavior were collected to understand the various contributing factors to PAM in this region. Analyses of the results show that the majority of PAM malaria illnesses were seen in local individuals associated with mild clinical complications. Of the 6 detected PAM cases, 4 were due to P.vivax and one each due to P.falciparum and mixed (P.vivax and P.falciparum) infections as diagnosed by microscopic examinations. These cases were referred to local government hospitals for further monitoring and treatment. These data suggest that P.vivax causes a significant number of PAM infections in this region. Introducing stringent preventive public measures by governments and creating awareness of using preventive protective and environmental hygienic measures through educational programs may substantially reduce the risk of contracting malaria infection.