Prevalence, risk factors and treatment-seeking behaviour for malaria: the results of a case study from the Terai region of West Bengal, India

Abstract

India is among the countries that are worse affected by human malaria, one of the major vector-borne diseases that continue to affect vast populations across the world. In a recent household survey in the Terai region of eastern India, the factors that might explain the occurrence and clustering of human malaria and the consequent healthcare-seeking behaviour of the human population were explored. The topography and geo-climatic conditions in Terai appear to intensify the risks of malaria but some socio-economic attributes, such as engagement in agricultural occupations, poor economic status and congested household environments, were also identified as significant risk factors for the disease. In the study area, public health facilities predominate as sources of medical care for malaria, although, at least in the early stages of treatment seeking, informal providers and pharmacies are also often involved. Unfortunately, despite the high frequency of malarial outbreaks, the local public health facilities were found to be ill-equipped to tackle and contain the spread of malaria. Preventive public-health measures, health education on malaria and malaria-awareness exercises were found to be scarce and irregular. The reliance on a reactive strategy of offering curative care to the affected led to overcrowding in healthcare facilities and shortages of medicines and diagnostic procedures. Along with a more efficient and reliable emergency system to deal with major outbreaks of malaria, more effective convergent interventions, by the local government and other stakeholders, should be developed to help prevent the disease.

Figure 1

Map showing the locations of the district of Darjeeling, within the Indian state of West Bengal (WB), and the study area (circled in red).

Figure 2

The monthly distribution of reported malaria cases in Nandalal and Sebdella (based on data for the 12 months prior to the interviews).

Figure 3

The reasons given for seeking informal treatment for malaria. ‘Other’ reasons include lack of confidence in the treatment available in public facilities, and inability to gain the approval and permission of the head of household (because he was absent).

Figure 4

The reasons given for seeking formal treatment for malaria from public facilities. ‘Other’ reasons include being taken to the rural hospital by a gram panchayat member, and the perception that public facilities offered a faster cure than the other treatment options.

Figure 5

The respondents’ opinions of the malaria-treatment facilities at Naxalbari Rural Hospital.