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Treatment outcome of inpatient malaria cases: a study in a tertiary care hospital of Odisha, India.

Odisha, India. It contributes to 20% of total malaria cases and 17% of total deaths of India1. The proportion of Plasmodium vivax cases is comparatively low in Odisha (15%) as compared to the National figure (60%). Annual parasite incidence (API) rate decreased from 12.38 in 2001 to 8.84 in 2010 but the Plasmodium falciparum positive cases increased from 83.1 to 88.5%2. There are few studies on hospital situation depicting the severity and mortality due to malaria on our state which encouraged to conduct the study among the cases of malaria, admitted to S.C.B. Medical College and Hospital, Cuttack, situated in the central zone of Odisha and catering to the needs of 10 densely populated districts. This was a retrospective study, carried out at S.C.B. Medical College and Hospital, Cuttack, Odisha from 1 April 2010 to 31 March 2011. During the study period of one year total indoor admission in medicine ward was 24,072 of which fever cases (suspected malaria) were 2552. The bed head tickets of laboratory confirmed malaria cases, detected by any of the following test like microscopy/rapid diagnostic test (RDT)/malaria parasite quantitative buffy coat (MP-QBC) test were considered for the present study. Hence, the study subjects included all the laboratory confirmed cases found positive during their stay. The suspected malaria cases found negative on above mentioned laboratory test were excluded from the study. Centre for Disease Control and Prevention guidelines were adopted for classifying malaria into uncomplicated and complicated (severe) form3. The schedule was designed to collect necessary information from the bed head tickets of malaria patients as per the study objectives. The data thus collected were fed into SPSS version 16 and analysed with suitable statistical procedures. Total 557 laboratory confirmed malaria cases were admitted to the indoor ward of the medicine department. The most common presenting symptoms on admission were fever followed by chill and rigor in 55% and vomiting in 36% cases. Other symptoms like convulsion, loss of consciousness, jaundice, decreased urination, black coloured urine and diarrhoea were reported in 5, 0.4, 20, 16, 2 and 3% cases, respectively. In all, 9% cases were infected by P. vivax (Pv), 42% by P. falciparum (Pf) and 49% by both (Pv + Pf). Regarding investigation conducted for confirmation of the diagnosis, 89.1% cases were confirmed by RDT followed by MP-QBC in 5.3% cases. Only 3.2% were diagnosed by microscopy. Both microscopy and RDT were used for diagnosis in 2.4% cases. Table 1 shows that 65% cases were complicated (severe) and 35% were uncomplicated malaria. Among the 360 complicated malaria cases, the most common complication was cerebral malaria in 38% cases, followed by acute renal failure (ARF) in 24% cases, hepatopathy in 23% cases, both ARF and hepatopathy in 11% cases, shock in 4% and algid malaria in 1% cases. In complicated cases, majority 346 (96%) were infected by either P. falciparum or by both (P. falciparum + P. vivax) and 14 (4%) by P. vivax infection alone. In 197 uncomplicated malaria cases, 35 (18%) were infected by P. vivax and the rest 162 (82%) were infected by either P. falciparum or P. vivax + P. falciparum. Regarding the treatment of malaria cases artesunate injection was given to 86% cases followed by artesunate and quinine combination to 11% cases. Artesunate, sulphadoxine and pyrimethamine combination was administered in 2% cases, artesunate and mefloquinine to 0.2% cases and only quinine to 1% cases. J Vector Borne Dis 51, December 2014, pp. 343–344