Anti-malarials in India

Nick-H

My very unscientific (and utterly unmathematical) sense of the current day situation is that the most dangerous places to be are Assam, where falciparam is dangerously common and chloroquine resistance high; N. Goa where there has been an increase of malaria of late, and Andamans where, as a news report I read a couple of weeks puts it, malaria is spiralling.

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pundabee

For the sake of it: attached are the falciparum occurrences. Here Orissa scores highest with 9 cases for every 1000 people.

Attached Files

malaria2.pdf (14.2 KB, 34 views)

brownboy66

that's what I understood as well, that you had to have the full course of treatment.

wow! Nice job pundabee. So what do you do with the stuff you're really interested in?

Its interesting to play around with the numbers isn't it. I'm not a mathematician but have done risk assessment, disaster and continuity planning work in the past. From what I understand what you've provided is a statistical average based on population divided by known cases per state - averaged out over a year expressed in percentage terms? So then a smaller portion of that time is then expressed as a smaller percentage of risk? I'm not sure how that works (then again it might - I'm not a scientist)?

For example, statistical averages (where a value is spread evenly over a known spectrum) are a theoretical construct. In real life there are "clumps" "aggregations", "groupings" as such. Applied in this scenario - there will be times of the year when mozzies are more prevalent, and times when they are less. Geographically there will be locations, environments where they are more prevalent, and places where they are not to be found (I'm picking the desert about now is probably fairly mozzie free).

Then there are the people. Where do they live, how densely are they populated. Are they located in or next too areas of high concentration of disease carrying mozzies? Then there are the health factors to input. How many people are resistant? How many people undertake some sort of the preventative regime (coils, nets, etc - if anything at all). If bitten what access to health services do they have? If they have access, how quickly are the able to begin a course of treatment, etc.

So 32 out of a 1000 contract malaria in AP - the question really is what series of factors contributes towards someone being 1 of the 32, or 1 of the 968?

I imagine to get something close to an idea of what the risk factor would be would require an algorithm that factors in group behaviour, time variations, seasonal patterns, not to mention health data on resistance, preventative measures, etc. This of course is just pure speculation on my part.......

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Nick-H

Check out the map on p.45 of the UK Health Protection Agency malria guidelines I mentioned above.

There is a band across central Inda, "Risk variable, take tablets...". There is Assam, "Risk High...", and there is the rest of India, now considered by them to be low enough risk just to take precautions rather than prophylaxis. Please note that an update on their site adds N. Goa to the area recommended for prophylaxis.

It is very much more detailed than the map shown on post 10.

The map should be taken in the context of the entire publication, about 100pp long, which I would recommend to anyone interested in or concerned about this subject. It would be a mistake to take the map out of context, and say you don't need antimalarials for most of India.

It is a detailed document, covering many situations and destinations. Easy to read too!

edwardseco

Nice job, we should hope for more periods of idleness that inspire such creativity. Umm, maybe iess unpaid periods..

HelenR

Wow, I'm happy to see fellow math geeks here

My conclusion: have a deet-bath it is

pundabee

Of course, all your points are reasonable. Also, the numbers don't, as Nick-H points out, take into account recent developments or sudden outbreaks. They do, however, show that, as a tourist, you should be more concerned about protecting yourself when travelling in Orissa than you should when in Delhi.

grikoo

Westerners might also be more susceptible to the parasites as well.

Nick-H

Actually, no we aren't. Didn't we do this one earlier in the thread, or was it another thread? Maybe another lifetime. God! How many lifetimes do I have to spend discussing malaria on the internet? What did I do? Have we all come together here to work out some terrible karma?

Err... coming back to a lucid moment: many of UK's malaria sufferers are those returning to their own countries with the assumption that they still have some immunity, and most of the world's million-plus-a-year deaths from the disease will be among people who never left.

This is not a traveller's disease; it is a local disease!

If anyone has a reference for anything (in not-too-scientific language) about the immunity/resistance thing, I'd be interested in reading it (guess I'd better google again). I mean, what determines whether a person, when first exposed to the parasite, gets sick or starts to develop resistance, and does this have to happen in the very early stages of one's life?

It's interesting. (that karma again!)

machadinha

My understanding (and no more than that) is that the one local may never contract it, while the other may do so repeatedly throughout their lives (and everything inbetween, i.e., contract it once or whatever). They may or may not die as a result of it (and taking treatment possibilities or their general health and so on into account).

In other words, that immunity is a myth (again, only in my understanding...) A form of resistance, yes, possibly; but then even that doesn't seem to do much for people. As you note, else why would millions of local people all over the world fall victim to it each year (poverty and lack of health measures and sanitation and malnutrition and so on, yes, of course, with infants in some African regions with the endemic strain[s] there taking the brunt. But I don't think that amounts to signs of immunity. More likely their overall immune system is less developed; pregnant [local, in Africa] women seem to be likewise at an increased risk, for instance.)

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grikoo

Yes, I wouldn't go so far as immunity, but resistence yes. Saw references recently to a study done in the terai, which apparently indicated such was the case there with the local inhabitants.

Nick-H

No, I think there is an immunity/resistance --- not that I don't see your point, Mach, I do.

I'd have to go back to the document again to check the exact language they use, but the British HPA booklet says that one of the highest risk groups in UK is those returning to their native countries who have lost their resistance. It also, iirc, says that it only takes a few years away to loose it --- so the 'resistance' must be something that requires continual re-infection, or at least exposure, perhaps.

I'd better look it up!

machadinha

As a sidenote, I've (finally, I know you've linked to it often before) been reading that HPA booklet (in your post #49 above) & it's really a comprehensive and accessible read, Nick. Would recommend people here to store it in their bookmarks, or print it out and take it along (better yet: Where I live at least there's a handy portable booklet on all possible tropical diseases, if your country offers something like that, take one along by all means).

Peak just remarked on this or another thread how advice ranges so widely between countries (of origin, i.e., for travelers seeking professional medical advice). It does between those professionals even. Surely doesn't help us to distinguish myths from facts. And then I guess it's forever a changing field in itself, with new and revised insights and etc. and so forth.

So anyway, yes, I'm quite willing to accept the idea of some form of resistance. But better not for people to rely on anything like that though. There are some weird notions flying about regarding building up "immunity" to drinking tap water and stuff ( ), or indeed people thinking they can become "resistant" to malaria in say half a year.

machadinha

ps

Don't forget you're talking about a very specific (and tiny) target group here. It could as well mean those people tend to overestimate their chances.

In any case, like you say malaria is more of an endemic/national problem, to the countries involved.

Haylo

That is a very helpful piece of work, which will allow me to make a more informed decision about medication during my visit.

[MilesOffTopic]Next time you're bored, any chance of your doing the same with accident figures - pedestrian / aircraft / bus / taxi / donkey?[/MilesOffTopic]