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.

The paper is a part of the author’s doctoral thesis at the International Institute for Population Sciences, Mumbai. The author is indebted to P. G. Mazumdar, for her painstaking efforts during the fieldwork, and M. Guruswamy, for his numerous discussions and editing. Valuable comments on the study design and concepts were provided by S. Mohanty, C. Sekhar and S. S. Narvekar. The excellent assistance of P. Kumar Chettry, the help extended by B. Ghosh and S. Oraon and the kind co-operation of the villagers of Hatighisha are also gratefully acknowledged.