Epidemiology and clinical outcomes of severe Plasmodium vivax malaria in India

Area of Science:

• Tropical Medicine
• Infectious Diseases
• Public Health

Background:

• Severe malaria remains a significant global health concern, with Plasmodium vivax increasingly recognized as a cause of severe disease.
• Understanding the epidemiology and clinical manifestations of severe vivax malaria (SVM) in specific regions like India is crucial for effective public health interventions.

Purpose of the Study:

• To conduct a systematic review and meta-analysis of Indian literature to determine the prevalence and characteristics of severe vivax malaria.
• To identify key clinical signs, symptoms, and outcomes associated with SVM in the Indian population.

Main Methods:

• A comprehensive search of eight electronic databases was performed to identify relevant studies on SVM in India.
• Studies were reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
• Methodological quality of included studies was assessed as part of the meta-analysis.

Main Results:

• A total of 162 studies were included, revealing a pooled proportion of 29.3% for SVM.
• The most frequent severity signs/symptoms were jaundice (37.4%), severe thrombocytopenia (37.2%), multi-organ dysfunction (24.2%), and severe anemia (20.4%).
• Plasmodium vivax was identified as the primary etiological agent in severe malaria cases, with a notable mortality rate ranging from 0 to 12.9% in monoinfections.

Conclusions:

• This systematic review and meta-analysis provides strong evidence for Plasmodium vivax as a cause of severe malaria and mortality in India.
• Identified research gaps include the need for further investigation into SVM during pregnancy, drug resistance, and cytoadherence correlations.