Malaria risk, treatment-seeking, and prevention in Northeastern India: Clinic-based surveillance of persistent transmission

Background Malaria has historically been a public health concern in Meghalaya with year-round transmission peaking during the monsoon and post-monsoon seasons. This study investigated malaria prevalence among suspected cases presenting at health centres across three districts of Meghalaya, in the northeastern region (NER) of India. Methods A multi-site, facility-based, cross-sectional study was conducted in five primary health centres (PHC) and one district hospital from three geographically distinct regions of Meghalaya: West Khasi Hills [KH] district, West Jaintia Hills [JH] district, and South Garo Hills [GH] district. Individuals presenting at the selected healthcare facilities with malaria-like symptoms between 2018 and 2021 were enrolled. Malaria cases were detected by light microscopy, RDT, and PCR. Malaria prevalence was estimated as the number of Plasmodium infections divided by the total number of participants providing a blood sample. Logistic regression analysis was conducted to assess the risk factors of malaria. Results A total of 1,031 participants provided a blood sample for testing. Forty-five (4.4%) participants had a Plasmodium infection, most (60%) of which were P. falciparum . Malaria prevalence ranged from 1.8% in KH to 12.3% in GH. Diagnosis of malaria within the past 12 months (OR = 9.2; P  < 0.001) and performing outdoor activities before bedtime (OR = 2.0; P  = 0.023) or early morning (OR = 3.1; P  = 0.010) were significantly associated with Plasmodium infection. Conclusion The results provide valuable insights into the epidemiology of malaria in an endemic region in NER of India. These findings emphasize the importance of considering specific local risk-factors, such as behavioural patterns, in designing effective malaria control strategies.