The shift from public to private health care providers and malaria deaths in Jalpaiguri district, West Bengal, India, 2006

We investigated an increase in malaria deaths in order to formulate control measures. A search of records in health care facilities for cases of death following fever, with a blood smear or rapid antigen test positive for Plasmodium falciparum, identified 77 fatalities. Of these, 72 (93%) occurred in hospitals (78% of which in the 24hours following admission). Of 60 family members of the patients who died interviewed, 70% reported that the patient had received care from unqualified rural private practitioners available round the clock. Among 100 of these rural practitioners assessed, 21% knew anti-malarial dosage and 7% knew malaria severity criteria. There were 65% and 42% vacancies among 240 community health worker and 12 microscopist positions, respectively, in the public sector in the area. As a result, the mean interval between active case search rounds in the community was 35 days (standard: 14) and the median time between blood slide collection and radical treatment was 12 days (standard<2 days). Deficiencies in the public health system may have led to a shift towards rural practitioners. Poor management of malaria may have contributed to deaths. We posted microscopists and community health workers in the area to restore appropriate malaria management in the public sector.