During this period, conflicts between the Maratha Empire and British East India Company led to famines that increased the mortality of smallpox cases.

Devotees most often refer to Shitala using honorific suffixes reserved for respected motherly figures, such as Shitala-Ma (Hindi: मां māṃ), Shitala-Mata (Sanskrit: माता mātā), and Shitala-Amma (Kannada: ಅಮ್ಮ am'ma).

She is mentioned in Tantric and Puranic literature, and her later appearance in vernacular texts (such as the Bengali 17th-century Shitala-mangal-kabyas ('auspicious poetry') written by Manikram Gangopadhyay) has contributed to popularising her worship.

[8] Shitala Devi's worship is especially popular in the regions of North India specially by Jatavs,[9] where she is traditionally identified as an aspect of goddess Parvati, the divine consort of Shiva.

Sheetala is primarily worshiped by women on Sitalastami, the eighth day of Phalguna, the eleventh month of the Hindu lunar calendar, which typically falls between mid-February and late March, as established by Raghunandana because the long, dry nights are associated with deaths from smallpox.

According to common belief, many families do not light their stoves on Ashtami/Saptami day, and all devotees cheerfully eat cold food (Cooked the previous night) in the form of prasada.

[12] Shitala is traditionally represented as a young maiden crowned with a winnowing fan, riding a donkey, and holding a short broom to spread the content of her pot full of viral pustules or cold water of immortality.

In smaller rural shrines built by Adivasi and Bahujan communities, Shitala may be simply represented by smooth stone slabs with painted facial features and decorative adornments donated by devotees.

Notably, references to neem leaves are ubiquitous in Shitala's liturgy and also appear in her iconography, suggesting an early understanding of Azadirachta indica as a medicinal plant.

[13] She is also depicted enthroned in an eight-handed form holding a trident, broom, discus (chakra), pot of viral pustules and healing water, branches of neem, scimitar, conch.