Abstract
BackgroundMilitary conflict has been a major challenge in the detection and control of emerging infectious diseases such as malaria. It poses issues associated with enhancing emergence and transmission of infectious diseases by destroying infrastructure and collapsing healthcare systems. The Orakzai agency in Pakistan has witnessed a series of intense violence and destruction. Military conflicts and instability in Afghanistan have resulted in the migration of refugees into the area and possible introduction of many infectious disease epidemics. Due to the ongoing violence and Talibanization, it has been a challenge to conduct an epidemiological study.Methodology/Principal FindingsAll patients were sampled within the transmission season. After a detailed clinical investigation of patients, data were recorded. Baseline venous blood samples were taken for microscopy and nested polymerase chain reaction (nPCR) analysis. Plasmodium species were detected using nested PCR (nPCR) and amplification of the small subunit ribosomal ribonucleic acid (ssrRNA) genes using the primer pairs. We report a clinical assessment of the epidemic situation of malaria caused by Plasmodium vivax (86.5%) and Plasmodium falciparum (11.79%) infections with analysis of complications in patients such as decompensated shock (41%), anemia (8.98%), hypoglycaemia (7.3%), multiple convulsions (6.7%), hyperpyrexia (6.17%), jaundice (5%), and hyperparasitaemia (4.49%).Conclusions/SignificanceThis overlooked distribution of P. vivax should be considered by malaria control strategy makers in the world and by the Government of Pakistan. In our study, children were the most susceptible population to malaria infection while they were the least expected to use satisfactory prevention strategies in such a war-torn deprived region. Local health authorities should initiate malaria awareness programs in schools and malaria-related education should be further promoted at the local level reaching out to both children and parents.
Highlights
Disease emergence is influenced by both natural and human factors
We report a clinical assessment of malaria endemicity in the Orakzai Agency, which is Pakistan’s most neglected area due to Talibanization and war in Afghanistan
This result agreed with previous studies performed in nearby areas in Pakistan, as it was shown that the prevalence of P. vivax changes from 70% (30% P. falciparum) in mid Pakistan province to 90% (10% P. falciparum) in areas near or inside Afghanistan including FATA [8]
Summary
Disease emergence is influenced by both natural and human factors. Among human activities, military conflicts characterized by war and regional tribal and/or sectarian strife have had huge impact by destroying infrastructure and collapsing healthcare systems. If the situation were to prolong, discontinued public and healthcare professional education investment and lack of proper surveillance and control of the disease should produce more severe and chronic outcomes. These outcomes make the people in the affected and nearby regions become newly vulnerable to a variety of communicable diseases and directly associated with the prevalence and emergence of the infectious diseases [1, 2]. Military conflict has been a major challenge in the detection and control of emerging infectious diseases such as malaria It poses issues associated with enhancing emergence and transmission of infectious diseases by destroying infrastructure and collapsing healthcare systems. Due to the ongoing violence and Talibanization, it has been a challenge to conduct an epidemiological study
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