Malaria--an experience at CMH Khuzdar (Balochistan).

Abstract

Malaria has been a fact of life and death since antiquity and ranks among the major health problems in the world and is the cause of mortality in different parts of the world including Pakistan. More than 2 billion people around the world are at risk for malaria infection. The estimated annual global incidence of malaria is 300-500 million clinical-cases, and about 20 million deaths occur worldwide each year.1 Although no accurate data is available for Pakistan, incidence of malaria has been reported upto 50,00,00 cases per annum, with cases reported from all the provinces of Pakistan.2 The available data reveals coastal city of Karachi, Thatta, Badin, Zhob, Larkana and Nawabshah as holoendemic for malaria with round the year transmission.3 The available data regarding Balochistan reveals Zhob as holoendemic, North Balochistan as mesoendemic, Ziarat and Kalat as hypoendemic,4 while there is insufficient or no published data regarding malaria status in Khuzdar. This limited preliminary study documents the occurrence and frequency of various types of malaria in Khuzdar, and its clinical presentation and to see the therapeutic response to conventional drugs. A total of 505 patients of either sex and from various age groups referred from Khuzdar and its tehsils Wadh and Nal, with clinical impression of malaria to CMH (Combined Military Hospital) Khuzdar, in whom laboratory diagnosis was confirmed, between August 2003 to December 2004, were included in the study. Information regarding age, sex, residence/stay at Khuzdar, duration of fever, associated clinical symptoms and finding on clinical examination, laboratory investigations were recorded on a standard proforma. Cases of malaria were seen throughout the year with maximum number during the months of May to November. Month-wise distribution of cases of malaria is shown in Table I. Majority of patients were young adult males. Only 10% of cases were below the age of 10 years while 10.61% were females. Common presenting clinical features are shown in Table II. Herpes labialis was found in 4.6% while 48% had splenomegaly and 14% had hepatomegaly. Five patients were hospitalized in comatose/confused state. Out of 505, 347 (69%) cases were positive for Plasmodium falciparum, 119 (24%) cases were positive for Plasmodium vivax, while 36 (7%) had mixed infection with a sexual stages of both Plasmodium falciparum and vivax. The malarial index was calculated. The highest malarial parasite of 8% was seen in 2 children hospitalized in comatosed state with severe anemia needing blood transfusion. Low hemoglobin (HB<10 gm/dl) was seen in 24 (4%) cases. Patients with P. vivax malaria responded to chloroquine phosphate and those with P. falciparum malaria and mixed infection without complication were given tab quinine sulphate and doxycycline. Patients were assessed clinically on a daily basis, parasitemia was evaluated daily till no malarial parasite was seen for 2 days. Patients were discharged from the ward when parasitemia became nil and they were afebrile on average for 3 consecutive days. In 92% of the cases malarial parasite disappeared from peripheral blood by 3rd day of treatment and rest of the cases by 5th day. All the patients made good recovery in the end and no death occurred. Patients were instructed regarding preventive measures and to report for consultation in case of recurrence of fever.