Molecular Epidemiology of Plasmodium species in Conflicted Federally Administered Tribal Area (FATA) Pakistan.

M F Nadeem,N Zeeshan,M A U Khan,W Ahmed,K Sughra,U Rashid,S Gul,U A Awan,S Alam,A A Khattak,A Afroz

doi:10.1590/1519-6984.247219

Abstract

Military conflicts have been significant obstacles in detecting and treating infectious disease diseases due to the diminished public health infrastructure, resulting in malaria endemicity. A variety of violent and destructive incidents were experienced by FATA (Federally Administered Tribal Areas). It was a struggle to pursue an epidemiological analysis due to continuing conflict and Talibanization. Clinical isolates were collected from Bajaur, Mohmand, Khyber, Orakzai agencies from May 2017 to May 2018. For Giemsa staining, full blood EDTA blood samples have been collected from symptomatic participants. Malaria-positive microscopy isolates were spotted on filter papers for future Plasmodial molecular detection by nested polymerase chain reaction (nPCR) of small subunit ribosomal ribonucleic acid (ssrRNA) genes specific primers. Since reconfirming the nPCR, a malariometric study of 762 patients found 679 positive malaria cases. Plasmodium vivax was 523 (77%), Plasmodium falciparum 121 (18%), 35 (5%) were with mixed-species infection (P. vivax plus P. falciparum), and 83 were declared negative by PCR. Among the five agencies of FATA, Khyber agency has the highest malaria incidence (19%) with followed by P. vivax (19%) and P. falciparum (4.1%). In contrast, Kurram has about (14%), including (10.8%) P. vivax and (2.7%) P. falciparum cases, the lowest malaria epidemiology. Surprisingly, no significant differences in the distribution of mixed-species infection among all five agencies. P. falciparum and P. vivax were two prevalent FATA malaria species in Pakistan's war-torn area. To overcome this rising incidence of malaria, this study recommends that initiating malaria awareness campaigns in school should be supported by public health agencies and malaria-related education locally, targeting children and parents alike.

Highlights

Malaria is the world’s most common arthropodborne disease transmitted by the protozoa of the genus Plasmodium responsible for the death of about 0.43 million deaths annually
According to the World Health Organization (WHO), it is startling that Pakistan is one of the seven top countries in the Eastern Mediterranean, with P. vivax and P. falciparum as the prevalent species comprising 98% of malaria prevalence
This study provides the molecular epidemiology baseline parasitological information of malaria incidence and species distribution among different age groups and gender in five agencies of Federally Administered Tribal Region (FATA), Pakistan

Summary

Introduction

Malaria is the world’s most common arthropodborne disease transmitted by the protozoa of the genus Plasmodium responsible for the death of about 0.43 million deaths annually. According to the World Health Organization (WHO), it is startling that Pakistan is one of the seven top countries in the Eastern Mediterranean, with P. vivax and P. falciparum as the prevalent species comprising 98% of malaria prevalence. The prevalence of Plasmodium species in this area varies from 75 to 85% P. vivax, 15 to 25% P. falciparum, and about 1% of both species’ mixed infections (Khan et al, 2020; Qureshi et al, 2020b; Khattak et al, 2013a). Pakistan’s Federally Administered Tribal Region (FATA) was second on Pakistan’s malaria-metric scale, where biological, where ecological, environmental and human intervention primarily affects outbreaks of infectious diseases. Afghan refugee movements and internal migration of people from war-affected agencies to neighboring areas, stuck in a vast number of temporary settlements and camps with rudimentary overcrowded dwellings; increasing susceptibility to numerous infectious and vector-borne diseases (Karim et al, 2016)

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