Abstract
BackgroundMalaria is the fifth leading cause of death worldwide. Pakistan is considered as a moderate malaria-endemic country but still, 177 million individuals are at risk of malaria. Roughly 60% of Pakistan’s population, live in malaria-endemic regions. The present study is based upon the survey of various health care centers in 10 major cities of Northern and Southern Punjab to find out the malarial infection patterns in 2015. The diagnosis, seasonal variations, age and gender-wise distribution of Plasmodium spp. circulating in the study area were also included in the objectives.MethodsThe malaria-suspected patients ‘16075’ were enrolled for malaria diagnosis using microscopy, out of which 925 were malaria positive which were processed for molecular analysis using nested PCR. The 18S rRNA genes of Plasmodium species were amplified, sequenced, blast and the phylogenetic tree was constructed based on sequences using online integrated tool MEGA7.ResultsThe 364 cases recruited from Northern Punjab with the highest incidence in Rawalpindi (25.5%) and lowest in Chakwal (15.9%). From Southern Punjab 561 cases were enlisted Rajanpur (21.4%) maximum and lowest from Multan and Rahim Yar Khan (18%). The slide positivity rate, annual parasite incidence, and annual blood examination rates were 5.7 per 1000 population, 0.1, and 0.2% respectively. The only P. vivax (66.7%), P. falciparum (23.7%) and mixed infection by these two species (9.6%) were diagnosed. The same trend (P. vivax > P. falciparum > mixed infection) in species identification %age was confirmed from molecular analysis. However, the occurrence of malaria was higher in Southern Punjab (5.5%) as compared to the Northern Punjab (4.0%). The overall malaria percentage occurrence of treatment-seeking patients in all recruited cities of Punjab was 4.9%. The age-group of 1–20 and males among genders were more affected by malaria. The comparison of different seasons showed that the malaria infection was at a peak in Summer and post-monsoon.ConclusionThe incidence of malaria was high in the flood infected rural areas of Southern Punjab, Summer, and post-monsoon. The age group (1–20) and gender-wise males were more affected by malaria.
Highlights
Malaria is the fifth leading cause of death worldwide
The Annual Parasite Incidence (API) within Northern Punjab was high in Jhelum and it was equal to API in Chakwal 0.4 per 1000 lowest in Gujranwala 0.04 per 1000 population
The present findings revealed that mixed infection was high in Southern Punjab as compared to Northern Punjab
Summary
Pakistan is considered as a moderate malariaendemic country but still, 177 million individuals are at risk of malaria. 60% of Pakistan’s population, live in malaria-endemic regions. Malaria is the globally largest vector born disease with over 200 million clinical cases happening every year. The number of malaria cases globally increases as 214, 217 and 219 million from 2015, 2016 and 2017 respectively [1,2,3]. In Pakistan 3.5 million suspected and confirmed malaria cases are reported each year. Sixty percent population of Pakistan lives in malaria-endemic regions. As reported by WHO in 2017 and 2018 [3, 4], Pakistan is among the six WHO Eastern Mediterranean region countries with high malaria transmission and about 100% of the population living at risk. Province wise breakdown indicates that during 2017 highest numbers of cases were reported from Khyber Pakhtunkhwa 30%, Sindh 26.5%, Federally Administered Tribal Area (FATA) 21.9%, Baluchistan 20.5% and Punjab with the least epidemiology of 1.1% [2]
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