Abstract
BackgroundBoth Plasmodium vivax and Plasmodium falciparum are prevalent in Pakistan, yet up-to-date data on the epidemiology of malaria in Pakistan are not available. This study was undertaken to determine the current prevalence and distribution of Plasmodium species across the country.MethodsA malariometric population survey was conducted in 2011 using blood samples collected from 801 febrile patients of all ages in four provinces and the capital city of Islamabad. Microscopically confirmed Plasmodium-positive blood samples were reconfirmed by polymerase chain reaction (PCR). Confirmed parasite-positive samples were subjected to species-specific PCR capable of detecting four species of human malaria.ResultsOf the 707 PCR-positive samples, 128 (18%) were P. falciparum, 536 (76%) were P. vivax, and 43 (6%) were mixed P. falciparum and P. vivax. Ninety-four microscopy-positive samples were PCR-negative, and Plasmodium malariae and Plasmodium ovale were not detected. Prevalence of P. vivax ranged from 2.4% in Punjab Province to 10.8% in Sindh Province and prevalence of P. falciparum ranged from 0.1% in Islamabad to 3.8% in Balochistan.ConclusionsPlasmodium infections in Pakistan are largely attributed to P. vivax but P. falciparum and mixed species infections are also prevalent. In addition, regional variation in the prevalence and species composition of malaria is high.
Highlights
Both Plasmodium vivax and Plasmodium falciparum are prevalent in Pakistan, yet up-to-date data on the epidemiology of malaria in Pakistan are not available
The majority of malaria cases in Pakistan is caused by P. vivax, trends in the past few decades have indicated that P. falciparum infection is on the rise
A total of 801 microscopy-positive samples was amplified by polymerase chain reaction (PCR) along with positive and negative controls
Summary
Both Plasmodium vivax and Plasmodium falciparum are prevalent in Pakistan, yet up-to-date data on the epidemiology of malaria in Pakistan are not available. An uptick in malaria can be partially attributed to floods that affected approximately 20 million people in over 60 districts [2]. Despite a well-established malaria control programme, 500,000 malaria infections and 50,000 malaria-attributable deaths occur each year in Pakistan [3], with approximately 37% of cases estimated to occur in regions along the borders with Afghanistan and Iran [4]. Pakistan’s climate ranges from tropical to temperate with dry conditions along the southern coast [5], and the majority of malaria cases in Pakistan is caused by P. vivax, trends in the past few decades have indicated that P. falciparum infection is on the rise. The World Health Organization (WHO) reported that in Pakistan the proportion of malaria infections attributed to P. falciparum rose from 34% in 1987 to 54% in 1990 [9,10]. In 2010, 73,857 (31%) of 240,591 total reported malaria cases in Pakistan were P. falciparum [13]
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