Malaria second most reported disease in Pakistan

4th major cause of death among communicable diseases

Rawalpindi

Malaria that is considered as the second most reportedly disease in Pakistan with an estimated well over four million cases each year remains the fourth largest preventable cause of death in the country among communicable diseases.

Approximately 60 per cent of the population in Pakistan is living in areas where the disease is endemic. Totally 39 districts of Baluchistan and Sind are called as the most risk areas. In 2015, there were 212 million new cases of malaria around the globe and 429,000 deaths. Malaria remains a major killer of children under five years old, taking the life of a child every two minutes. Approximately half of the world population, mostly those living in the world's poorest countries, remains at risk of malaria.

People living in the poorest countries, young children under the age of five, pregnant women, people with HIV/AIDS and international travelers from non-endemic areas are most vulnerable. Women are four times more likely to suffer malaria during pregnancy resulting in low-birth weight and still births.

Head of Community Medicine at CMH Lahore Medical College Professor Dr. Muhammad Ashraf Chaudhry expressed this while talking to ‘The News’ in connection with World Malaria Day to be observed on April 25 (today).

The theme for World Malaria Day 2017 is: “End Malaria for Good”. In the lead up to 25 April, WHO is shining a spotlight on prevention, a critical strategy for reducing the toll of disease that continues to kill more than 400,000 people annually, said Dr. Ashraf.

He said that control of disease is everybody’s business. Two forms of vector control – insecticide-treated mosquito nets and indoor residual spraying are effective in a wide range of circumstances. It is easy to prevent malaria in the country, but our government has totally ignored it, he said.

He believes that over the years, the absence of political will and poor resource planning has led to the rapid spread of infectious diseases impacting economic development.

To a query, he said factors contributing to the high burden of malaria in Pakistan are low coverage of effective interventions, changing diseases epidemiology, drug and insecticide resistance in parasites and vectors, security problems and insufficient case management skills in health care delivery levels.

Development of irrigation network coupled with population growth and haphazard urbanization together with deteriorating sanitary conditions, climatic changes and impact of natural disasters (heavy rains, floods etc), and a weak health system with insufficient diagnostic and treatment services in the peripheral health set up has increased the malariogenic potential of the country in both urban and rural areas, said Dr. Ashraf.

Malaria is a disease caused by parasites of the species Plasmodium that are spread from person to person through the bites of infected female Anopheles mosquitoes called “malaria vectors”, which bite mainly between dusk and dawn. Malaria is not transmitted from person to person like a cold or the flu. In the human body, the parasites multiply in the liver, and then infect red blood cells. The common first symptoms –severe shivering, fever, headache, vomiting, and profuse sweating – appear 10 to 15 days after a person is infected. If not treated promptly with effective medicines, malaria causes severe illness that may be fatal. The malaria bout lasts between 2-6 hours and malarial fever recurs periodically every 48 to 72 hours.

Studies reveal that malaria during pregnancy may cause spontaneous abortion, premature birth, still birth and intrauterine growth retardation.

He explained that major vector species in Pakistan are Anopheles culcifacies (rural area vector) and Anopheles stephensi (urban area vector) and prevalent causative parasites are Plasmodium vivax (75% malaria cases) and Plasmodium falciparum (25% cases) most deadly. There is significant rise in more lethal form that is falciparum in Balochistan and Sindh, he said.

He added Anopheles typically feed in natural water bodies with clean, slow moving water, with sufficient aquatic vegetation and rests in dark areas, behind curtains, furniture and pictures in homes. Over 40% falciparum malaria cases are resistant to chloroquine. All of the important vector species bite at night, he said.

To a query, he said the malariogenic potential of Pakistan has a negative impact on its socio-economic growth and productivity, as the main transmission season is spiraled with the harvesting and sowing of the main crops like wheat, rice, sugar cane etc.

Talking of prevention, he said key interventions to control malaria include: early diagnosis and prompt treatment of cases, universal coverage of all people with risk, use of long-lasting insecticide treated bed nets (LLINs) during sleeping, selective indoor residual insecticide spray (IRS) in high risk communities to control transmission of vector mosquitoes, and elimination of mosquito breeding sites (source reduction) by drainage, filling of waste water bodies with earth, cleaning of drains and clearing of vegetation etc.

Dr. Ashraf said that WHO is promoting T3 approach for malaria prevention and control. T3 means: test every suspected case of malaria: treat every confirmed case; and track every case through good surveillance.

For early diagnosis of malaria, microscopic examination of blood slides and use of Rapid Diagnostic Test (RDT) kits such as Dipsticks can be used, he said,

He said the risk of death from severe malaria is greatest in the first 24 hours. It is therefore very important that health care providers at the first level of contact of the patient initiate appropriate anti-malarial treatment. If malaria is suspected and the decision to treat is made, then a full effective treatment is required whether or not the diagnosis is confirmed by a test, said Dr. Ashraf.

Talking of treatment protocols, he said for prompt treatment of the disease, Artemisinine-Based Combination Therapy (ACTs) should be used for every Falciparum positive patient. Chloroquine and Primaquine therapy are used for vivax malaria. The use of monotherapy should be discouraged and discontinued, he said.

The objectives of treatment of uncomplicated malaria are to cure the infection, to prevent morbidity and mortality, to reduce transmission of infection to others means to reduce the infectious reservoir, to prevent the emergence and spread of resistance to anti-malarials, he said.

Talking of personal protective measures, he said individuals should wear light coloured clothes, long trousers, pants, full-sleeved shirts etc when outdoor after dusk. Avoid dark colours as they attract mosquitoes. Apply some mosquito repellent lotion on exposed parts of the skin when go outside and sit in the lawn after sunset. Sleep in rooms where there is screening of windows and doors. Use Coils and electric mats in rooms at night to prevent mosquito bites, he said.

Dr. Ashraf said community can also participate in malaria control activities by eliminating breeding sites of mosquitoes, by not allowing unnecessary water accumulation in residential areas, keeping surroundings clean, and by treating stagnant water with used automobile oil, chemicals and precautionary fogging before start of malaria season.