World Malaria Day means that the malaria situation in more countries outside Africa will be getting attention. The Daily Times of Pakistan has observed that “Pakistan reported 3.5 million suspected malaria cases in 2007 and 0.13 million of them were later confirmed, says an official of Directorate of Malaria Control (DOMC),” but also expressed concern that WHO “claims that high incidence of suspected malaria cases is exaggerated and the figure couldnâ€™t be more than 1.6 million because malaria has yet not reached epidemic proportions in Pakistan.”
Better data are needed. The website ‘fitfortravel‘ can compose a map to guide travelers on the need for antimalarials, but this is not intended as an accurate picture of the country’s malaria situation. That said, malaria is obviously a recognized problem in the country because the Global Fund to fight AIDS, TB and Malaria has awarded Pakistan three grants to fight the disease.
The Round 3 proposal to Global Fund explained that, “The plasmodium falciparum is on the rise and in 2001 as many as 25 districts had a P. falciparum ratio of more that 30 percent. The parasite has developed RI & RII level resistance to chloroquine in many areas.” The proposal also reports that the annual parasite incidence reaches 18 per 1000 in certain districts, but also says that only abouy 21% of the population use government health facilities were data could be collected. Therefiore it is not surprising that the Daily Times reports that, “The DOMC official said only 20 percent of the total population had access to malaria treatment.”
Some published data comes from hospitals, which of course would not reflect the general situation in the population, but at least is a step in the direction of documentation. Idris et al. from the Ayub Medical College in Abbotabad studied nearly 2000 febrile patients and found that over 7% had malaria parasites. While most cases were P. vivax, 24% were P. Falcuparun and 3% were mixed. In Karachi, Beg et al. documented among over 500 patients hospitalized that P. vivax and P. falciparun were found in almost equal measure (52% and 46%). They expressed concern that many were treated with inappropriate medicines, showing a need for updating pre-service and in-service training.
Bhatti et al., looked at malaria in pregnancy in Karachi. The findings they reported included the following: “Two patients had an abortion. One of the following complications including, threatened abortion, preterm labour, ARDS or Cerebral malaria, was observed in one patient each. Mean weight of babies born to cases was 2.8 kg (range 1.4-3.8) and of control babies was 3.2 kg (range 2.5-4.0 kg).” P. falciparum was identified as one of the risk factors for poor pregnancy outcome.
Among the 28 malaria Global Fund grants approved for Round 7, half came from regions outside Africa. As international attention is turning more to malaria all over the world, it is important for all endemic countries to seek better population based data about their malaria situation so that appropriate interventions can be targeted most effectively.