Half million malaria cases every year warning signal for Pakistan

Karachi, March 15, 2011 (PPI): Poor sanitation and vector control in Pakistan is resulting in sharp rise in malaria cases and according to the Health Report 2011 of Pakistan Medical Association (PMA) every year about 500000 new cases of malaria are being reported in the country. Malaria is caused by a parasite called Plasmodium, which is transmitted via the bites of infected mosquitoes. In the human body, the parasites multiply in the liver, and then infect red blood cells.

Recent devastating floods in Pakistan sent vast areas of Pakistan inundated in floodwater, further raising the spread of malaria in the country. In October 2010, World Health Organization (WHO) said almost 300,000 suspected malaria cases, including confirmed cases of the severe falciparum-malaria, have been recorded in flood-affected areas of Pakistan since 29 July 2010, an overall number which is slightly above the average annual malaria seasonal levels.

WHO is supporting the Ministry of Health to prevent and control a malaria epidemic in the country. It says malaria is endemic in rural areas of Pakistan where there are two seasonal peaks: in August (mainly due to the milder vivax-malaria) and October (the potentially fatal falciparum-malaria). Huge number of malaria cases is ‘registered’ annually but 12% of people living in the rural areas carry malaria parasites in the blood without showing symptoms of malaria.

Balochistan province has recorded the largest proportion of consultations for suspected malaria, while increasing numbers of cases are also being reported in Punjab and Sindh provinces according to the Disease Early Warning System of WHO and the Federal Ministry of Health. The increased number of malaria cases is definitely caused by the floods that have displaced millions of people, leaving many in poor shelter, and has left many water ponds, which are ideal breeding sites for Anopheles mosquitoes.

Though malaria is the fourth most common medical condition after diarrhoea, ARI (acute respiratory infection) and tuberculosis, strengthening the existing surveillance system is the major challenge at the moment, as the healthcare department does not have accurate data. WHO classifies Pakistan as a country with moderate malaria prevalence and relatively well-established control programmes. Despite this, the disease is estimated to cause at least 50,000 deaths out of an estimated 500,000 reported malaria cases every year.

It is said that only one in four malaria sufferers in Pakistan actually gets treated for the disease. Health experts say people can be easily treated for the ‘Vivax’ strain of malaria generally found in rural areas of the country, which if diagnosed properly could be treated with easily available medicines. However, a weak health infrastructure, poverty, shortage of doctors and poor monitoring account for the high mortality rate from the disease.

There are many programs sponsored by the government and donor agencies are running in Pakistan against this disease. However, controlling malaria would be distant dream until health authorities put the required amount of resources and political will into tackling the killer.

Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anaemia. It is caused by a parasite that is transmitted from one human to another by the bite of infected Anopheles mosquitoes. In humans, the parasites (called sporozoites) travel to the liver, where they mature and release another form, the merozoites. These enter the bloodstream and infect the red blood cells.

The parasites multiply inside the red blood cells, which then rupture within 48 to 72 hours, infecting more red blood cells. The first symptoms usually occur 10 days to 4 weeks after infection, though they can appear as early as 8 days or as long as a year after infection. Then the symptoms occur in cycles of 48 to 72 hours.

Malaria can also be transmitted from a mother to her unborn baby (congenitally) and by blood transfusions. Malaria can be carried by mosquitoes in temperate climates, but the parasite disappears over the winter.

In some areas, mosquitoes that carry malaria have developed resistance to insecticides. In addition, the parasites have developed resistance to some antibiotics. This has led to difficulty in controlling both the rate of infection and spread of this disease.

Falciparum malaria, one of four different types of malaria, affects a greater proportion of the red blood cells than the other types and is much more serious. It can be fatal within a few hours of the first symptoms.

Symptoms of malaria include anaemia, chills, coma, convulsion, fever, headache, jaundice, muscle pain, nausea, bloody stools, sweating and vomiting.

During a physical examination, the doctor may identify an enlarged liver or an enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.

Malaria, especially Falciparum malaria, is a medical emergency requiring hospitalization. There are many drugs available to treat malaria. However, a doctor could determine about the choice of drugs after examining patient.

Complications of malaria include destruction of blood cells (haemolytic anaemia), liver failure and kidney failure, meningitis, respiratory failure from fluid in the lungs (pulmonary edema), and rupture of the spleen leading to massive internal bleeding (haemorrhage.

Prevention of malaria can aim at preventing infection, by avoiding bites by parasite-carrying mosquitoes, or preventing disease, by using antimalarial drugs prophylactically. The drugs do not prevent initial infection through a mosquito bite, but they prevent the development of malaria parasites in the blood, which are the forms that cause disease. This type of prevention is also called “suppression.”

Prevention is an important component of malaria control in endemic areas. It is achieved through vector control, personal protection measures such as insecticide-treated bed nets, and preventive treatment with antimalarial drugs of vulnerable groups such as pregnant women, who receive intermittent preventive treatment.

Malaria control does not aim to eliminate malaria totally. Complete elimination of the malaria parasite (and thus the disease) would constitute eradication. While eradication is more desirable, it is not currently a realistic goal for most of the areas of Pakistan where malaria is endemic.

Vector control is best regime to control this disease. Vector control aims to reduce contacts between mosquitoes and humans. Some vector control measures (destruction of larval breeding sites, insecticide spraying inside houses) require organized teams (for example, from the Ministry of Health) and resources that are not always available.

An alternate approach, insecticide-treated bed nets (ITNs), combines vector control and personal protection. This intervention can often be conducted by the communities themselves and has become a major intervention in malaria control.

The main activities necessary for carrying out malaria control interventions are:

Health education (also called Information-Education-Communication, IEC), where the communities are informed of what they can do to prevent and treat malaria. Training and supervision of health workers, to ensure that they carry out their tasks correctly. Provision of equipment and supplies (e.g., microscopes, drugs, bed nets) to allow the health workers and the communities to carry out the interventions.

Barriers to Malaria Control: Malaria control is made difficult by several technical and administrative problems. Drug-resistant malaria parasites hinder case management by decreasing the efficacy of antimalarial drugs and by requiring the use of alternate drugs that are often more costly, less safe and less easy to administer. Insecticide resistance decreases the efficacy of interventions that rely on insecticides such as insecticide-treated bed nets and insecticide spraying. Inadequate health infrastructures in poor countries are unable to conduct the recommended interventions. The people most exposed to malaria are often poor and lack education. They often do not know how to prevent or treat malaria. Even when they do know, they often do not have the financial means to purchase the necessary products, such as drugs or bed nets.