Abstract
About 3.6 million Pashtun and over 1.5 million immigrants from Afghanistan live in the federally administered tribal areas (FATA) on the border between Pakistan’s Khyber Pakhtunkhwa Province and southern Afghanistan. Although malaria cases are common in FATA, no detailed studies have yet been performed to reveal the actual status of malaria in the local population and epidemiological data are insufficient to elucidate the actual incidence. A malariometric survey of 691 patients of all ages and genders in seven agencies (districts) in FATA was carried out in 2013 using whole blood samples. Microscopically confirmed positive species were subjected to nested-PCR for the reconfirmation and detection of four species of Plasmodium causing human malaria. Of the 626 PCR positive cases, 81.1% were P. vivax, 13.8% P. falciparum and 4.9% mixed species containing both P. vivax and P. falciparum. P. malariae and P. ovale and were not found in any analysis. Sixty-five microscopic positive samples were identified as negative by PCR. The incidence of P. vivax ranged from 10.4% in Orakzai Agency to 22.8% in North Waziristan Agency. The prevalence of P. falciparum ranged from 1.3% in Orakzai Agency to 4.7% in North Waziristan, and Khyber Agency had the highest prevalence of 1.7% of mixed species. In FATA, P. vivax and P. falciparum are the main causative agents of malaria, while mixed species infections are also prevalent with varying transmission intensities. In addition, Estimates of malaria incidence shows that variation in the incidence, frequency and species composition of malarial parasites is high.
Acknowledgements
We thank the study participants for their involvement in the study, and the anonymous reviewer for comments that substantially improved the manuscript.
Competing interests
The authors declare that they have no competing interests.
References
Abdullah N.R., Barber B.E., William T., Norahmad N. A., Satsu U.R., Muniandy, P.K., Ismail Z., Grigg J.M., Jelip J., Piera K., Seidlein L.V., Yeo T.W., Anstey N.M., Price R. N. Auburn S. 2013. Plasmodium vivax Population Structure and Transmission Dynamics In Sabah Malaysia. PloS One, 8, 178–200. DOI:10.1371/journal.pone.0082553Search in Google Scholar
Binello N., Brunetti E., Cattaneo F., Lissandrin R., Malfitano A. 2014. Oligohydramnios in a pregnant Pakistani woman with Plasmodium Vivax malaria. Malaria Journal, 13, 1–4. DOI: 10.1186/1475-2875-13-156Search in Google Scholar
Bouma M., Dye C., Van der Kaay H. 1996. Falciparum malaria and climate change in the Northwest Frontier Province of Pakistan. Bulletin of the World Health Organization, 74, 413–42110.4269/ajtmh.1996.55.131Search in Google Scholar
Elyazar I.R., Gething P. W., Patil A.P., Rogayah H., Sariwati E., Palupi N.W., Hay S. I. 2012. Plasmodium vivax malaria endemicity in Indonesia in 2010. PloS One, 7, e37325. Doi:10.1371/jour-nal.pone.0037325Search in Google Scholar
Kazmi J.H., Pandit K. 2001. Disease and dislocation: the impact of refugee movements on the geography of malaria in NWFP, Pakistan. Social Science and Medicine, 52, 1043–1055. DOI: 10.1016/S0277-9536(00)00211-2Search in Google Scholar
Khan H., Khattak A.M. 2006. A study of prevalence of malaria in adult population of DI Khan, Pakistan. Biomedica, 22, 99–104Search in Google Scholar
Khatoon L., Baliraine F.N., Bonizzoni M., Malik S.A., Yan G. 2010. Genetic structure of Plasmodium vivax and Plasmodium falciparum in the Bannu district of Pakistan. Malaria Journal, 9, 112. DOI:10.1186/1475-2875-9-112Search in Google Scholar
Khatoon L., Jan M.I., Khan I.U., Ullah F., Malik S.A. 2013. Genetic diversity in human malarial parasites of Khyber Agency Pakistan. Acta Parasitologica, 58, 564–569. DOI:10.2478/s11686-013-0181-3Search in Google Scholar
Khattak A.A., Venkatesan M., Nadeem M.F., Satti H.S., Yaqoob S., Khatoon M.S., Plowe C. 2013. Prevalence and distribution of human Plasmodium infection in Pakistan. Malaria Journal, 12, 297. DOI:10.1186/1475-2875-12-297Search in Google Scholar
Leslie T., Kaur H., Mohammed N., Kolaczinski K., Ord R.L., Rowland M. 2009. Epidemic of Plasmodium falciparum malaria involving substandard antimalarial drugs, Pakistan, 2003. Emerging Infectious Diseases, 15, 1753. DOI: 10.3201/eid1511.090886Search in Google Scholar
Nawaz, S. 2009. FATA-a Most Dangerous Place: Meeting the Challenge of Militancy and Terror in the Federally Administered Tribal Areas of Pakistan. Center for Strategic and International Studies, Washington, DC 2600 USASearch in Google Scholar
Oyedeji S.I., Awobode H.O., Monday G.C., Kendjo E., Kremsner P. G., Kun J.F. 2007. Comparison of PCR-based detection of Plasmodium falciparum infections based on single and multicopy genes. Malaria Journal, 61, 112. DOI:10.1186/1475-2875-6-112Search in Google Scholar
Prybylski D., Khaliq A., Fox E., Sarwari A.R., Strickland G. T. 1999. Parasite density and malaria morbidity in the Pakistani Punjab. The American Journal of Tropical Medicine and Hygiene, 61, 791–80110.4269/ajtmh.1999.61.791Search in Google Scholar
Rowland M., Mahmood P., Iqbal J., Carneiro I. and Chavasse D. 2000. Indoor residual spraying with alpha cypermethrin controls malaria in Pakistan: a Community-randomized trial. Tropical Medicine and International Health, 5, 472–481. DOI: 10.1046/j.1365-3156.2000.00581.xSearch in Google Scholar
Rowland M., Rab M.A., Freeman T., Durrani, N., Rehman N. 2002. Afghan refugees and the temporal and spatial distribution of malaria in Pakistan. Social Science and Medicine, 55, 2061–2072. DOI: 10.1016/S0277-9536(01)00341-0Search in Google Scholar
Siraj A., Santos-Vega M., Bouma M., Yadeta D., Carrascal D. R., Pascual M. 2014. Altitudinal changes in malaria incidence in highlands of Ethiopia and Colombia. Science, 343, 1154–1158. DOI: 10.1126/science.1244325Search in Google Scholar
Suleman M. 1988. Malaria in Afghan refugees in Pakistan. Transactions of the Royal Society of Tropical Medicine and Hygiene, 82, 44–47. DOI: 10.1016/0035-9203(88)90257-XSearch in Google Scholar
Tareen A. M., Rafique M., Wadood A., Qasim M., Rahman H., Shah, S., Pirkani G. 2012. Malaria burden in human population of Quetta, Pakistan. European Journal of Microbiology and Immunology, 2, 201–204. DOI: 10.1556/EuJMI.2.2012.3.5Search in Google Scholar
Singh B., Sung K.L., Matusop A., Radhakrishnan A., Shamsul S.S., Cox-Singh J., Balbir T.S., Albino B., Janet C.S., Georges S., Shukri A.M., Hasan A.R. 1999. A genus and species-specific nested polymerase chain reaction malaria detection assay for epidemiologic studies. American Journal of Tropical Medicine and Hygiene, 60, 687–69210.4269/ajtmh.1999.60.687Search in Google Scholar
Woyessa A., Deressa W., Ali A., Lindtjorn B. 2012. Prevalence of malaria infection in Butajira area, south-central Ethiopia. Malaria Journal, 11, 84. DOI:10.1186/1475-2875-11-84Search in Google Scholar
Yasinzai M.I., Kakarsulemankhel J.K. 2008. Incidence of human malaria infection in desert area of Pakistan: District Kharan. Journal of Agriculture and Social Sciences, 4, 39–41Search in Google Scholar
Zakeri S., Kakar Q., Ghasemi F., Raeisi A., Butt W., Safi N. 2010. Detection of mixed Plasmodium falciparum and P. vivax infections by nested-PCR in Pakistan, Iran and Afghanistan. Indian Journal of Medical Research, 132, 31–5Search in Google Scholar
Zoghi S., Mehrizi A.A., Raeisi A., Haghdoost A.A., Turki H., Safari R. 2012. Survey for asymptomatic malaria cases in low transmission settings of Iran under elimination programme. Malaria Journal, 11, 126. DOI: 10.1186/1475-2875-11-126Search in Google Scholar
Zubairi A.B.S., Nizami, S., Raza A., Mehraj V., Rasheed A.F., Ghanchi N. K., Beg M. A. 2013. Severe Plasmodium vivax Malaria in Pakistan. Emerging Infectious Diseases, 19, 1851. DOI:10.3201/eid1911.130495Search in Google Scholar
© W. Stefański Institute of Parasitology, PAS