ABSTRACT
The purpose of this study was to understand the malarial situation in Punjab, Pakistan. In this study, the data was collected from different health facilities, malaria control programme offices, reference laboratories and field stations of 91 districts from 2005 to 2009. The data of past five years [2005-2009] from health facilities, malaria control programme offices, reference laboratories and field stations was collected. An excel databank was created and analysis was done by using SPSS. Out of the total of 123 districts, 91 districts [86.7%] were endemic for malaria in Pakistan. Balochistan and FATA [Federally Administered Tribal Areas] had highest malaria incidence, while Sind and KPK [Khyber Pakhtoon Khah] had moderate. The lowest malaria incidence was confined to Punjab and AJK [Azad Jammu Kashmir]. In Punjab the maximum API [Annual Parasitic Incidence] was noted 0.04 in 2005 and 0.05 in 2009. The incidence of cases in south Punjab was more than central and north Punjab, 82% of indigenous cases were of Plasmodium vivax, 18% were of P.falciparum, P.ovale and P.malariae or mix infection was not reported. In Punjab malaria has reduced significantly [p=0.028] and fully qualifies the embarkation of malaria elimination strategy. Prioritizing to target P.falciparum first and subsequently eliminate the P. vivax malaria. KAP [Knowledge, Attitudes and Practices] study is required before initiating malaria elimination in Punjab, Pakistan
ABSTRACT
Survival probability of P.falciparum was determined against the chloroquine and its combination with sulphadoxine-pyremethamine, Type of study: Prospective nonrandomizcd descriptive study. Place and duration of study: Study was conducted in five districts [Muzaffargarh, D.G, Khan, Jhang, Sheikhupura and Multan] of Punjab, Pakistan, During the non-transmission season of the year 1999 to 2000 and 2008, among the rural populations 5952 persons were screened for malarial parasites, Methodology: During the malaria non transmission season [November, December and January], 5952 persons were screened for malaria and 1409 positive cases were detected, 404 subjects out of total positive cases were selected to be tested against chloroquine and 50 with combination of chloroquine and sulphadoxine-pyremethamine by in vivo technique. Follow up was carried out for 28 days [on day 1, 2, 3, 7, 14, 21 and 28], Over all 35, 4% resistance-I was detected against chloroquine monotherapy and 4% with combination therapy [chloroquine and sulphadoxine-pyremethamine] Resistance-Ill was not found. Two variables were found important predictors of drug resistance; a young child and a high parasitaemia count [>6000/micro1] at day 0, It is concluded that malaria is still significant problem and resistance against monotherapy is increasing, hence adoption of combination therapy as first line treatment for uncomplicated falciparum malaria in Punjab Pakistan is recommended
Subject(s)
Humans , Chloroquine , Drug Combinations , Pyrimethamine , Sulfadoxine , SurvivalABSTRACT
Antimalarial drug resistance was checked against Plasmodium falciparum in Punjab Pakistan, Prospective nonrandomized descriptive study. Study was conducted in seven districts [Muzaffargarh, D.G.Khan, Jhang, Sheikhupura, Faisalabad, Lahore and Multan] of Punjab, Pakistan during the transmission season from July-November of 2003 to 2008. Out of total positive for P.falciparum 612 [228+192+192] subjects were enrolled for study as per eligibility criteria of World Health Organization [WHO] and in vitro standard test kit was used for study. Differences in proportions and its significance were analyzed by chi-square tests. Resistance [%] to chloroquine was noted higher in males [79.5%] and in females [20.4%]. Highest resistance [%] 31.8 was detected in 6-15 years age group. Same resistance [%] trend was observed in basoquine for males [72], females [28.35], for age groups 6-15 years [41.7] and total was 34.8. Sulphadoxine-pyrimethamine found highly effective with only 5.7% resistance. Trend of resistance [%] in male, female and among different age groups was found same in chloroquine and basoquine. Differences among the resistance [%]sulphadoxine-pyrimethamme and chloroquine or basoquine was highly significant [p<0.00l] and between basoquine and chloroquine resistance difference was non significant [p>0.177]. Male of age group 6-15 years having 6000 parasite >/= microl must be treated on priority basis by artesunate combination therapy [ACT]. Chloroquine was less effective than sulfadoxine-pyrimethamine [adjusted odds ratio [OR], 6.4; 95% confidence interval [CI], 2.4-17.0; P<.001] and basoquine [adjusted OR, 8.4; 95% CI, 2.0-36.5; P = .004]. Chloroquine and sulfadoxine-pyrimethamine were equivalent in efficacy at day 28 [adjusted OR, 1.3; 95% CI, 0.3-7.0; P = .73]