ABSTRACT
Malaria is a serious global health challenge. It continues to be a threat to the developing countries. Epidemiological data from different regions of Pakistan is insufficient to exactly evaluate the incidence of various types of malaria. D. I. Khan is a hot area on the right bank of the river Indus, providing favourable circumstances for mosquito breeding. We conducted this study to see the prevalence and presentation of various types of malaria in adult patients presenting with fever, and its response to anti-malarial agents in this region. This cross-sectional study was conducted in the department of Medicine, Gomal Medical college, D. I. Khan, from 28[th] August 2005 to 27[th] February 2006. All adult patients presenting to the outpatient clinic with fever were included in the study. A total of 490 patients presented with fever as a chief complaint. After detailed history and thorough clinical examination, Giemsa stained thick and thin blood films were examined. Species determination and parasite count were performed. Patients were grouped into two; Group A having Falciparum malaria and Group B any other type. Group A patients were randomly given either Quinine or Artemnether. Group B patients were given Chloroquine, Quinine or Artemether in standard doses. MP and parasite count were repeated on day 7 and 14 and the presence of more than 25% parasitaemia as compared to pretreatment was taken as treatment failure. Out of 490 patients, ninety-eight [20%] were found positive for malaria, seventy-five males and 23 females. Comparing the symptoms in falciparum and vivax malaria, it was found that nausea/vomiting was twice as common in falciparum malaria. Comparing the anti-malarial drugs, Chloroquine and Quinine were found to be effective in all patients. On the other hand Artemether was found to be 100% effective in vivax malaria and poor response to therapy was observed in two [4%] patients with falciparum malaria. As a conclusion malaria is responsible for fever in every fifth adult patient in our setup. Males are three times more commonly affected than females. Plasmodium falciparumn is 1.5 times more common than vivax. Nausea/vomiting and pallor are more common in falciparum, while splenomegaly is seen in vivax malaria. Commonly used anti-malarial drugs are effective in most of the cases