a Department of Zoology , University of Peshawar , Peshawar , Pakistan.
b Department of Pharmacy , University of Peshawar , Peshawar , Pakistan.
Pathog Glob Health. 2019 Mar;113(2):75-85. doi: 10.1080/20477724.2019.1595904. Epub 2019 Mar 21.
The present study was aimed at elucidation of malaria epidemiology and comparing performance of several diagnostic procedures in Bannu, a highly endemic district of Khyber Pakhtunkhwa, Pakistan. Dried blood spots were collected from patients suspected of malaria visiting a hospital and two private laboratories in district Bannu and processed for species-specific PCR (rRNA). Patients were also screened for malaria through microscopy and RDT. A well-structured questionnaire was used to collect patient information to assess risk factors for malaria. Of 2033 individuals recruited, 21.1% (N = 429) were positive for malaria by at least one method. Overall, positivity detected by PCR was 30.5% (95/311) followed by 17.7% by microscopy (359/2033) and 16.4% by RDT (266/1618). Plasmodium vivax (16.9%, N = 343) was detected as the dominant species followed by Plasmodium falciparum (2.3%, N = 47) and mixed infections (1.2%, N = 39). Microscopy and RDT (Cohen's kappa k = 0.968, p = <0.0001, McNemar test p = 0.069) displayed significant agreement with each other. Satisfactory health, sleeping indoors, presence of health-care facility in vicinity (at an accessible range from home), living in upper middle class and in concrete houses significantly reduced malaria risk; whereas, low literacy level, presence of domestic animals indoors and malaria diagnosis recommended by clinician increased the disease risk. Overall, findings from the study provide reasonable basis for use of RDT as a cost-effective screening tool in field and for clinicians who can proceed with timely treatment of malaria patients. Appropriate management of identified risk factors could contribute to reduction of malaria prevalence in Bannu and its peripheries.
本研究旨在阐明疟疾流行病学，并比较几种诊断程序在巴基斯坦开伯尔-普赫图赫瓦高度流行地区班努的表现。从疑似疟疾就诊于医院和班努区两家私人实验室的患者中采集干血斑，并进行种特异性 PCR（rRNA）处理。还通过显微镜检查和 RDT 对患者进行疟疾筛查。使用结构化问卷收集患者信息，以评估疟疾的危险因素。在招募的 2033 人中，至少有一种方法检测出 21.1%（N=429）为疟疾阳性。总体而言，PCR 检测的阳性率为 30.5%（95/311），其次是显微镜检查的 17.7%（2033/359）和 RDT 的 16.4%（1618/266）。检测到以间日疟原虫（16.9%，N=343）为主，其次是恶性疟原虫（2.3%，N=47）和混合感染（1.2%，N=39）。显微镜检查和 RDT（Cohen's kappa k=0.968，p<0.0001，McNemar 检验 p=0.069）彼此显示出显著一致性。健康状况良好、室内睡眠、附近有医疗设施（从家可及范围内）、中上层阶级生活和住在混凝土房屋中可显著降低疟疾风险；而低文化程度、室内有家畜和临床医生建议的疟疾诊断则增加了疾病风险。总体而言，该研究结果为在实地和临床医生中使用 RDT 作为具有成本效益的筛查工具提供了合理依据，以便及时治疗疟疾患者。适当管理已确定的危险因素有助于降低班努及其周边地区的疟疾流行率。
