Department of Bioscience and Biotechnology, The University of Suwon, Hwaseong City, Gyeonggi-do, Republic of Korea.
Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia.
PLoS Negl Trop Dis. 2021 May 3;15(5):e0009371. doi: 10.1371/journal.pntd.0009371. eCollection 2021 May.
Malaria, disproportionately affects poor people more than any other disease of public health concern in developing countries. In resource-constrained environments, monitoring the occurrence of malaria is essential for the success of national malaria control programs. Militancy and military conflicts have been a major challenge in monitoring the incidence and controlling malaria and other emerging infectious diseases. The conflicts and instability in Afghanistan have resulted in the migration of refugees into the war-torn tribal districts of Pakistan's Khyber Pakhtunkhwa (KPK) province and the possible introduction of many contagious epidemics. Although malaria is very common in all tribal districts, molecular, clinical and epidemiological data are scarce in these high-burden districts. Therefore, for the proper surveillance, detection, and control of malaria, obtaining and analyzing reliable data in these districts is essential.
METHODOLOGY/PRINCIPAL FINDINGS: All 1,127 malaria-suspected patients were sampled within the transmission season in the tribal districts of KPK province between March 2016 to December 2018. After a detailed demographic and clinical investigation of malaria-suspected patients, the data were recorded. The data of the control group was collected simultaneously at the same site. They were considered as uncomplicated cases for statistical analyses. Blood samples were collected from malaria-suspected patients for the detection of Plasmodium species using microscopy and nested PCR (nPCR). Microscopy and nPCR examination detected 78% (n = 882) and 38% (n = 429) Plasmodium-positive patients, respectively. Among1,127 of 429nPCR detected cases with both species of malaria, the frequency of complications was as follows: anemia (n = 71; 16.5%), decompensated shock (n = 40; 9%), hyperpyrexia (n = 117; 27%), hyperparasitaemia (n = 49; 11%) hypoglycemia (n = 45; 10.5%), jaundice (n = 54; 13%), multiple convulsions (n = 37; 9%), and petechia (n = 16; 4%). We observed that 37% (n = 157 out of 429) of those patients infected by both Plasmodium species were children between the ages of 1 and 15 years old. The results revealed that Bajaur (24%), Kurram (20%), and Khyber (18%) districtshada higher proportion of P. vivax than P. falciparum cases. Most of the malaria cases were males (74%). Patients infected by both Plasmodium species tended to less commonly have received formal education and ownership of wealth indicators (e.g., fridge, TV set) was lower.
CONCLUSIONS/SIGNIFICANCE: Malaria in tribal districts of the KPK province largely affects young males. P. vivax is a major contributor to the spread of malaria in the area, including severe malaria. We observed a high prevalence of P. vivax in the Bajaur district. Children were the susceptible population to malaria infections whereas they were the least expected to use satisfactory prevention strategies. A higher level of education, a possession of TV sets, the use of bed nets, the use of repellent fluids, and fridges were all associated with protection from malaria. An increased investment in socio-economic development, a strong health infrastructure, and malaria education are key interventions to reduce malaria in the tribal districts.
疟疾在发展中国家比任何其他公共卫生关注的疾病都更严重地影响贫困人口。在资源有限的环境中，监测疟疾的发生对于国家疟疾控制规划的成功至关重要。好战和军事冲突一直是监测发病率和控制疟疾和其他新出现的传染病的主要挑战。阿富汗的冲突和不稳定导致难民涌入巴基斯坦开伯尔-普赫图赫瓦省（开普省）饱受战争蹂躏的部落地区，可能引入了许多传染性流行病。虽然疟疾在所有部落地区都很常见，但这些高负担地区缺乏分子、临床和流行病学数据。因此，为了对疟疾进行适当的监测、检测和控制，在这些地区获取和分析可靠的数据是必要的。
方法/主要发现：2016 年 3 月至 2018 年 12 月期间，在开普省部落地区的疟疾传播季节内对所有 1127 名疟疾疑似患者进行了采样。在对疟疾疑似患者进行详细的人口统计学和临床调查后，记录了数据。对照组的数据同时在同一地点收集。它们被认为是用于统计分析的简单病例。从疟疾疑似患者采集血液样本，通过显微镜检查和巢式 PCR（nPCR）检测疟原虫种。显微镜检查和 nPCR 检测分别检测到 78%（n=882）和 38%（n=429）的疟原虫阳性患者。在 429 例 nPCR 检测到的疟疾病例中，有 4 种疟疾病例，并发症的频率如下：贫血（n=71；16.5%）、失代偿性休克（n=40；9%）、高热（n=117；27%）、高寄生虫血症（n=49；11%）、低血糖（n=45；10.5%）、黄疸（n=54；13%）、多发性惊厥（n=37；9%）和瘀点（n=16；4%）。我们观察到，感染两种疟原虫的患者中有 37%（n=157 例）是 1 至 15 岁的儿童。结果表明，巴焦尔（24%）、库拉姆（20%）和开伯尔（18%）地区的 P. vivax 病例比例高于 P. falciparum 病例。大多数疟疾病例是男性（74%）。感染两种疟原虫的患者往往受正规教育程度较低，拥有财富指标（如冰箱、电视机）的比例也较低。
结论/意义：开普省部落地区的疟疾主要影响年轻男性。P. vivax 是该地区疟疾传播的主要原因，包括严重疟疾。我们观察到巴焦尔地区的 P. vivax 发病率较高。儿童是疟疾感染的易感人群，但他们最不可能使用令人满意的预防策略。较高的教育水平、拥有电视机、使用蚊帐、使用驱虫液和冰箱都与预防疟疾有关。增加对社会经济发展的投资、加强卫生基础设施建设和疟疾教育是减少部落地区疟疾的关键干预措施。
