부산대학교 도서관

Background: 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. Author summary: The malaria epidemic and endemic in tribal areas of KPK, Pakistan is a present and constant threat to public health. It has been a great challenge in monitoring the incidence of malaria in tribal districts of KPK because of the military conflict. We report an epidemiological, clinical, and household assessment of malaria endemicity in the six tribal districts of KPK, Pakistan, which is the most neglected area due to militancy and war in Afghanistan. The study sample comprised of1,127malaria-suspectedpatients. Their blood samples were collected for microscopy, nPCR and biochemical analysis. Of the samples collected, 78% were identified as Plasmodium-positive by microscopic analysis, whereas, 38% were determined as Plasmodium-positive by nPCR. Then PCR analysis detected 87% (n = 373 out of 429) and 13% (n = 56 out of 429) P. vivax and P. falciparum cases, respectively. Cases were noticeably higher in males (74%). We found poor hygiene conditions in all the districts we examined, probably caused by low socioeconomics settings. Hyperpyrexia (27%) was the prominent clinical feature among all the cases infected by both P. vivax and P. falciparum. Our findings have substantial implications for both malaria control and public health in the tribal districts of Pakistan. [ABSTRACT FROM AUTHOR]