s the world celebrates Global Malaria Day on April 25, malaria remains a significant global health challenge, with high numbers of cases and deaths in regions around the equator, especially in sub-Saharan Africa. Pregnant women and children under five years old are particularly vulnerable, with a high percentage of malaria deaths occurring in these sections of society. (https://www.who.int/news-room/fact-sheets/detail/malaria). Pakistan is considered a moderate malaria-endemic country. A large portion of the population is at risk of contracting the disease, particularly in malaria-endemic regions. Plasmodium vivax is the primary cause of malaria cases in the country, followed by plasmodium falciparum.

(https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON413). Effective prevention and treatment strategies are critical to controlling the spread of malaria and reducing its impact on economic challenges and human health.

Malaria is a febrile illness caused by the plasmodium parasite, which is transmitted to humans through the bite of infected female Anopheles mosquitoes. There are five species of plasmodium that can cause the disease: falciparum, vivax, ovale, malaraiae and knowlesi. Of these, plasmodium falciparum infections are generally considered the most serious and potentially fatal. The Anopheles mosquito typically bites at night in hot and humid climates, where they can easily breed. When an infected mosquito bites a person, it injects plasmodium parasites into their blood. The parasite then invades and infects the red blood cells, where they multiply rapidly and cause the cells to burst, releasing more parasites into their bloodstream. (White, N. J (1992). Advances in parasitology, 31, 83-173).

Symptoms of malaria appear within one to four weeks after infection. The initial symptoms are often flu-like in nature, including fever, chills, headache, muscle pain, fatigue and nausea. These symptoms may be mild at first, and may be mistaken for other illnesses. However, as the disease progresses, patients may develop additional symptoms such as jaundice, anaemia and respiratory distress. In severe cases, malaria can lead to organ failure, seizures, coma and death. Initial diagnosis of febrile disease in Pakistan is commonly done by front-line caregivers, the general physician in primary, secondary and tertiary care settings. Diagnosis is by identifying malarial parasites through “thick and thin blood film”. This is done by examining a stained drop of a patient’s blood taken through finger-prick testing, under a microscope known as a “blood smear”. The Giemsa stain is commonly used for identifying plasmodium species. As in the early stages of the disease, fewer parasites are present, a thick blood film identifies the plasmodium. On the other hand, a thin blood film allows doctors to better visualise the shape and size of the various stages of the parasite’s lifecycle. Other diagnostic methods, such as rapid diagnostic tests (RDT) and molecular techniques, are also used in certain situations depending on the availability of resources and the specific needs of the patient. All this information is utilised to help determine the severity of the infection, monitor the effectiveness of treatment and guide decisions about further diagnostic testing or treatment options. (DhordaM;2015).

Researchers in the developed world are working on developing a vaccine for malaria. In 2021, Oxford’s antimalarial vaccine trial in Burkina Faso involving 450 children, showed promising results.However, further testing is needed to ensure the safety and efficacy of the vaccine.

The disease is most common in hot and humid areas where mosquitoes can breed easily. The severity of the disease depends on a person’s immune status and other underlying health conditions. Young children under five years old, pregnant women, patients with other conditions like HIV/ AIDS, and travellers with no prior exposure to malaria are the most vulnerable populations. Pregnant women with no prior exposure to malaria are the most vulnerable. Furthermore, pregnant women and young children are particularly susceptible to severe forms of malaria, which can have long-lasting effects on their health and well-being. Therefore, the WHO advises certain preventive therapies for children under five and recommends anti-malarial medications for pregnant women at each of their scheduled antenatal visits (https://www.who.int/news-room/fact-sheets/detail/malaria).

Preventing and controlling the spread of malaria is essential to protect vulnerable populations. The use of long-lasting insecticide-treated bed nets in all at-risk areas can help reduce the number of mosquito bites. Mosquito-proof screening on windows can also reduce the risk of being bitten. In addition, spraying insecticide in homes and communities can also help reduce the risk of malaria transmission. This method is effective for 3 to 6 months, depending on the insecticide type and usage. Researchers in the developed world are working on developing a vaccine for malaria. In 2021, Oxford’s antimalarial vaccine trial in Burkina Faso involving 450 children, showed promising results. However, further testing is needed to ensure the safety and efficacy of the vaccine. (https://www.youtube.com/watch?v=bHATMZF6AFc World-changing’ malaria vaccine developed – BBC News).

The increase in suspected malaria cases in Pakistan in the first eight months of 2022 is a cause for concern. A majority of the confirmed cases were caused by plasmodium vivas, with a rapid upsurge observed after floods in Balochistan and Sindh. A similar increase has been observed in the Punjab as well, in spite of being the most developed region of the country (Qureshi et al. BMC Infectious Diseases (2019) 19:935).

Effective education, collaboration and surveillance systems are needed for sustained malaria elimination (Tang et al. Malar J (2016) 15:373 ). Prompt diagnosis and treatment at the basic health unit level are crucial for reducing the burden of malaria and improving access to healthcare. This is only achievable if continued efforts and resources are put in place to control the spread of malaria in affected areas. Reducing malaria prevalence and elimination of this preventable illness will require multi-disciplinary actions with a focus on empowering and capacity building of primary care physicians.

The writer is a family physician