Prevalence and associated risk factors of malaria: a population-based study in northwestern Pakistan

Abstract

Introduction: Malaria is the one of major health problem, predominant in the world and leading cause of illness and death in Pakistan and other developing countries. Major receptors for Plasmodium are glycophorin on red blood cells, which are gate for parasite entry. The present study was designed to investigate the prevalence of malaria prevalence in district Bannu, a highly endemic district of Khyber Pakhtunkhwa, Pakistan and association of glycophorin gene with malarial severity. Material and Methods: Blood sample were from 400 patients visiting diagnostic laboratories of DHQ hospital, KGN hospital, W&C hospital of district Bannu, examined via microscopy. A well-structured questionnaire was used to collect patient information to assess risk factors associated with malaria. DNA extraction of 50 positive blood samples was performed. GYPB gene exon 4 was amplified by PCR. Results: The study detected over all 113 (28.25%) confirmed positive patients, and prevalence of malaria was high in male 73(18.3%), and among age group 11-20 years, rural communities 73(18.5%), and in primary level of education 54(13.5%). Malaria infection was significantly higher at Miryan 16(4.0%) as compared to other areas of Bannu district. According to blood groups, prevalence was high among AB-ive, B+ive and O+ive (n=22, 5.5%) blood groups. Clinical factors such as fever, malaria symptoms, repeated malaria infection, home treatment with antimalarial drugs were significantly (P=<0.0001) associated with malaria. The prevalence of malaria was significantly (P=<0.0001) associated with preventive measures such as mosquito repellent, indoor residual spraying, mosquito nets used, water preservation at home, wearing sleeveless shirts. Other environmental factors such as presence of plants at home, sewage canal close to home, standing water bodies in surrounding area, environmental cleanness, holes in the walls were also found significant (P=<0.0001) risk factors for malarial prevalence. The PCR product of 245bp of exon 4 of GYPB gene was obtained. Conclusion: The finding suggested high malarial prevalence in Bannu district and environment and household conditions, lack of preventive measures found as major risks factors for high prevalence of malaria. Due to paucity of funds GYP gene exon 4 sequencing was not done. Further studies are required to sequence this gene to find the association with malaria severity and resistance.