Professional Documents
Culture Documents
Dr Tariq Mahmood
MSPH 2009-10
Health Services Academy
Islamabad
INTRODUCTION
Malaria1 is the most important of the parasitic diseases of humans, with 107 countries & territories having
areas at risk of transmission containing close to 50 % of the world’s population (Hay & others 2004; WHO
2005).
CLINICAL FEATURES
In Uncomplicated cases
Intermittent fever
Chills
Headache
In Complicated cases
Altered consciuosness
Generalized seizures
Severe anemia
CASE DEFINITION
SUSPECTED MALARIA
Person has intermittent fever, chills & headache. Severe or complicated malaria may be suspected if patient
has any of these signs such as altered consciousness, generalized seizures, difficulty in breathing, low urinary
output, dark urine, severe anemia
CONFIRMED MALARIA
Malaria can be confirmed by identification of the malarial parasite in the peripheral blood film.
GLOBAL SITUATION
BURDEN OF DISEASE
In 2001, the WHO ranked malaria as the 8th -highest contributor to the
global disease burden as reflected in disability-adjusted life years (DALYs),
& 2nd highest in Africa (WHO 2002a). The DALYs attributable to malaria
were estimated largely from effects of P. falciparum infection as a direct
cause of death (Murray & Lopez 1996, 1997).
Malaria accounts for 2.0% of global deaths2 & 2.9% of global DALYs. In the
African region of WHO, 9.0% of deaths & 10.1% of DALYs are attributable
to malaria. Recent analysis of falciparum malaria morbidity concludes that
515 (IQR 298 to 659) million cases occur yearly. (Snow & others 2005).
Recent estimates of malaria deaths have varied from 0.5 to 3.0 million per
year (Breman 2001; Breman, Alilio, & Mills 2004; Snow & others 2003). In
1998, an analysis of malaria mortality by WHO, used malaria risk maps to
capture measures of disability, morbidity, & mortality associated with P.
falciparum prevalence rates among African populations & yielded an
estimate of about 1 million (Korenromp & others 2003; Snow & Marsh 2003;
Snow & others 2002).
REGIONAL SITUATION
Plasmodium
vivax
distribution
(2005)
Malaria Morbidity & Mortality
Pakistan
Malaria Situation
The National Malaria Control Program reported a total of 131,179 confirmed
cases of malaria from public sector sources in 2003. During the same year,
the API in Pakistan was reported at 0.8/1000 population with significant
regional variations; the highest being for Balochistan (5.81/1000 population).
Malaria control was initiated in Pakistan in the 1950s & has passed through
several evolutionary phases. In 1975, a malaria control strategy was adopted
with provincial commitment to implementation & in 1998, Pakistan joined the
global Roll Back Malaria (RBM) initiative. This led to the development of a
five-year RBM project in 2001 as part of which efforts were intensified in the
28 high-risk districts. More recently, a Strategic Plan for 2005-10 based on
the RBM strategy has been developed & a number of steps taken for its
implementation. The MDG-6 Combat HIV/AIDS Malaria & other diseases
targets for malaria prevention – implying an average increase in malaria
prevention of 4-5% p.a for 10 years– although ambitious, may be achievable
with recent expansion of RBM strategy.
Disease pattern in Pakistan
Falciparum as % of
all malaria cases, 2001
Falciparum % NWFP
FATA
Orange 40-85 %
Pink 8-40 % PUNJAB
Green 1-8 %
BALOCHISTAN
N
SINDH W E
S
Percentage of Plasmodium Falciparum from 1997- 2001
70
1997 1998 1999 2000 2001
60
50
40
30
20
10
0
Punjab S indh N W FP & FA TABaluchistan P A KIS TAN
1997 28.8 63.7 17.1 29.6 32.6
1998 25.1 63.8 22.9 29.2 33.9
1999 24.2 62.1 24.2 24.8 33.1
2000 21.9 57.3 23.4 32 33.2
2001 26.2 49.9 21.9 37.4 33.8
Chart showing
Annual Falciparum Incidence
International Statistical Classification of Diseases & Related Health Problems
10th Revision
Version for 2007
ICD 10 Definition
ICD-10 was endorsed by the Forty-third World Health Assembly in
May 1990 and came into use in WHO Member States as from 1994
Chapter 1
Certain infectious and parasitic diseases (A00-B99)
Protozoal diseases (B50-B64)
B50 Plasmodium falciparum malaria Includes: Mixed infection
of Plasmodium falciparum é any other Plasmodium species
The delivery of IPT will be part of focused ANC services coordinated by the
reproductive health program of the MOH. Emphasis will be on at least 4 visits for
each pregnant woman in order to provide all services needed & allow timely delivery
of at least 2 doses of IPT.
Pregnant women will be targeted for the distribution with ITN/LLIN particularly
through ANC services.
Treatment of clinical malaria cases during pregnancy & the management of severe
malaria are part of the general approaches towards case management.
Key Determinants of Malaria
Roll Back Malaria’s Strategy & Goals for 2010
The goal of Roll Back Malaria6 Partnership is to halve the burden of malaria by 2010. The following
targets for specific intervention strategies were established at the Abuja Malaria Summit in April 2000.
AIM
• To reduce the mortality & morbidity due to plasmodium
falciparum malaria in pregnancy in Pakistan
OBJECTIVES
• To have 50% of all pregnant women access IPT by 2011
• To have at least 60% of pregnant women access quality
case management according to national guidelines by 2011
• To have at least 60% of all pregnant women have access to
ITNs by 2011
INTERVENTIONS & THEIR EFFECTIVENESS