Prevalence of Drug Resistance Malaria in Pakistan (Plasmodium.vivax and P. falciparum)
Malaria every year kills million of people in tropical areas across the world. The major obstacle to roll back malaria is drug resistance, thus conducting research is very important in this field. It’s known that drug efficacy determines by plasma separation and quantification and several factors play important role in it such as sensitivity, partial immune response and toxic effects. The poor cure rates due to substandard and fake anti-malarial drugs are another obstacle to roll back malaria in developing countries; substandard tablets contain poor action ingredients. The general aim of the present study is to assess the prevalence of drug resistance malaria (Plasmodium vivax and P. falciparum) in malaria endemic areas of Pakistan. This is a literature review study and it included published research papers on drug resistance malaria in Pakistan. Inclusion and exclusion criteria was used, Pubmed and Scopus data basis were used, eight papers were selected, coded, analyzed and critically discussed. Therapeutic efficacy tests involving choloroqunie and other artemisin-combined therapy (ACTs) based on post-1973 WHO protocols found several factors which take part in emergence of decreased anti-malarial sensitivity. One factor is substandard tablets which contain poor action ingredients. In addition sub-theraputic dosing increases drug resistance for malaria. In some regions other factors could be duration, artemisininsin used from last few decades, unique massive drug pressure, low malaria transmission are facilitating anti-malarial sensitivity and resistance. Late diagnosis, lifestyle, male gender, traveling, poor diagnosis, vector control, education of medical practitioners and miss use of medicine are other significant factors for the prevalence of drug resistance malaria in Pakistan. Most of studies observed that children are more vulnerable to anti-malarial resistance (6-15 years age group), in addition male gender were more affected, which could be due to nature of their work. Progressive Artemisinin resistance P.falciparam malaria has been reported during routine surveillance. Despite progress in health system malaria still remains a major burden to public health. Its fact that incidence of P. falciparum is increasing compared with P.vivax. The major obstacle to roll back malaria in Pakistan is anti-malarial resistance and poor cure rates of anti-malarial drugs. The prevalence trend of P.falciparam has shown continuous increase in all endemic areas of Pakistan. Drug efficacy trials conducted in Pakistan has given important indication to guide country’s national malaria treatment policy. There is need of more extensive studies to observe, find obstacles and conduct drug resistance surveillance regarding anti-malarial in Pakistan. Furthere, there is need to monitor response of anti-malarial and take measures to prevent surfacing of drug resistance. Prevention of resistance could be possible through access of high quality effective ACTs in large scale. Furthermore there is need of proper education of practitioners, raise observance of ACTs users, proper diagnosis to avoid medicine misuse, transmission control to decrease use of anti-malarial drugs and diminish reservoir of infection. In Pakistani context encouragement of early diagnosis, proper treatment, reduce drug pressure, optimize vector control, target mobile population, proper management, good surveillance and operational research is important.
Plasmodium;Vivax;Falciparm;Malaria;Drug resistance;Sulphadoxine pyrimethamine