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WHO's efforts to prevent a malaria epidemic in Pakistan, 12 October

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12 October 2010, Islamabad - Almost 300 000 suspected cases of malaria, including confirmed cases of severe falciparum malaria, have been recorded in flood-affected areas of Pakistan since 29 July 2010, an overall number which is slightly above the average annual malaria seasonal levels. WHO is supporting Pakistan's Ministry of Health malaria control programme, as well as Health Cluster partners, to prevent and control a malaria epidemic in the country.

Malaria is endemic in rural areas of Pakistan where there are two seasonal peaks: in August (mainly due to the milder vivax -malaria) and October (the potentially fatal falciparum malaria). More than one million malaria cases are registered annually but 12% of people living in the rural areas carry malaria parasites in the blood without showing symptoms of malaria.

Balochistan province has recorded the largest proportion of consultations for suspected malaria, while increasing numbers of cases are also being reported in Punjab and Sindh provinces according to the Disease Early Warning System of WHO and the Federal Ministry of Health. The increased number of malaria cases is definitely caused by the floods that have displaced millions of people, leaving many living in poor shelters, and has left many water ponds, which are ideal breeding sites for Anopheles mosquitoes.

"The total number of suspected malaria cases reported in flood-affected districts is only slightly higher than at the same period in previous years, however, falciparum malaria needs special consideration as it is responsible for severe cases and it can be fatal", says Dr Guido Sabatinelli, WHO Representative in Pakistan.

WHO is coordinating the deployment of preventive and curative measures in each of Pakistan's provinces and is supporting Pakistani health authorities through the Health Cluster network of humanitarian health providers. Communicable disease surveillance of all epidemic-prone diseases has been strengthened and senior malariologists are currently visiting Sindh, Punjab and Baluchistan provinces to assist the Pakistan Ministry of Health's malaria control programme in conducting outbreak investigation, training and malaria control activities. The United States Agency for International Development (USAID) has donated, through WHO, US$ 5 million for malaria prevention and control activities in flood-affected districts of Pakistan.

“Rapid diagnostic tests have been provided by WHO to health authorities and cluster partners in areas where laboratory diagnosis by microscopy is either not possible or unreliable," says Dr Kakar. "The rapid diagnostic test can detect in a single drop of a person's blood, in a few minutes, the presence of Plasmodium vivax or P. falciparum. Such rapid diagnosis and effective treatment saves lives", says Dr Kakar Qutbuddin, WHO malariologist.

As part of its response activities so far, WHO has provided 320 700 rapid diagnostic tests and procured 145 000 long-lasting insecticidal nets, distributing 95 000 to health authorities in Sindh province (75 000 to Sukkur district, and 20 000 in Hyderabad district). WHO in the last week has also dispatched to provinces 55 000 arthemisine-based combination treatments for falciparum malaria and 30 000 primaquine tablets for radical cure of vivax malaria, while 5 million tablets have been ordered. The UK-based nongovernmental organization, International Health Partners, has donated 600 000 primaquine tablets that can treat 18 000 people.