Alarming surge in malaria cases in Sindh termed ‘tip of the iceberg’

• Govt says 64,519 test positive in August compared to 49,112 cases reported in July
• Stagnant floodwater, poor sanitation blamed for rising cases of vector-borne disease

KARACHI: Despite experiencing a largely dry August so far, the province of Sindh is seeing growing numbers of malaria cases this month in every division, particularly lower Sindh, forcing the health minister to direct the officials concerned to prepare a province-specific action plan to counter the mosquito-borne illness and set up separate wards for patients, it emerged on Saturday.

Sources blamed the situation on failure on the part of local administrations in draining out water still standing in several districts of lower Sindh almost a year after the floods hit the province.

The sources said that the local administrations had also failed to improve the pitiable state of drainage, sanitation and solid waste management system across the province.

Poor sanitation conditions took a huge toll on public health every year affecting countless people and costing the government billions of rupees every year, they added.

Official figures — often disputed by independent health experts who considered it as the tip of the iceberg — showed that 286,317 cases of high fever were reported at health facilities in the province this month.

Of them, 64,519 patients tested positive for malaria — an increase of 31 per cent as compared to last month, which saw 49,112 cases.

Most of these cases, according to the official data, are reported in Hyderabad division (31,891) followed by Mirpurkhas division (18,553), Larkana division (8,476), Sukkur division (2,595), Shaheed Benaziarabad (2,530) and Karachi division (474).

The most affected districts were Thatta (10,182) followed by Mirpurkhas (9,621), Umarkot (6,195), Hyderabad (6,531), Larkana (4,512), Dadu (3,188), Shikarpur (2,000) Jamshoro (2,242) Badin (4,399), Sujawal (2,681), Tando Allah Yar (1,202) and Tharparkar (2,737).

Official figures show that there has been a gradual increase in malaria cases over the months and the province has reported 247,799 malaria cases from January till August.

Speaking to Dawn, provincial Director General of Health Dr Irshad Memon linked the surge in malaria cases to standing floodwater (in some districts) and poor sanitation conditions in rest of the province.

“The situation exists because the local and district administrations have decided that fumigation and fogging isn’t their job,” he said, adding that there won’t be any malaria cases if the concerned departments were fulfilling their responsibilities that included draining out stagnant water/sewage and properly disposing of liquid and solid waste.

According to him, malaria diagnosis and relevant medicines are available at all basic health units across the province free of cost.

The health department, he added, had done extensive screening for vector-borne diseases across the province and distributed mosquito nets in the four high-risk districts of Thatta, Sujawal, Tando Mohammad Khan and Umarkot.

“We are also setting up dedicated clinics and wards at hospitals. Drug inspectors have been directed to look into the shortage of malaria medicines in the market,” he said, emphasising that all efforts would go in vain unless the local government carried out its job.

Responding to a question about 221,798 cases of high fever, excluding malaria cases, screened this month, he said that these illnesses included cases of viral fever and typhoid.

A day earlier, Health Minister Dr Saad Khalid Niaz had also directed the officials to prepare a province-specific action plan to counter malaria and hold meetings with partner Global Fund to address medicines’ shortage.

Karachi cases

The official data also showed Malir district as the most affected in Karachi, reporting 474 malaria cases this month.

Speaking to Dawn, doctors practicing in different parts of the city stated that the official figure underestimated the situation and that the actual number of cases in Karachi was much higher, though smaller in numbers as compared to the cases in the interior parts of Sindh.

“Malaria cases are on the rise across Karachi. I don’t think that official stats represent the real picture,” Dr Altaf Hussain Khatri, a senior general physician, said, adding that he had been examining at least three to four patients of malaria daily since the start of this month at his clinic located in the old city area.

“And, it’s only about one clinic. One can safely assume a similar pattern exists in other parts of the city,” Dr Khatri, also heading the Pakistan Medical Association, Karachi chapter, shared, adding that he received patients from Gadap and Hub Chowki areas as well.

Seconding his opinion, Dr Abdul Ghafoor Shoro representing PMA-Centre and senior Karachi-based general physician, said that often patients didn’t opt for laboratory diagnosis due to financial constraints.

“The recent unprecedented inflation has compounded poor men’s miseries. Many of them prefer to have provisional diagnosis and spend money on the medicine rather than having a laboratory diagnosis,” he said.

According to Dr Shoro, the situation with respect to malaria and other infections such as typhoid is more serious in the interior parts of the province especially lower Sindh, particularly Keti Bandar, where people were forced to live in subhuman conditions.

“The public health situation is worrisome in areas where floodwater is still standing and doctors frequently report cases of vector-borne diseases.”

The experts called for steps that could help prevent the outbreak of easily preventable illnesses that could be achieved through improving sanitation conditions, timely fumigation and creating public awareness.

They also called upon the government to cut down prices of all medicines that had been raised up to 25 per cent by the Drug Regulatory Authority of Pakistan.

Published in Dawn, August 27th, 2023