KARACHI: As dengue has started rearing its head and creating fear that the vector-borne illness is likely to affect a large segment of population in coming weeks, mosquitoes carrying malaria pathogens seemed to have expanded their range with reports of more than a hundred cases in a day being reported at one major tertiary care public sector hospital of the metropolis, sources told Dawn.

Information gathered from different healthcare facilities reveal that malaria has become a major source of concern over the past few months, affecting hundreds of people in the city and that the official figures do not reflect the reality.

The health department data shows that only a few hundred cases of malaria had been reported over the past few months in Karachi, contrary to the situation in the interior parts of Sindh where thousands of people were getting affected by the mosquito-borne illness.

Official figures vs reality

According to the official data, more than 31,000 cases were reported in Hyderabad division alone in August. A total of 213 malaria cases were reported in Karachi in May, 255 in June, 277 in July and 474 cases in August. No mortality was reported.

Official figures show fewer cases and no mortality, hospitals report three deaths among hundreds of patients

It also shows that a total of 828 cases of dengue were reported in Karachi so far this year with no death.

However, the data gathered from the Sindh Infectious Disease Hospital and Research Centre shows that two patients died of malaria in May this year and one from dengue in June.

A total of 320 patients (37 in May and 52 in June) received treatment for malaria this year at the hospital where patient admission has risen from 52 cases in July to 133 cases last month.

The hospital has also treated 102 dengue patients this year. Fourteen malaria and five dengue patients were admitted for treatment this month (September).

According to a spokesperson for the Indus Hospital, Korangi campus, the hospital has seen 20 and 36 admissions of malaria patients in July and August, respectively. Eight dengue patients were admitted for treatment over the last two months.

“Right now, we have nine patients of malaria and three of dengue under treatment at the hospital,” he said.

One major reason for discrepancy in data, sources said, was the fact that most of malaria as well as dengue patients reported at clinics and not tertiary care hospitals, which provided data to the health department, and recovered without having any complications. A limited number of patients developed complications and reported at hospitals.

Malaria outbreak

Surprisingly, the official figures have no mention of the hundred-plus malaria cases being reported at Dr Ruth K.M. Pfau Civil Hospital Karachi these days.

According to Dr Kalbe Hussain, who heads the hospital’s emergency department, there has been a dramatic surge in malaria cases this week.

“More than a hundred patients out of the 500-plus cases that we daily examine at our unit are of malaria these days. Patients largely comprised adults coming from different parts of the city.”

About the reason behind the outbreak, he said: “What could be the reason other than extensive breeding of mosquitoes affecting every household due to unhygienic conditions prevailing in the city.”

According to him, most cases of malaria involved Plasmodium vivax – one of the six species of malaria that commonly infects humans.

“The infection is confirmed through lab tests after which we attempt to subside fever and maintain the patient’s platelet level followed by an oral administration of anti-malaria medicine. Often patients are discharged after getting treatment for about four hours at the unit,” Dr Hussain explained, adding that Plasmodium vivax could cause severe and even fatal infection.

‘No let-up in intensity’

Dr Altaf Hussain Khatri, a senior general physician running a clinic in the old city area, said that he had been examining four to five suspected cases of malaria for the past three weeks.

“There isn’t any letup in malaria’s intensity in recent weeks at my clinic. Today, I saw three patients who have already tested positive for malaria,” said Dr Khatri, who also heads Pakistan Medical Association’s Karachi chapter. He added that most of these patients came from Lyari, Shershah, Lea Market, Hub Chowki, Gadap and as far as Hawkesbay.

Dengue fears

Malir, according to the official data, is the most affected district, seeing a gradual increase in the number of malaria cases since May (120 cases). A total of 156 cases were reported in June, 173 in July and 254 in August, indicating a lack of action on the part of local government.

“Official inaction may also contribute to an increase in dengue cases in coming weeks. I attend to at least two dengue patients at my Korangi clinic daily and I assume a similar number of patients are reporting at other clinics across the city,” Dr Abdul Ghafoor Shoro, a senior family physician heading the PMA Centre said, adding that the current weather conditions helped dengue mosquitoes thrive.

Patients, he pointed out, didn’t get tested for dengue as they know that the illness was generally self-limiting. Hence, the government system for dengue/malaria surveillance had completely lost its relevance and meaning, he added.

Published in Dawn, September 9th, 2023