Chloroquine resistance and Plasmodium falciparum in Punjab, Pakistan during 2000-2001.

During the years 2000-2001, the rural populations of 5 districts in Punjab were examined for malarial parasites. The incidence of Plasmodium falciparum was more than double (8.98%) that of P. vivax (4.06%). The incidence was higher among male subjects (53.5%) than females (46.9%). The largest number of infected male subjects was found in Sheikhupura district (77.78%). Chloroquine resistance was only checked in the subjects harboring P. falciparum, using in vivo techniques. Overall chloroquine sensitivity was 63.8%. Overall frequency of chloroquine resistance in the 5 Punjabi districts was 35%, with 30.6% RI and 4.4% RII. It is important that RIII was not found in the present study. Among the five districts, maximum RI (35.1%) and RII (5.4%) were noted in Multan. By age, maximum chloroquine resistance was noted in the 1-5 year age group (ie RI, 41%; RII 8%). A similar RI value (41%) was noted for the 6-14 age group, but with a low RII (3%) value. Although, the present finding is an outcome of a survey conducted in only 5 districts of Punjab, it reflects an alarming situation, as not only RI and RII resistance against chloroquine is increasing, but at the same time the incidence of P. falciparum is increasing two-fold that of P. vivax. The findings warrant that top priority be given to determining the exact status of chloroquine resistance among P. falciparum in this region, which is now hosting a heavy influx of refugees from Afghanistan, a country endemic for P. falciparum.