Frequency of malaria and glucose-6-phosphate dehydrogenase deficiency in Tajikistan.
BACKGROUND
During the Soviet era, malaria was close to eradication in Tajikistan. Since the early 1990s, the disease has been on the rise and has become endemic in large areas of southern and western Tajikistan. The standard national treatment for Plasmodium vivax is based on primaquine. This entails the risk of severe haemolysis for patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Seasonal and geographical distribution patterns as well as G6PD deficiency frequency were analysed with a view to improve understanding of the current malaria situation in Tajikistan.


METHODS
Spatial and seasonal distribution was analysed, applying a risk model that included key environmental factors such as temperature and the availability of mosquito breeding sites. The frequency of G6PD deficiency was studied at the health service level, including a cross-sectional sample of 382 adult men.


RESULTS
Analysis revealed high rates of malaria transmission in most districts of the southern province of Khatlon, as well as in some zones in the northern province of Sughd. Three categories of risk areas were identified: (i) zones at relatively high malaria risk with high current incidence rates, where malaria control and prevention measures should be taken at all stages of the transmission cycle; (ii) zones at relatively high malaria risk with low current incidence rates, where malaria prevention measures are recommended; and (iii) zones at intermediate or low malaria risk with low current incidence rates where no particular measures appear necessary. The average prevalence of G6PD deficiency was 2.1% with apparent differences between ethnic groups and geographical regions.


CONCLUSIONS
The study clearly indicates that malaria is a serious health issue in specific regions of Tajikistan. Transmission is mainly determined by temperature. Consequently, locations at lower altitude are more malaria-prone. G6PD deficiency frequency is too moderate to require fundamental changes in standard national treatment of cases of P. vivax.
Rebholz
Cornelia E
CE
Swiss Centre for International Health, Swiss Tropical Institute, P,O,-Box, Socinstrasse 57, CH-4002 Basel, Switzerland. corneliarebholz@yahoo.com
Michel
Anette J
AJ
Maselli
Daniel A
DA
Saipphudin
Karimov
K
Wyss
Kaspar
K
D000328:Adult; D002738:Chloroquine / Q000627:therapeutic use; D005953:Glycogen Storage Disease Type I / Q000150:complications / Q000453:epidemiology*; D006461:Hemolysis; D006801:Humans; D008288:Malaria / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D016780:Malaria, Vivax / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011319:Primaquine / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D012621:Seasons; D013620:Tajikistan / Q000453:epidemiology; D013696:Temperature
D002738:Chloroquine; D011319:Primaquine