title: Epidemiology and Clinical Burden of Malaria in the War-Torn Area, Orakzai Agency in Pakistan.
abstract: BACKGROUND
  Military conflict has been a major challenge in the detection and control of emerging infectious diseases such as malaria. It poses issues associated with enhancing emergence and transmission of infectious diseases by destroying infrastructure and collapsing healthcare systems. The Orakzai agency in Pakistan has witnessed a series of intense violence and destruction. Military conflicts and instability in Afghanistan have resulted in the migration of refugees into the area and possible introduction of many infectious disease epidemics. Due to the ongoing violence and Talibanization, it has been a challenge to conduct an epidemiological study.
  
  
  RESULTS
  All patients were sampled within the transmission season. After a detailed clinical investigation of patients, data were recorded. Baseline venous blood samples were taken for microscopy and nested polymerase chain reaction (nPCR) analysis. Plasmodium species were detected using nested PCR (nPCR) and amplification of the small subunit ribosomal ribonucleic acid (ssrRNA) genes using the primer pairs. We report a clinical assessment of the epidemic situation of malaria caused by Plasmodium vivax (86.5%) and Plasmodium falciparum (11.79%) infections with analysis of complications in patients such as decompensated shock (41%), anemia (8.98%), hypoglycaemia (7.3%), multiple convulsions (6.7%), hyperpyrexia (6.17%), jaundice (5%), and hyperparasitaemia (4.49%).
  
  
  CONCLUSIONS
  This overlooked distribution of P. vivax should be considered by malaria control strategy makers in the world and by the Government of Pakistan. In our study, children were the most susceptible population to malaria infection while they were the least expected to use satisfactory prevention strategies in such a war-torn deprived region. Local health authorities should initiate malaria awareness programs in schools and malaria-related education should be further promoted at the local level reaching out to both children and parents.
authors.affiliation: National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, Gyeonggido, Republic of Korea.
authors.forename: Asad Mustafa
authors.initials: AM
authors.lastname: Karim
authors.affiliation: Department of Zoology, Kohat University of Science and Technology, Kohat, Pakistan.|Department of Biotechnology, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.
authors.forename: Irfan
authors.initials: I
authors.lastname: Hussain
authors.affiliation: National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, Gyeonggido, Republic of Korea.
authors.forename: Sumera Kausar
authors.initials: SK
authors.lastname: Malik
authors.affiliation: National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, Gyeonggido, Republic of Korea.
authors.forename: Jung Hun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: University of British Columbia, Vancouver, Canada.
authors.forename: Ill Hwan
authors.initials: IH
authors.lastname: Cho
authors.affiliation: Department of Natural Science, North Shore Community College, Danvers, Massachusetts, United States of America.
authors.forename: Young Bae
authors.initials: YB
authors.lastname: Kim
authors.affiliation: National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, Gyeonggido, Republic of Korea.
authors.forename: Sang Hee
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology / Q000635:transmission; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D010961:Plasmodium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D014857:Warfare; D055815:Young Adult
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