Bridging the Gap for Subnational Tailoring: Towards a More Accurate Assessment of Malaria Burden

Abstract

Background: Accurate estimates of malaria burden are crucial for allocating resources and designing effective control strategies. However, global reports often underestimate the burden in low- and middle-income countries due to limitations in surveillance systems. This study addresses this gap by providing a detailed analysis of malaria burden and spatio-temporal distribution in Sindh province, Pakistan. Methods: We utilized data on monthly suspected malaria cases reported from 1,211 primary healthcare facilities across twenty-three districts (excluding Karachi city) for an 11-year period (2012-2022). Facility weighted and population-weighted estimates calculated to account for variations in population size across districts. Findings: An incidence of 76 per 1000 population per annum suspected malaria cases were reported at primary public healthcare facilities. Pooled estimates of 1.16 million cases occurred annually. Marked heterogeneity observed in malaria burden across districts and high burden districts were identified. The study revealed a distinct seasonal pattern with peaks coinciding with the wet season and post-monsoon period. Malaria persisted heavily in few districts over the last decade. Conclusions: These findings highlight the substantial malaria burden in Sindh, particularly in specific high-burden districts. Since 60-70% of population seek healthcare from private providers, the reported figures are gross underestimate. Also, the analysis suggest that sub-national analysis and tailoring of strategies are needed. The underestimation by global reports emphasizes the need for country-level and subnational analyses for informed decision-making. By addressing these gaps and refining burden estimates, Pakistan can develop more targeted strategies towards malaria control.