Directorate of Malaria Control (DOMC), Islamabad

Directorate of Malaria Control

(DOMC), Islamabad

FOREWORD

Malaria ranks sixth amongst the top ten causes of deaths and fourth

amongst the communicable diseases causing deaths in low income

countries of the world. Pakistan is among seven countries of the WHO

Eastern Mediterranean Region sharing 95% of the total regional malaria

burden. An estimated 98% of Pakistan population (205 million) is at varying

risk while 60% (123 million) population at high risk for malaria.

This annual report provides information for the malaria disease burden

across Pakistan for 2017. A total of 369,615 confirmed malaria cases have

been reported to the Directorate of Malaria Control (DOMC) as a result

of screening of around 6.2 million cases from all health facilities in provinces across Pakistan.

Epidemiologically, Pakistan is divided into high and low burden sharing districts based on the reported

malaria cases each year. Government of Pakistan is providing free of cost malaria diagnostic and treatment

services in around 5000 health facilities throughout the country with its own resources. However, the

support of Global Fund is available for further strengthening of around 3500 of these health facilities. The

number of Global Fund grant supported districts has increased from 43 in 2016 to 66 in 2017.

The malaria disease burden is still very high as a marked increase in the overall number of reported

confirmed malaria cases is seen in 2017 as compared to 2016. The major during 2017 activities have

focused towards provision of long-lasting insecticidal nets, trainings of health care providers on malaria

case management, malaria diagnosis through microscopy and Rapid diagnostic test (RDT), malaria

information system and outbreak response and BCC activities at different levels.

Several important developments took place during 2017. DOMC carried out nationwide consultation

meetings for development and successful submission of the New Funding Request for next three years

(2018-2020) under the program continuation to the Global Fund (TGF). Malaria Information System got

on board with new set of tools and trained personal to capture disaggregated information for confirmed

malaria cases. An online District Health Information System (DHIS-2) has been developed with the support

of Indus Health Network by end of the year. This will replace the manual excel based reporting system in

all the Global Fund grant supported districts in the next year.

Directorate of Malaria control (DOMC) is making utmost efforts to achieve the given targets and I can

see that with focused efforts, dedication and hard work of our teams, we will be able to eliminate Malaria

from Pakistan. I really appreciate the support of our partners including the Provincial Programs of

Balochistan, KP, KP-Tribal Districts and Sindh, the Global Fund, World Health Organization (WHO) and

Indus Health Network (IHN/TIH).

I believe that persistent efforts can bring positive change, and DOMC is focusing on that change, informing

policies and improving quality of services to control malaria and save precious lives.

Dr. Abdul Baseer Khan Achakzai

Director, Directorate of Malaria Control (DOMC)

M/O NHSR&C, Islamabad.

ACKNOWLEDGMENTS

Malaria annual report has been regularly developed by the Directorate of Malaria Control (DOMC) since

2016 onwards. This year report is focused on reporting of the malaria burden from all districts of Pakistan

including those supported by the Global Fund grant. The report has been developed primarily through a

secondary analysis of the programmatic and surveillance data received at the DOMC for the malaria

control activities in Pakistan.

We are also extremely thankful to our technical partner WHO, the Provincial Malaria Control Programs

of Balochistan, KP, KP-Tribal Districts (Ex. FATA) and Sindh, and the Global Fund for supporting malaria

control activities in Pakistan.

We would also like to appreciate the private sector Principal Recipient (PR), Indus Health Network

(IHN/TIH) and Sub-Recipients (SRs) of this grant including Association for Community Development

(ACD), Association for Social Development (ASD), Balochistan Rural Support Program (BRSP), Frontier

Primary Health Care (FPHC), National Rural Support Program (NRSP) and Pakistan Lions Youth Council

(PLYC) for all their hard work and efforts to ensure that all the planned activities are timely executed in

the best possible manner.

Lastly, we owe pronounced acknowledgements for the needy, deserving and suffering communities living

in the grant supported districts who have been a great source of motivation for us to deliver in the field

and continuously strive for malaria elimination from Pakistan.

CONTENTS

1. EXECUTIVE SUMMARY ................................................................................................................................... 8

1.1. INTRODUCTION ............................................................................................................................................ 8 1.2. DISEASE BURDEN & PROGRAMMATIC ACHIEVEMENTS ............................................................................... 8 1.3. PROVINCIAL FINDINGS ................................................................................................................................. 9 1.4. MALARIA CONTROL & PREVENTION ............................................................................................................. 9

1.4.1. Long Lasting Insecticidal Nets (LLINs) .................................................................................................. 9 1.4.2. BCC activities ..................................................................................................................................... 10

1.5. ISSUES AND CHALLENGES ........................................................................................................................... 10

2. MALARIA OVERVIEW ................................................................................................................................... 11

2.1. GLOBAL SITUATION .................................................................................................................................... 11 2.2. SITUATION IN PAKISTAN ............................................................................................................................. 11 2.3. PROGRAM GOAL AND OBJECTIVES5 ........................................................................................................... 12

2.3.1. Goal ................................................................................................................................................... 12 2.3.2. Objectives .......................................................................................................................................... 12

3. COUNTRY OVERALL FINDINGS ..................................................................................................................... 13

3.1. POPULATION COVERAGE ............................................................................................................................ 13 3.2. OVERALL DISEASE BURDEN IN 2017 ........................................................................................................... 13 3.3. ANNUAL PARASITE INCIDENCE (API) .......................................................................................................... 13 3.4. ANNUAL BLOOD EXAMINATION RATE (ABER) ............................................................................................ 14 3.5. TEST POSITIVITY RATE (TPR) ....................................................................................................................... 14

4. THE GLOBAL FUND (TGF) GRANT SUPPORTED DISTRICTS ............................................................................ 15

4.1.1. The Global Fund (TGF) Grant ............................................................................................................. 15 4.2. TGF GRANT GOAL AND OBJECTIVES ........................................................................................................... 15

4.2.1. Goal ................................................................................................................................................... 15 4.2.2. Objectives .......................................................................................................................................... 15 4.2.3. Total number of health facilities under the Global Fund grant ......................................................... 16

4.3. TGF DISTRICTS POPULATION COVERAGE .................................................................................................... 16 4.4. DISEASE BURDEN IN TGF SUPPORTED DISTRICTS ....................................................................................... 16 4.5. ANNUAL PARASITE INCIDENCE (API) .......................................................................................................... 18 4.6. ANNUAL BLOOD EXAMINATION RATE (ABER) ............................................................................................ 19 4.7. TEST POSITIVITY RATE (TPR) ....................................................................................................................... 20 4.8. TREND OF API, ABER AND TPR .................................................................................................................... 21

5. PROVINCIAL PROGRESS / ACHIEVEMENTS ................................................................................................... 22

5.1. KHYBER PAKHTUNKHWA (KP)..................................................................................................................... 22 5.2. SINDH ......................................................................................................................................................... 24 5.3. KP-TRIBAL DISTRICTS (FATA) ........................................................................................................................... 26 5.4. BALOCHISTAN............................................................................................................................................. 29

6. MALARIA CONTROL INTERVENTIONS .......................................................................................................... 32

6.1. LLINS/MOSQUITO NETS DISTRIBTION ........................................................................................................ 32 6.1.1. Mass distribution of LLINs ................................................................................................................. 32 6.1.2. Continuous distribution of LLINs through Antenatal Care (ANC) Clinics ............................................ 33

6.2. CAPACITY BUILDING ................................................................................................................................... 33

MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD

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6.2.1. Malaria case management................................................................................................................ 33 6.2.2. Malaria Diagnosis .............................................................................................................................. 33 6.2.3. Malaria information system (MIS) and outbreak response ............................................................... 34 6.2.4. Behavior Change Communication (BCC) activities ............................................................................ 34 6.2.5. Development of guidelines and training manuals ............................................................................. 35 6.2.6. Surveys conducted during 2017 ......................................................................................................... 35

7. ISSUES AND CHALLENGES ............................................................................................................................ 36

7.1. DELAYS IN ESTABLISHMENT AND FUNCTIONALITY OF NEW HEALTH FACILITIES ............................................................... 36 7.2. DELAYS IN REPORTING FROM THE NEW DISTRICTS................................................................................................... 36 7.3. INCREASED NUMBER OF YEARLY MALARIA CASES .................................................................................................... 36 7.4. FRAGMENTED HEALTH SYSTEM AND PARALLEL REPORTING SYSTEM ............................................................................ 36 7.5. LACK OF COMPLIANCE TO THE NATIONAL MALARIA TREATMENT GUIDELINES ................................................................ 36 7.6. LOWER COVERAGE OF MALARIA TRAININGS........................................................................................................... 37 7.7. CHALLENGES RELATED TO THE LLINS DISTRIBUTION................................................................................................ 37 7.8. UNREGULATED PRIVATE SECTOR ......................................................................................................................... 37

8. IMPORTANT EVENTS DURING 2017 ............................................................................................................. 38

8.1. ONLINE DISTRICT HEALTH INFORMATION SYSTEM (DHIS-2) MALARIA MODULE .......................................................... 38 8.1.1. WHO mission to Pakistan for DHIS-2 ................................................................................................. 38 8.1.2. Inception session for the provincial programs ................................................................................... 38 8.1.3. Training of trainers (TOT) and the data entry operators on DHIS-2 malaria module ........................ 38

8.2. WHO REGIONAL TRAINING WORKSHOP ON M&E AND SURVEILLANCE (MUSCAT-OMAN; OCT-2017)............................. 39 8.3. WHO 9TH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAM MANAGERS FROM HANMAT AND PIAM-NET

COUNTRIES (CAIRO-EGYPT; OCT-2017) ........................................................................................................................... 39 8.4. WHO AND UNIVERSITY OF OSLO MISSION VISIT TO PAKISTAN FOR DHIS-2 (DEC-2017) .............................................. 39 8.5. PROCUREMENT & SUPPLY CHAIN ....................................................................................................................... 39

9. ANNEXURES ................................................................................................................................................ 40

9.1. LIST OF THE GLOBAL FUND GRANT SUPPORTED DISTRICTS ........................................................................................ 40 9.2. DOMC PROCURED AMDS AND HP DURING 2017 (FOR BOTH PRS) ......................................................................... 42


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ACRONYMS AND ABBREVIATIONS

ACD Association for Community Development

ABER Annual Blood Examination Rate

ASD Association for Social Development

ACTs Artemisinin-Based Combination Therapy

API Annual Parasite Incidence

ASD Association for Social Development

BHU Basic Health Unit

BRSP Balochistan Rural Support Program

DHIS District Health information System

DHQ District Headquarter

DOMC Directorate of Malaria Control

FATA Federally Administered Tribal Areas

FPHC Frontier Primary Health Care

GTS Global Technical Strategy

IHN Indus Health Network

IRS Indoor Residual Spraying

LLINs Long Lasting Insecticidal Nets

MC Microscopy

MDGs Millennium Development Goals

MIS Malaria Information System

NFR New Funding Request

NRSP National Rural Support Program

PF Plasmodium Falciparum

PLYC Pakistan Lions Youth Council

PR Principal Recipient

PV Plasmodium Vivax

RDT Rapid Diagnostic Test

RHC Rural Health Center

SDGs Sustainable Development Goals

SPR Slide Positivity Rate

SR Sub-Recipients

TGF the Global Fund

THQ Tehsil Headquarter

TIH The Indus Hospital

TPR Test Positivity Rate

WHO World Health Organization


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LIST OF FIGURES

FIGURE 1 SHARE OF ESTIMATED MALARIA CASES, 2016 ........................................................................................................... 11 FIGURE 2 PROPORTION OF PLASMODIUM SPECIES, 2010 AND 2016 .......................................................................................... 11 FIGURE 3 TOTAL CONFIRMED MALARIA CASES IN 2017 ............................................................................................................ 13 FIGURE 4 API, ABER AND TPR IN 2017 .............................................................................................................................. 13 FIGURE 5 COUNTRY ANNUAL PARASITE INCIDENCE (API) OF 2017 ............................................................................................ 13 FIGURE 6 COUNTRY ANNUAL BLOOD EXAMINATION RATE (ABER) FOR 2017 ............................................................................. 14 FIGURE 7 COUNTRY TEST POSITIVITY RATE (TPR) FOR 2017 .................................................................................................... 14 FIGURE 8 FUNCTIONAL HEALTH FACILITIES UNDER TIH AND DOMC IN 2017 .............................................................................. 16 FIGURE 9 REPORTED CONFIRMED MALARIA CASES IN 2017 ....................................................................................................... 16 FIGURE 10 CONFIRMED MALARIA CASES REPORTED BY THE PROVINCES IN 2017 ........................................................................... 17 FIGURE 11 MONTHLY TRENDS OF CASES FROM 2014-2017 ..................................................................................................... 17 FIGURE 12 API, ABER AND TPR IN 2017 ............................................................................................................................ 18 FIGURE 13 ANNUAL PARASITE INCIDENCE (API) OF 2017 ........................................................................................................ 18 FIGURE 14 COMPARISON OF API IN LAST SIX YEARS ................................................................................................................. 19 FIGURE 15 ANNUAL BLOOD EXAMINATION RATE (ABER) FOR 2017 ......................................................................................... 19 FIGURE 16 COMPARISON OF ABER OF LAST SIX YEARS ............................................................................................................. 20 FIGURE 17 TEST POSITIVITY RATE (TPR) FOR 2017 ................................................................................................................ 20 FIGURE 18 COMPARISON OF TPR IN LAST SIX YEARS ................................................................................................................ 21 FIGURE 19 TRENDS OF API, ABER AND TPR OF LAST SIX YEARS ................................................................................................ 21 FIGURE 20 MALARIA CONFIRMED CASES DISTRIBUTION IN KP .................................................................................................... 22 FIGURE 21 DISTRICT WISE DISTRIBUTION OF CASES IN KP 2017 ................................................................................................. 22 FIGURE 22 BER, API AND TPR COMPARISON DISTRICT WISE OF KP 2017 ................................................................................... 23 FIGURE 23 MONTHLY TREND OF CASES REPORTED IN KP IN 2017 .............................................................................................. 23 FIGURE 24 YEAR WISE MONTHLY TREND OF CASES IN KP FROM 2014-2017 ............................................................................... 24 FIGURE 25 MALARIA CONFIRMED CASES DISTRIBUTION IN SINDH ............................................................................................... 24 FIGURE 26 DISTRICT WISE DISTRIBUTION OF CASES IN SINDH 2017 ............................................................................................ 25 FIGURE 27 BER, API AND TPR COMPARISON DISTRICT WISE OF SINDH 2017 .............................................................................. 25 FIGURE 28 MONTHLY TREND OF CASES REPORTED IN SINDH IN 2017 ......................................................................................... 26 FIGURE 29 YEAR WISE MONTHLY TREND OF CASES IN SINDH FROM 2014-2017 ........................................................................... 26 FIGURE 30 CASE DISTRIBUTION IN FATA ............................................................................................................................... 27 FIGURE 31 AGENCY WISE DISTRIBUTION OF CASES IN FATA 2017 ............................................................................................. 27 FIGURE 32 BER, API AND TPR COMPARISON AGENCY WISE OF FATA 2017 ............................................................................... 28 FIGURE 33 MONTHLY TREND OF CASES REPORTED IN FATA IN 2017 .......................................................................................... 28 FIGURE 34 YEAR WISE MONTHLY TREND OF CASES FROM 2014-2017 ........................................................................................ 29 FIGURE 35 MALARIA CONFIRMED CASES DISTRIBUTION IN BALOCHISTAN ..................................................................................... 29 FIGURE 36 DISTRICT WISE DISTRIBUTION OF CASES IN BALOCHISTAN 2017 .................................................................................. 30 FIGURE 37 BER, API AND TPR COMPARISON DISTRICT WISE OF BALOCHISTAN 2017 .................................................................... 30 FIGURE 38 MONTHLY TREND OF CASES REPORTED IN BALOCHISTAN IN 2017 ............................................................................... 31 FIGURE 39 YEAR WISE MONTHLY TREND OF CASES FROM 2014-2017 ........................................................................................ 31 FIGURE 40 MASS DISTRIBUTION OF LLINS IN PROVINCES/REGIONS IN 2017 ............................................................................... 32 FIGURE 41 DISTRICT WISE MASS DISTRIBUTION OF LLINS IN 2017 ............................................................................................. 33 FIGURE 42 LLINS ANC DISTRIBUTION IN 2017 ...................................................................................................................... 33 FIGURE 43 MALARIA TRAININGS CONDUCTED IN 2017 ............................................................................................................ 34 FIGURE 44 BCC (ADVOCACY AND AWARENESS SESSION CONDUCTED IN 2017.............................................................................. 34


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1. EXECUTIVE SUMMARY

1.1. INTRODUCTION

According to the WHO World Malaria Report 2017, 91 countries reported a total of 216 million cases

of malaria in 2016, an increase of 5 million cases over the previous year. In 2016, 85% of estimated vivax

malaria cases occurred in just five countries (Afghanistan, Ethiopia, India, Indonesia and Pakistan). Pakistan

is among seven countries of the WHO Eastern Mediterranean Region sharing 95% of the total regional

malaria burden. An estimated 98% of Pakistan population (205 million) is at varying risk while around 60%

(123 million) population at high risk for malaria. Pakistan is amongst the countries having a malaria control

program. Malaria stratification according to the National Strategic Plan (2015-2020) shows three

epidemiological strata. Stratum-I (API/TPR>5 annually) has the highest significance and includes 66 out of

the total 151 districts. TGF support has been mainly targeted for decreasing the burden of disease in the

highest endemic districts of the country through the provision of prompt diagnostic and treatment services

for malaria and prevention of the disease through providing insecticide treated nets (ITNs) and Indoor

Residual Spray (IRS) to the high risk group of communities.

1.2. DISEASE BURDEN & PROGRAMMATIC ACHIEVEMENTS

Overall country disease burden

A total of 369,615 confirmed malaria cases have been reported from all the health facilities across Pakistan

to the federal directorate. Around 6.2 million cases were screened at these facilities. Highest numbers of

the reported cases were P. Vivax (PV) 81.3% (300,426) followed by P. Falciparum (PF) 14.7% (54,405) and

Mix cases 4.0% (14,784). The cumulative API of all the districts/agencies of Pakistan in 2017 was 1.8 with

ABER of 3.04 and TPR of 5.9. Provincial breakdown indicates that during 2017 highest number of cases

was reported from KP 30.0% (110,739) followed by Sindh 26.5% (98,040), FATA 21.9% (80,924),

Balochistan 20.5% (75,790) and Punjab 01.1% (4,122).

The Global Fund Grant supported districts

The population coverage in the Global Fund supported districts was enhanced from 20.6 million in 2016

to 54.4 million in 2017 in four provinces. This has resulted in an increase of population by around 33.8

million (164%). The Global Fund grant support coverage has been enhanced during the year as the number

of reporting districts are increased from 43 in 2016 to 66 in 2017. The number of reporting health facilities

providing malaria diagnostic services have also been increased from 1955 in 2016 to 3396 in 2017. Around

3 million cases were screened at these facilities (0.8 million more than 2016).

A marked increase in the overall number of reported confirmed malaria cases is seen from 0.26 million in

2016 to 0.34 million in 2017. Highest number of the reported cases was P. Vivax (PV) 81% (277,713)

followed by P. Falciparum (PF) 15% (51,552) and Mix cases 4% (14,778). It has been seen that P. Vivax and

P. Falciparum cases had proportionally increased by 03% and 02% respectively while the proportion of mix

cases has decreased by around 05% in 2016 as compared to 2017. Provincial breakdown indicates that

during 2017 highest number of cases were reported from KP 31% (106,915) followed by Sindh 24%

(81,216), FATA 23% (80,924), Balochistan 21% (72,867) and Punjab 01% (2,121).

Regarding the trend of peak malaria season, 2017 reports highest number of cases with a peak reaching

in the month of August followed by September and October. The average API for TGF supported 66

districts and agencies was 6.3. Highest API was reported by FATA (16.2) followed by Balochistan, KP and

Sindh while lowest was reported by Punjab (0.7). The ABER for the year 2017 for TGF supported districts


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was reported to be 5.4. FATA (10.1) and Balochistan (5.8) reported the highest ABER followed by Sindh

(4.6). Punjab (0.9) reported the lowest ABER. The reported cumulative TPR was 11.6 for the year 2017.

FATA reported the highest TPR which was 16.1.

1.3. PROVINCIAL FINDINGS

During 2017, Khyber Pakhtunkhwa (KP) reported the highest number of cases with a total 106,915

cases as compared to 75,653 cases in 2016. A total of 101,854 cases of PV (95%) were reported followed

by PF 3992 (4%) and mix 1069 cases (1%). In 2017, KP reported API of 6.2, ABER of 4.6 and TPR of 13.4

as compared to API of 8.27, ABER of 6.27 and TPR of 13.2 in 2016. Highest number of cases were reported

from DI Khan (13182) followed by Charsadda (12715) and Bannu (12539). The highest API was reported

from district Tank of 20.6 followed by Lakki (13.5) and Bannu (10.7). Monthly trend of the number of

cases reported indicates a highest rise of cases in August reaching a peak of 10698 cases to 8771 cases in

October.

The number of malaria cases reported from Sindh was 81,216 as compared to 34,413 cases reported

during 2016. A total of 57,549 cases of PV (71%) were reported followed by PF 20,626 (25%) and mix

1069 cases (4%). Sindh reported an API of 4.6, ABER of 5.4 and TPR of 8.5 as compared to the reported

API of 5.67, ABER of 8.42 and TPR of 6.74 in 2016. Highest number of cases were reported from Thatta

(15,515) followed by Mirpur Khas (9597) and Khairpur (8920). Highest API was reported of district Thatta

(15.8) followed by Sujawal (7.9) and Umerkot (6.8). Monthly trend of the number of cases reported

indicates a highest rise of cases in August reaching a peak of 7902 cases to 5596 cases in October.

The number of malaria cases reported from FATA was 80,924 as compared to 84,002 cases reported

during 2016; hence a decline of around 04% (3078) cases despite no change in the number of reporting

agencies and FRs during the current as compared to the last year. A total of 72,392 cases of PV (89%)

were reported followed by PF 6653 (8%) and mix 1879 cases (2%). In 2017, FATA reported API of 16.2,

ABER of 10.1 and TPR of 16.1 as compared to the API of 17.54, ABER of 10.37 and TPR of 17.01 reported

during 2016. Highest number of cases were reported from Khyber (21068) followed by SWA (12556) and

Mohmand (7946). The highest API was reported by FR Lakki of 121.0 followed by FR Bannu (86.6) and FR

Tank (79.3). Monthly trend of the number of cases reported indicates a highest rise of cases in August

reaching a peak of 8204 cases to 7158 cases in October.

Balochistan reported a total 72,867 cases as compared to 66,032 cases reported during 2016. A total

of 44,655 cases of PV (61%) were reported followed by PF 19,666 (27%) and mix 8546 (12%) cases. In

2017, Balochistan reported API of 6.3, ABER of 5.8 and TPR of 10.7 as compared to reported API of 12.39,

ABER of 10.30 and TPR of 12.03 during 2016. Highest number of cases were reported from district

Jaffarabad (7912) followed by Zhob (7182) and Musakhel (6300). The highest API was reported of district

Musakhel of 37.7 followed by Sherani (25.9) and Zhob (23.1). Monthly trend of the number of cases

reported indicates a highest rise of cases in September reaching a peak of 6370 cases to 6032 cases in

October.

1.4. MALARIA CONTROL & PREVENTION

1.4.1. Long Lasting Insecticidal Nets (LLINs)

Around 1.19 million LLINs were distributed in TGF covered districts in 2017 through ‘Mass Distribution’.

Highest number of LLINs (0.6 million) distributed through mass distribution was seen in the Balochistan

province. Highest number of LLINs distributed through mass distribution was seen in South Waziristan

(145,152) followed by Dera Bugti (126,576). A total of 233,398 LLINs were distributed in 2017 through


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‘ANC clinics’ as compared to 195,754 LLINs distributed in 2016. Highest distribution through ANC clinics

took place in Sindh province (85,856).

1.4.2. BCC activities

In 2017, 52,888 personnel participated in the ‘advocacy sessions’ regarding preventive and curative services

pertinent to malaria. These participants then conducted community awareness sessions and a total of

around 1,442,302 members from the communities were reached.

1.5. ISSUES AND CHALLENGES

Following are the major issues and challenges faced during the year:

▪ Around 23 new districts were added under the Global Fund grant. SRs had to establish new malaria

diagnostic centers in these new districts. There was a delay in establishment and functionality of the

new centers mainly due to the delayed trainings of the facility focal persons.

▪ Due to the delays in training of the new facility focal persons and establishment of the new malaria

diagnostic centers, the reporting from the 23 new districts was also delayed till around July 2016.

▪ The number of malaria cases like the last year has shown an increase in the current year as well. This

increase can be attributed to the increased number of reporting health facilities, increased number of

grant supported districts, and better screening rates of malaria suspects.

▪ Malaria screening and confirmed cases data at the health facilities level is recorded and reported

through two parallel reporting and surveillance systems namely the District Health Information System

(DHIS) and Malaria Information System (MIS). When there are parallel reporting systems and different

recording and reporting tools from same health facilities, the data quality is usually compromised as

entering the data into separate platforms will result in more errors. An integrated disease reporting

system and use of the update online DHIS-2 are the potential options for better integrity and

coherence of reported data.

▪ Compliance to the national malaria treatment guidelines remained low mainly in few old and many

new grant supported districts. The turnover of health care providers and transfer of trained health

care providers is a big challenge. The overall coverage of trainings is far low than the desired levels.

▪ LLINs distribution along with Logistics arrangement of LLINs in terms of establishing warehouses and

transportation in the remote and security prone areas of Balochistan and FATA during the year has

been challenging. Issues were mainly seen in the districts of Dera Bugti, Musakhel, Jhal Magsi and

Jaffarabad in Balochistan while FR regions in FATA. These challenges resulted in delayed distribution

of LLINs in these remote districts.

▪ Ensuring the availability of key anti-malarial drugs (AMDS) in the security prone areas especially FR

regions in FATA has been a challenge. Mainly issues were access of logistics staff for the reporting and

providing the logistic support. Despite of these, above 90% stock availability was ensured.

▪ Both DOMC and IHN/TIH have scaled up the involvement of the private sector GPs (approx. 15 per

district) for the free of cost malaria diagnosis and treatment services, however their regulation as per

program requirement remains a challenge.


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2. MALARIA OVERVIEW

2.1. GLOBAL SITUATION

According to the WHO World Malaria Report 2017, 91 countries reported a total of 216 million cases

of malaria in 2016, an increase of 5 million cases over the previous year. The global tally of malaria deaths

reached 445,000 deaths, about the same number reported in 2015. All regions recorded reductions in

mortality in 2016 when compared with 2010, with the exception of the WHO Eastern Mediterranean

Region, where mortality rates remained virtually unchanged in the period. In 2016, 85% of estimated vivax

malaria cases occurred in just five countries (Afghanistan, Ethiopia, India, Indonesia and Pakistan).

Although malaria case incidence has fallen globally since 2010,

the rate of decline has stalled and even reversed in some

regions since 2014. Mortality rates have followed a similar

pattern. Effective surveillance of malaria cases and deaths is

essential for identifying the areas or population groups that

are most affected by malaria, and for targeting resources for

maximum impact. A strong surveillance system requires high

levels of access to care and case detection, and complete

reporting by all health sectors, whether public or private.1

2.2. SITUATION IN PAKISTAN

Pakistan is among seven countries of the WHO Eastern Mediterranean Region sharing 95% of the total

regional malaria burden.2 An estimated 98% of Pakistan population (205 million) is at varying risk while

around 60% (123 million) population at high risk for malaria. In this country, Malaria with Plasmodium vivax

is more common (88%), while malaria with Plasmodium falciparum is seen only during rainy seasons or post

rain accounting for 12% of the malaria burden.3

In 2016, with around 2.1 million cases, Pakistan

contributed to 12% of the overall P. vivax

malaria cases. Malaria is present in 91 countries,

some of these are those progressing toward

elimination and others with a high burden of

malaria that are in control phase experiencing

setbacks in their responses. Pakistan is amongst

the countries having a malaria control program.

Mass population movements within the country

and across international borders, unpredictable

transmission patterns, the low immune status of

the population, climatic changes, poor socioeconomic conditions, declining health infrastructure, resource

1 WHO, World Malaria Report 2017 2 EMRO WHO. Country Total reported cases Total confirmed Total reported cases Total confirmed Total

reported cases Total confirmed Afghanistan Djibouti. 2016;1–6 3 Khattak AA, Venkatesan M, Nadeem MF, Satti HS, Yaqoob A, Strauss K, et al. Prevalence and distribution of

human Plasmodium infection in Pakistan. Malar J. 2013;12(1):1–8

Figure 1 Share of estimated malaria cases, 2016

Figure 2 Proportion of Plasmodium species, 2010 and 2016


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constraints, poor access to preventive and curative services, and mounting drug and insecticide resistance

in parasites and vectors, all contribute to this huge disease burden.4

Malaria stratification5 according to the National Strategic Plan (2015-2020) shows three epidemiological

strata. Stratum-I (API/TPR>5 annually) has the highest significance and includes 66 out of the total 151

districts6. A significant reduction was observed in the overall incidence of P. falciparum cases by >80%

(73,925 in 2011 to 18,432 in 2015) in TGF supported districts7. This reduction is attributed mainly to TGF

interventions including ACT and LLINs.

Epidemiologically, it is classified as a moderate malaria endemic country with a National annual parasite

incidence (API) averaging at 1.16. Annual program data of 2016 shows that there is high variation of API

within different provinces of Pakistan (Sindh 1.06, KP 2.28, Balochistan 5.39, FATA 8.63 and Punjab 0.03).8

2.3. PROGRAM GOAL AND OBJECTIVES5

2.3.1. Goal

By 2020, reduce the malaria burden by 75% in high and moderate endemic districts/agencies and eliminate

malaria in low endemic districts of Pakistan.

2.3.2. Objectives

The key objectives of the programme are:

1. To achieve <5 API in high endemic areas of province of Balochistan, Sindh, KP and FATA region by

2020

2. To achieve <1% API within moderate endemic districts of Balochistan, Sindh, KP and Punjab by 2020

3. To achieve Zero API within low endemic districts of Sindh, KP and Punjab by 2020

Specific Objectives

1) To ensure and sustain the provision of quality assured early diagnosis and prompt treatment services

to >80% at risk population by 2020

2) To ensure and sustain coverage of multiple prevention interventions (IRS, LLINs & and other

innovative tools and technologies) to 100% in the target high risk population as per national guidelines

and coverage in foci in moderate and low risk districts by 2020

3) To increase community awareness up to 80% on the benefits of early diagnosis and prompt treatment

and malaria prevention measures using health promotion, advocacy and BCC intervention by 2020

4) To enhance technical and managerial capacity in planning, implementation, management and MEAL

(Monitoring, Evaluation, Accountability and Learning) of malaria prevention and control intervention

by 2016

5) To ensure availability of quality assured strategic information (epidemiological, entomological and

operational) for informed decision making and; functional, passive and active case based weekly

surveillance system in all low risk districts by 2017

6) To ensure provision of malaria prevention, treatment and control services in humanitarian crises,

emergencies and cross-border situation.

4 http://www.emro.who.int/pak/programmes/roll-back-malaria.html accessed on 24th July 2017 5 Strategic Plan Malaria Control Program Pakistan (2015-2020) 6 Pakistan Bureau of Statistics; http://www.pbscensus.gov.pk/content/distribution-districts-phases 7 Routine malaria information system 2015 8 Unit PM. Malaria Annual Report 2016.

http://www.emro.who.int/pak/programmes/roll-back-malaria.html

http://www.pbscensus.gov.pk/content/distribution-districts-phases

3. COUNTRY OVERALL FINDINGS

3.1. POPULATION COVERAGE

Directorate of Malaria Control (DOMC) in collaboration with the Provincial Malaria Control Programs

of all the provinces has been providing malaria preventive and treatment services all over the country.

The interventions were carried out at primary health facilities including Basic Health Units (BHUs) and

Civil Dispensaries (CDs), secondary level health facilities including District Headquarter (DHQ) hospitals,

Tehsil Headquarter (THQ) hospitals and Rural Health Centers (RHC).

3.2. OVERALL DISEASE BURDEN IN 2017

A total of 369,615 confirmed malaria cases have been reported from all the health facilities across Pakistan

to the federal directorate. Around 6.2 million cases were screened at these facilities. Highest numbers of

the reported cases were P. Vivax (PV) 81.3% (300,426) followed by P. Falciparum (PF) 14.7% (54,405) and

Mix cases 4.0% (14,784). (Figure: 3)

The cumulative API of all the districts/agencies of Pakistan in 2017 was 1.8 with ABER of 3.04 and TPR of

5.9. Provincial breakdown indicates that during 2017 highest number of cases was reported from KP 30.0%

(110,739) followed by Sindh 26.5% (98,040), FATA 21.9% (80,924), Balochistan 20.5% (75,790) and Punjab

01.1% (4,122).

3.3. ANNUAL PARASITE INCIDENCE (API)

The overall API of country was 1.8 (using census-2017 population). Highest API was reported by FATA

(16.2) followed by Balochistan, KP and Sindh while lowest was reported by Punjab. (Figure: 5)

Figure 5 Country Annual Parasite Incidence (API) of 2017

0.02.0

3.6

6.3

16.2

1.8

0.0

5.0

10.0

15.0

20.0

Punjab Sindh KP Balochistan FATA Overall

300,426

54,40514,784

369,615

P. Vivax P. Falciparum Mix Confirmedcases

3.0

5.9

1.8

0.0

2.0

4.0

6.0

8.0

ABER TPR API

Figure 4 API, ABER and TPR in 2017 Figure 3 Total confirmed malaria cases in 2017


Page | 14

3.4. ANNUAL BLOOD EXAMINATION RATE (ABER)

The overall ABER9 for all country was 3.0. FATA (10.1) and Balochistan (5.9) reported the highest ABER.

(Figure: 6)

Figure 6 Country Annual Blood Examination Rate (ABER) for 2017

3.5. TEST POSITIVITY RATE (TPR)

The reported cumulative TPR was 5.9. FATA reported the highest TPR which was 16.1 followed by

Balochistan (12.4) as shown in Figure: 7.

Figure 7 Country Test Positivity Rate (TPR) for 2017

9 Annual Blood Examination Rate (ABER) = The number of patients receiving a parasitological test for

malaria (blood slide for microscopy or malaria rapid diagnostic test) per 100 population per year

2.42.9 3.2

5.9

10.1

3.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0


0.2

6.3

10.712.4

16.1

5.9

0

2

4

6

8

10

12

14

16

18




Page | 15

4. THE GLOBAL FUND (TGF) GRANT SUPPORTED DISTRICTS

4.1.1. The Global Fund (TGF) Grant

TGF support has been mainly targeted for decreasing the burden of disease in the highest endemic districts

of the country through the provision of prompt diagnostic, treatment and preventive services for malaria

through providing Long Lasting Insecticidal Nets (LLINs) and Indoor Residual Spray (IRS) to the high risk

groups. Facility level services include screening of the suspects through microscopy and rapid diagnostic

test (RDT), confirmation, treatment and follow-up of the malaria cases.10

Directorate of Malaria Control Program (DOMC) is the main public sector Principal Recipient (PR) for

the Global Fund New Funding Model (NFM) grant while Indus Health Network (IHN/TIH) is the main

private sector PR. In 2017, DOMC implemented Malaria Control interventions in 48 highly endemic

districts and agencies of Pakistan (Table 1) through 8 public and private Sub-Recipients (SRs) in Balochistan

(18), FATA (10)*11, KP (7), Sindh (12) and Punjab (1). Public SRs for DOMC were Integrated Vector

Control / Malaria Control Program (IVC/MCP) Khyber Pakhtunkhwa (KP), Integrated Vector Management

Program (IVMP) FATA, Directorate of Malaria Control (DOMC) Sindh and Directorate of Vector Borne

Diseases (VBD) Balochistan. Private SRs were Association for Community Development (ACD),

Association for Social Development (ASD), National Rural Support Program (NRSP) and Pakistan Lions

Youth Council (PLYC).

Indus Health Network (IHN/TIH) is implementing similar interventions in 18 districts (Table 1) of KP (7)

and Balochistan (11) through 2 SRs namely Balochistan Rural Support Program (BRSP) and Frontier

Primary Health Care (FPHC).

4.2. TGF GRANT GOAL AND OBJECTIVES

4.2.1. Goal

By 2020, reduce the malaria burden by 60% in 66 high endemic districts/agencies (Stratum- I) of Pakistan.

4.2.2. Objectives

The key objectives of the programme are to:

1. Ensure and sustain universal coverage of multiple prevention to population at risk in target districts

by 2020

2. Ensure and sustain > 80% coverage for the provision of quality assured early diagnosis and prompt

treatment services to population at risk in target districts by 2020

3. Increase community awareness up to 80% on the benefits of early diagnosis, prompt treatment and

Malaria preventive measures using health promotion, advocacy and BCC interventions by 2020

4. Ensure availability of quality assured strategic information (epidemiological, entomological and

operational) for informed decision making

5. Enhance technical and managerial capacities of malaria control programs in planning, implementation,

management and M&E

10 The Global Fund. Pakistan - Country Overview [Internet]. [cited 2018 Mar 30]. Available from:

https://www.theglobalfund.org/en/portfolio/country/ 11 * For administrative purposes, six FRs of FATA had been merged to three; hence a total of 13 FRs and Agencies

of FATA have been taken as 10 FRs and agencies.

https://www.theglobalfund.org/en/portfolio/country/


Page | 16

4.2.3. Total number of health facilities under the Global Fund grant

A total of 2540 public and private diagnostic centers (Microscopy + RDT) were fully functional in 2017

under DOMC covered districts and agencies. Similarly a total of 984 public and private diagnostic centers

(Microscopy+ RDT) were fully functional in IHN/TIH covered districts.

4.3. TGF DISTRICTS POPULATION COVERAGE

The population coverage in the Global Fund supported districts was enhanced from 20.6 million in 2016

to 54.4 million in 2017 in four provinces. This has resulted in an increase of population by around 33.8

million (164%). The interventions were carried out at primary health facilities including Basic Health Units

(BHUs) and Civil Dispensaries (CDs), secondary level health facilities including District Headquarter

(DHQ) hospitals, Tehsil Headquarter (THQ) hospitals and Rural Health Centers (RHC).

4.4. DISEASE BURDEN IN TGF SUPPORTED DISTRICTS

The Global Fund grant support coverage has been enhanced during the year as the number of reporting

districts are increased from 43 in 2016 to 66 in 2017. The number of reporting health facilities providing

malaria diagnostic services have also been increased from 1955 in 2016 to 3396 in 2017. Around 3 million

cases were screened at these facilities (0.8 million more than 2016).

A marked increase in the overall number of reported confirmed malaria cases is seen from 0.26 million in

2016 to 0.34 million in 2017. A total of 344,043

confirmed malaria cases were reported from

grant supported facilities in the Global Fund

districts and agencies in 2017 as compared to

260,100 cases in 2016. Highest number of the

reported cases were P. Vivax (PV) 81%

(277,713) followed by P. Falciparum (PF) 15%

(51,552) and Mix cases 4% (14,778); as shown

in Figure: 9. It has been seen that P. Vivax and P.

Falciparum cases had proportionally increased

by 03% and 02% respectively while the

proportion of mix cases has decreased by

around 05% in 2016 as compared to 2017. This

MIX, 14,778, 4%

PF, 51,552, 15%

PV, 277,713, 81%

MIX PF PV

192522

270

984

476

1755

309

2540

0

500

1000

1500

2000

2500

3000

Public Private

MS RDT Total

TIH DMC

Figure 8 Functional Health Facilities under TIH and DOMC in 2017

Figure 9 Reported confirmed malaria cases in 2017


Page | 17

may be attributed to the type of RDT kits (Pf/Pv combo) which have been used in the grant supported

health facilities during 2017. These are more specific for detection of the P. Falciparum and P. Vivax cases.

Provincial breakdown indicates that during

2017 highest number of cases were reported

from KP 31% (106,915) followed by Sindh

24% (81,216), FATA 23% (80,924),

Balochistan 21% (72,867) and Punjab 01%

(2,121). This was different than the last year

2016 where FATA had reported the highest

number of cases 32% (84,002), followed by

KP 29% (75,653), Balochistan 26% (66,032),

and Sindh 13% (34,413). The possible reason

may be that new additional districts included

in the grant were from the provinces of KP,

Sindh and Balochistan in 2017, while all

areas of FATA were already covered in the

grant even during 2016.

Regarding the trend of peak malaria season, 2017 reports highest number of cases with a peak reaching

in the month of August followed by September and October (Figure: 11). The trend is almost the same in

previous three years as well with highest number of cases reported from August to October.

Figure 11 Monthly trends of cases from 2014-2017

9,379 8,224 10,40815,756

24,30626,841

41,601

65,617

52,175

45,011

27,967

14,637

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Jan Feb Mar April May June July Aug Sept Oct Nov Dec

2017 2016 2015 2014

KP31%

Sindh24%

Balochistan 21%

FATA23%

Punjab1%

Figure 10 Confirmed malaria cases reported by the Provinces in 2017


Page | 18

The average API of these 66 districts/agencies in 2017 was 6.3 with ABER of 5.4 and TPR of 11.6 as

compared to the reported API of 10.28, ABER of 8.4 and TPR of 12.23 in 2016 (Figure: 12). The decline

in API and ABER has majorly been contributed by the increased population of the grant supported districts

due to the inclusion of 23 new districts. Furthermore, the updated population figures have been taken

from census-2017 data. This has resulted in an increase of around 164% in the overall population in all

grant supported districts.

Figure 12 API, ABER and TPR in 2017

4.5. ANNUAL PARASITE INCIDENCE (API)

Based on the compiled reported malaria data from public and private facilities for 2017 and using census

2017 population data, the average API for TGF supported 66 districts and agencies was 6.3. Highest API

was reported by FATA (16.2) followed by Balochistan, KP and Sindh while lowest was reported by Punjab

(0.7). (Figure: 13).

Figure 13 Annual Parasite Incidence (API) of 2017

5.46.3

11.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

ABER API TPR

0.7

4.66.2 6.3

16.2

6.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0


Under the Global Fund grant, the number of targeted districts for intervention has been varying over the

period of time. API declined from 7.82 per 1000 per year in 2012 to 5.54 in 2015. The 2016 API showed

an increase in malaria incidence which could be attributed to the increase in coverage of the malaria

diagnostic and case management services. However, API estimates for year 2017 showed a decline as

compared to 2016. This may be due to the inclusion of many new districts under the grant where the

TGF support was enhanced from 43 districts and agencies in 2016 to 66 districts and agencies in 2017.

Furthermore, the inclusion of 23 new districts in 2017 also increased the overall targeted population by

around 164% for the grant supported districts. The newly included districts and agencies were those

having relatively less disease burden as compared to earlier ones. This may have also resulted in a drop in

API in 2017 as compared to 2016. The year-wise comparison of the APIs since 2012 is shown in the graph

below: (Figure: 14)

Figure 14 Comparison of API in last six years

4.6. ANNUAL BLOOD EXAMINATION RATE (ABER)

The overall ABER12 for different provinces/regions is shown in Figure: 15. The ABER for the year 2017 for

TGF supported districts was reported to be 5.4. FATA (10.1) and Balochistan (5.8) reported the highest

ABER followed by Sindh (4.6). Punjab (0.9) reported the lowest ABER.

Figure 15 Annual Blood Examination Rate (ABER) for 2017

12 Annual Blood Examination Rate (ABER) = The number of patients receiving a parasitological test for

malaria (blood slide for microscopy or malaria rapid diagnostic test) per 100 population per year

7.8 7.97.3

5.5

10.3

6.3

0.0

2.0

4.0

6.0

8.0

10.0

12.0

2012 2013 2014 2015 2016 2017

0.9

4.65.4

5.8

10.1

5.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0



Page | 20

The blood screening rates of 2017 (5.4) were also lower as compared to 2016 (8.4). Year wise comparison

since 2012 is shown in Figure: 16. Due to inclusion of 23 new districts in the grant in 2017 and because of

the increased population of these districts, the ABER has shown a decline from 8.4 to 5.4 in 2017 as

compared to 2016.

Figure 16 Comparison of ABER of last six years

4.7. TEST POSITIVITY RATE (TPR)

The reported cumulative TPR was 11.6 for the year 2017. FATA reported the highest TPR which was

16.1 (Figure: 17).

Figure 17 Test Positivity Rate (TPR) for 2017

5.9 6.2

7.1

6.0

8.4

5.4

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

2012 2013 2014 2015 2016 2017

8.0 8.5

10.7

13.4

16.1

11.6

0

2

4

6

8

10

12

14

16

18


The yearly trends show that TPR in cumulative TPR in 2017 (11.6) has slightly declined as compared to

2016 (12.2). (Figure: 18).

Figure 18 Comparison of TPR in last six years

4.8. TREND OF API, ABER AND TPR

Comparing the trends of API, ABER and TPR of last six years, slight decrease can be seen in all the three

indicators in 2017. (Figure: 19) The probable reason may be that the coverage of diagnosis and cases

management services was further expanded in 2017 as compared to 2016 in both the public and private

sector in all 66 grant supported districts. Due to the inclusion of the new districts, the total targeted

population in the grant supported districts has increased. This has decreased the API and ABER as the

newly strengthened health facilities are supposed to take much longer time for reaching the desired level

of screening for the suspected malaria cases. Due to ABER just around 6.3 in these districts, the TPR may

not be true reflective of the malaria endemicity. It may improve with the passage of time as the screening

of malaria suspects in increased in the grant supported new districts.

Figure 19 Trends of API, ABER and TPR of last six years

16.6

13.2

10.6 10.5

12.211.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

2012 2013 2014 2015 2016 2017

7.8 7.97.3

5.5

10.3

6.35.9 6.27.1

6.0

8.4

5.4

16.6

13.2

10.6 10.5

12.211.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

2012 2013 2014 2015 2016 2017

API ABER TPR


Page | 22

5. PROVINCIAL PROGRESS / ACHIEVEMENTS

5.1. KHYBER PAKHTUNKHWA (KP)

During 2017, KP reported the highest number of cases with a total 106,915 cases as compared to 75,653

cases in 2016. As discussed earlier, the main reason of increased number of reported malaria cases seems

to be the inclusion of seven new districts from KP province in the grant. The seven newly added districts

included Buner, Hangu, Karak, Kohat, Lower Dir, Shangla, and Swat. Earlier KP had only seven grant

support districts. After addition of seven new districts, the total number of grant supported districts has

now doubled from seven to fourteen in KP province. A total of 101,854 cases of PV (95%) were reported

followed by PF 3992 (4%) and mix 1069 cases (1%).

Figure 20 Malaria confirmed cases distribution in KP

In 2017, KP reported API of 6.2, ABER of 4.6 and TPR of 13.4 as compared to API of 8.27, ABER of 6.27

and TPR of 13.2 in 2016. The decrease in API and ABER may be attributed to the increase in population

due to the inclusion of seven new districts during 2017.

Considering district wise situation, during 2017 highest number of cases were reported from DI Khan

(13182) followed by Charsadda (12715) and Bannu (12539). Last year in 2016, Bannu had reported the

highest number of malaria cases (16,161). (Figure: 21)

Figure 21 District wise distribution of cases in KP 2017

1,069 3,992

101,854106,915

0

20,000

40,000

60,000

80,000

100,000

120,000

Mix PF PV Total

1,5102,665 3,018 3,068

4,5535,535

7,919 8,078 8,317

11,824 11,99212,539 12,715 13,182

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000


Page | 23

The highest API was reported from district Tank of 20.6 followed by Lakki (13.5) and Bannu (10.7). (Figure:

22).

Figure 22 BER, API and TPR comparison district wise of KP 2017

Monthly trend of the number of cases reported indicates a highest rise of cases in August reaching a peak

of 10698 cases to 8771 cases in October. Minimal cases have been reported from January to March.

(Figure: 23)

Figure 23 Monthly trend of cases reported in KP in 2017

1.3 2.04.3 4.6 5.1 5.1 5.5 5.5 6.2

7.9 8.1

10.7

13.5

20.6

0

5

10

15

20

25

ABER API TPR

2348 20442403

3351

47825129

6603

1069810295

8771

6306

3986

0

2000

4000

6000

8000

10000

12000



Page | 24

A yearly comparison of the cases reported from 2014-2017 also indicates a peak season of August –

October followed by a decline (Figure: 24).

Figure 24 Year wise monthly trend of cases in KP from 2014-2017

5.2. SINDH

The number of malaria cases reported from Sindh in 2017 was 81,216 as compared to 34,413 cases

reported during 2016. During 2017, seven new districts were included in the grant namely Badin, Kambar

Shahdadkot, Larkana, Naushahro Feroz, Sukkur, Tando Muhammad Khan, and Umerkot; while Thatta was

divided into one additional district namely Sujawal. Earlier in 2016, only five districts had reported while

during 2017 the number of reporting districts has increased to 13 now. It seems that the addition of these

seven new districts to the grant during 2017 has contributed in reporting higher number of cases from

the Sindh province.

A total of 57,549 cases of PV (71%) were reported followed by PF 20,626 (25%) and mix 1069 cases

(4%). (Figure: 25)

Figure 25 Malaria confirmed cases distribution in Sindh

In 2017, Sindh reported API of 4.6, ABER of 5.4 and TPR of 8.5 as compared to the reported API of

5.67, ABER of 8.42 and TPR of 6.74 in 2016. The decrease in API and ABER may be attributed to the

increase in population due to the inclusion of seven new districts during 2017.

2227 1797 24073737

67818205

12771

19274

15891

12844

8347

4317

0

5000

10000

15000

20000

25000


2017 2016 2015 2014

3,041

20,626

57,549

81,216

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Mix PF PV Total


Page | 25

Considering district wise situation, highest number of cases were reported from Thatta (15,515) followed

by Mirpur Khas (9597) and Khairpur (8920). (Figure: 26) During 2016, Khairpur (10,550) had reported

the highest number of malaria cases.

Figure 26 District wise distribution of cases in Sindh 2017

Highest API was reported of district Thatta (15.8) followed by Sujawal (7.9) and Umerkot (6.8). (Figure:

27).

Figure 27 BER, API and TPR comparison district wise of Sindh 2017

1,814 2,056 2,127

3,673 3,684

5,0836,157

6,782 7,2928,516 8,920

9,597

15,515

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

1.2 1.62.3

3.0 3.3 3.7 4.1 4.4 4.7

6.4 6.87.9

15.8

0

2

4

6

8

10

12

14

16

18

ABER API TPR


Page | 26


of 7902 cases to 5596 cases in October. Minimal cases have been reported from January to March. (Figure:

28)

Figure 28 Monthly trend of cases reported in Sindh in 2017



Figure 29 Year wise monthly trend of cases in Sindh from 2014-2017

5.3. KP-Tribal Districts (FATA)

The number of malaria cases reported from FATA in 2017 were 80,924 as compared to 84,002 cases

reported during 2016; hence a decline of around 04% (3078) cases. There was no change in the number

of reporting agencies and FRs during 2017 as compared to 2016. However, due to the updated population

figures of census-2017, an increase in the population of FATA has been seen. Earlier the population used

in 2016 for estimation of API was 4,761,021 based on EPI population estimates; the revised census

population for FATA is 4,996,556 (an increase of around 5%).

1555 1383 15152185

2664 2652

3750

7902

62295596

3704

2519

0

1000

2000

3000

4000

5000

6000

7000

8000

9000


1834 1290 15002783

4358 4288

8782

21023

1347512328

6062

3493

0

5000

10000

15000

20000

25000


2017 2016 2015 2014

A total of 72,392 cases of PV (89%) were reported followed by PF 6653 (8%) and mix 1879 cases (2%).

Figure 30 Case distribution in FATA

In 2017, FATA reported API of 16.2, ABER of 10.1 and TPR of 16.1 as compared to the API of 17.54,

ABER of 10.37 and TPR of 17.01 reported during 2016. The decrease in API may be contributed by the

increased population of FATA as reported by censuse-2017.

Considering district wise situation, highest number of cases were reported from Khyber (21068) followed

by SWA (12556) and Mohmand (7946). (Figure: 31). During 2016, highest number of confirmed malaria

cases was reported from same agency, i.e. Khyber (23,492).

Figure 31 Agency wise distribution of cases in FATA 2017

1,8796,653

72,392

80,924

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Mix PF PV Total

2305 2887 3190 3356 3712 37334740

62177250 7946

12556

21068

0

5000

10000

15000

20000

25000


Page | 28

The highest API was reported by FR Lakki of 121.0 followed by FR Bannu (86.6) and FR Tank (79.3)

(Figure: 32).

Figure 32 BER, API and TPR comparison agency wise of FATA 2017


of 8204 cases to 7158 cases in October. Minimal cases have been reported from January to March. (Refer

to Figure: 33)

Figure 33 Monthly trend of cases reported in FATA in 2017

5.7 7.7 9.1 13.3 17.0 18.6 21.330.4 31.3

49.0

79.386.6

121.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Bajaur Kurram Orakzai NWA Mohmand SWA Khyber FRPeshawar

FR Kohat FRD.I.Khan

FR Tank FR Bannu FR Lakki

BER API TPR

18121549

1838

2876

47505294

6461

8204

7274 7158

5352

3200

0

1000

2000

3000

4000

5000

6000

7000

8000

9000



Page | 29



Figure 34 Year wise monthly trend of cases from 2014-2017

5.4. BALOCHISTAN

Balochistan reported a total 72,867 cases in 2017 as compared to 66,032 cases reported during 2016.

During 2017, eight new districts were included in the grant namely Awaran, Barkhan, Khuzdar, Killa

Abdullah, Kohlu, Lasbella, Quetta, and Ziarat. Earlier in 2016, 21 grant supported districts had reported

while during 2017 the number of reporting districts has increased to 29.

A total of 44,655 cases of PV (61%) were reported followed by PF 19,666 (27%) and mix 8546 (12%) cases.

(Figure: 35).

Figure 35 Malaria confirmed cases distribution in Balochistan

In 2017, Balochistan reported API of 6.3, ABER of 5.8 and TPR of 10.7 as compared to reported API of

12.39, ABER of 10.30 and TPR of 12.03 during 2016. The decrease in API and ABER may be attributed to

the increase in population due to the inclusion of eight new districts during 2017.

2485 22292881

4376

69227840

11056

13834

10592

9086

6169

3454

0

2000

4000

6000

8000

10000

12000

14000

16000


2017 2016 2015 2014

8,546

19,666

44,655

72,867

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Mix PF PV Total


Page | 30

Considering district wise situation, highest number of cases were reported from district Jaffarabad (7912)

followed by Zhob (7182) and Musakhel (6300). (Figure: 36). During 2016, same Jaffarabad district had

reported the highest number of cases but with very high magnitude (13,678).

Figure 36 District wise distribution of cases in Balochistan 2017

The highest API was reported of district Musa Khel of 37.7 followed by Sherani (25.9) and Zhob (23.1).

(Figure: 37).

Figure 37 BER, API and TPR comparison district wise of Balochistan 2017

131 183 271 307 326 404 404 711 773 831 931 1,2481,6861,7061,7532,059

2,4302,4852,8293,1463,4863,6013,9603,982

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Page | 31

Monthly trend of the number of cases reported indicates a highest rise of cases in September reaching a

peak of 6370 cases to 6032 cases in October. Minimal cases have been reported from January to March.

(Figure: 38)

Figure 38 Monthly trend of cases reported in Balochistan in 2017



Figure 39 Year wise monthly trend of cases from 2014-2017

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Page | 32

6. MALARIA CONTROL INTERVENTIONS

Various interventions for malaria control in Pakistan include:

a. Malaria case management: Early diagnosis, treatment as per national guidelines

b. Long Lasting Insecticidal Nets (LLINs)/Mosquito nets distribution

c. Capacity building / trainings of healthcare providers on:

i. Malaria case management,

ii. Malaria diagnosis through microscopy and RDT,

iii. Malaria microscopy quality assurance, and

iv. Malaria information system (MIS)

d. Behavior Change Communication (BCC), and

e. Malaria surveillance and outbreak response.

A review of malaria control activities that took place in 2017 is discussed below:

6.1. LLINS/MOSQUITO NETS DISTRIBTION

Long lasting insecticidal nets (LLINs) or simply mosquito nets have been one of the major key interventions

for prevention of malaria under the Global Grant since 2012. Under TGF grant, LLINs distribution strategy

includes mass distribution and continuous distribution to pregnant women during their Antenatal care

(ANC) visits.

6.1.1. Mass distribution of LLINs

The mass distribution of LLINs is shown in Figure: 37. Around 1.19 million LLINs were distributed in TGF

covered districts in 2017. The LLINs distributed through mass distribution during last year (2016) were

around 2.4 million. Highest number of LLINs (0.6 million) distributed through mass distribution was seen

in the Balochistan province as shown in the figure below:

Figure 40 Mass distribution of LLINs in Provinces/Regions in 2017

619,435

275,263

64,024

228,544

1,187,266

Balochistan FATA KP Sindh Total


Page | 33

Highest number of LLINs distributed through mass distribution was seen in South Waziristan (145,152)

followed by Dera Bugti (126,576). District wise LLINs distribution in ascending order is shown in the

figure 41:

Figure 41 District wise mass distribution of LLINS in 2017

6.1.2. Continuous distribution of LLINs through Antenatal Care (ANC) Clinics

Distribution of LLINs to pregnant women during ANC visits was more as compared to last year. A total

of 233,398 LLINs were distributed in 2017 as compared to 195,754 LLINs distributed in 2016. Highest

distribution through ANC clinics took place in Sindh province as shown in the graph below:

Figure 42 LLINs ANC distribution in 2017

6.2. CAPACITY BUILDING

6.2.1. Malaria case management

The target for 2017 was to train a total of 2,951 health care providers on malaria case management. A

total of 3,319 HCPs were trained thus achieving the target by 112%.

6.2.2. Malaria Diagnosis

The target was to train 2,463 technicians on malaria diagnosis. In 2017, a total of 2,946 malaria technicians

were trained thus achieving the target by 120%.

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

5,000 19,393

58,454 70,093

85,343

106,829 121,715

145,152

65,479 39,448 42,615

85,856

233,398

Balochistan FATA KP Sindh Total

6.2.3. Malaria information system (MIS) and outbreak response

The target was to train 3,017 HCPs on MIS and outbreak response. A total of 3,878 HCPs were trained

in 2017 from various districts under TGF grant. This resulted in achieving the target by 129%.

The details of DOMC, IHN/TIH and total achievements vs the targets is shown in the graph below:

Figure 43 Malaria trainings conducted in 2017

6.2.4. Behavior Change Communication (BCC) activities

BCC activities include ‘advocacy sessions’ with community based activists including Lady Health Workers

(LHWs), Community Based Organizations (CBOs), Non-Governmental Organizations (NGOs), religious

leaders, local elders and elected representatives for community awareness to enhance preventive and

curative services utilization in the districts. These trained LHWs, CBOs/NGOs and community

representatives then conduct the awareness sessions at community and health facility level.

In 2017, 52,888 personnel participated in the ‘advocacy sessions’ regarding preventive and curative services

pertinent to malaria. These participants then conducted community awareness sessions and a total of

around 1,442,302 members from the communities were reached.

Figure 44 BCC (Advocacy and awareness session conducted in 2017

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C A S E M A N A G E M E N T H C P M A L A R I A D I A G N O S I S M I S & O U T B R E A K R E S P O N S E H C P

DOMC-Target DOMC-Ach: IHN-Target IHN-Ach: Total-Target Total-Ach:

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Advocacy sessions Awareness sessions

DOMC-Target DOMC-Ach: IHN-Target IHN-Ach: Total-Target Total-Achieved


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6.2.5. Development of guidelines and training manuals

During 2017, DOMC developed guidelines and training manuals for malaria case management, G6PD

screening, diagnosis & quality assurance.

a. Malaria Case Management training manuals

b. Guidelines for Malaria Microscopy

c. Guidelines for Malaria diagnosis through RDT

d. Guidelines for Quality Assurance (of Malaria Microscopy)

e. Guidelines for G6PD deficiency testing

6.2.6. Surveys conducted during 2017

The long pending surveys (quality of anti-malaria drugs in private sector, therapeutic efficacy survey, and

Insecticide resistance monitoring) were conducted by DOMC during 2017. The brief details are as under:

a. Insecticide resistance monitoring of malaria vector mosquitoes in 5 provinces of Pakistan

b. Monitoring Antimalarial drug efficacy at two sentinel sites

c. Survey on Quality of Anti-Malarial Drugs (AMDs) in private sector

All these surveys and guidelines were endorsed by the Technical Working Group (TWG) members in the

TWG meeting held on 27th Dec, 2018.


Page | 36

7. ISSUES AND CHALLENGES

The main challenges faced during the implementation of grant activities during 2017 are as under:

7.1. Delays in establishment and functionality of new health facilities

Around 23 new districts were added under the Global Fund grant. SRs had to establish new malaria

diagnostic centers in these new districts. Along with this, SRs also had to establish new diagnostic centers

in old 43 districts where there was a gap in services provision and more centers were identified by the

district health authorities to enhance the coverage. There was a delay in establishment and functionality

of the new centers mainly due to the delayed trainings of the facility focal persons.

7.2. Delays in reporting from the new districts

Due to the delays in training of the new facility focal persons and establishment of the new malaria

diagnostic centers, the reporting from the 23 new districts was also delayed. Many districts started

reporting on the malaria information systems during after June 2016 so no surveillance information was

received in the first half of the year.

7.3. Increased number of yearly malaria cases

The number of malaria cases like the last year has shown an increase in the current year as well. This

increase can be attributed to the increased number of reporting health facilities, increased number of

grant supported districts, and better screening rates of malaria suspects. However, the yearly increase in

malaria cases is still an area of concern regarding the effectiveness of malaria control interventions in

Pakistan.

7.4. Fragmented health system and parallel reporting system

Malaria screening and confirmed cases data at the health facilities level is recorded and reported through

two parallel reporting and surveillance systems namely the District Health Information System (DHIS) and

Malaria Information System (MIS). The start of donor support for malaria control interventions in the

country had brought with it an additional reporting system to the DHIS, i.e., the MIS which is more

comprehensive and has many additional indicators as per the donor requirement. The MIS has its own

data recording and reporting tools at the health facility level in parallel to already existing tools for DHIS.

When there are parallel reporting systems and different recording and reporting tools from same health

facilities, the data quality is usually compromised as entering the data into separate platforms will result in

more errors. An integrated disease reporting system and use of the update online DHIS-2 are the potential

options for better integrity and coherence of reported data.

7.5. Lack of compliance to the national malaria treatment guidelines

Compliance to the national malaria treatment guidelines remained low mainly in few old and many new

grant supported districts. The old districts included Gwadar while new included districts from Balochistan,

KP and Sindh. Major reason was that specialists/experienced doctors prefer to prescribe medicines based

on their own clinical experience and knowledge, sign and symptoms of the patients and complications with

the other diseases with the result that they do not comply to the treatment guidelines. Continuous efforts

were made by DOMC and partners to improve the compliance to the national malaria treatment

guidelines so as to assure proper radical cure for malaria cases as per guidelines.


Page | 37

7.6. Lower coverage of malaria trainings

Although the trainings have been planned for a high number of service providers working at facility level

in the targeted districts, still a big gap has been mainly at the Rural Health Centers (RHC), Tehsil

Headquarter (THQ) and the District Headquarter (DHQ) hospitals. DOMC and IHN have been training

additional number of staff in the targeted districts, still due to budgetary constraints the overall coverage

of trainings in these hospitals is far low than the desired levels.

7.7. Challenges related to the LLINs distribution

LLINs distribution in the remote and security prone areas of Balochistan and FATA during the year has

been challenging. Issues were mainly seen in the districts of Dera Bugti, Musakhel, Jhal Magsi and Jaffarabad

in Balochistan while FR regions in FATA. These challenges resulted in delayed distribution of LLINs in

these remote districts.

7.8. Unregulated private sector

Both DOMC and IHN/TIH have scaled up the involvement of the private sector GPs (approx. 15 per

district) for the free of cost malaria diagnosis and treatment services, however their regulation as per

program requirement remains a challenge.


Page | 38

8. IMPORTANT EVENTS DURING 2017

8.1. Online District Health Information System (DHIS-2) malaria module

DMC is determined to have a robust surveillance system (third pillar of Global Technical Strategy) for

ensuring accurate and timely reporting of malaria cases from the targeted health facilities. For reporting

from TGF funded districts DMC and TIH have strategically planned to shift to an online malaria information

system with the support from TGF and technical guidance from WHO. In this regard, an online DHIS-2

malaria module has been developed for reporting of malaria cases and other programmatic achievement.

A number of consultative meetings with WHO mission, National TB control Program (NTP) and Ministry

of National Health Services Regulation and Coordination (NHSR&C) were held.

8.1.1. WHO mission to Pakistan for DHIS-2

WHO mission consisting of Dr. Ghasem Zamani (Regional

Advisor WHO) and Ryan Williams (DHIS-2 Focal Person

WHO) visited Pakistan in July 2017. The purpose of the mission

was the assessment of malaria situation in Pakistan in post

devolution scenario. Ryan gave an orientation of DHIS-2. Dr.

Zamani and Dr. Qutbuddin Kakar (NPO-WHO) visited health

facilities in Balochistan, KP, Punjab and Sindh provinces and had

meetings with DHOs and other important Government

officials.

8.1.2. Inception session for the provincial programs

An inception session for the Provincial Program Managers, DMC and TIH team was held on 12th Dec,

2018 at Hill View Hotel, Islamabad. This was followed by the

Provincial level trainings and hands-on practices at Peshawar-

KP, Hyderabad-Sindh and Quetta-Balochistan for the Data

Management Units (DMUs) and SRs’ district and provincial MIS

staff. It was planned that the period of Jan-June 2018 will be a

transition period where both manual and online systems will

run in parallel. Later on, the malaria cases reporting will be done

only through the online DHIS-2 system.

8.1.3. Training of trainers (TOT) and the data entry operators on DHIS-2 malaria

module

A series of trainings was conducted in December 2017 for the

implementation of DHIS-2 malaria module. The TOT was held in

Islamabad followed by the training of data entry operators for

DHIS-2 at the provincial level. The trainings was mainly facilitated

by the consultants namely the Pace Tech who were hired for the

development and trainings of the malaria information system

based on the DHIS-2 module.


Page | 39

8.2. WHO regional training workshop on M&E and surveillance (Muscat-Oman; Oct-2017)

The WHO Global Technical Strategy encompass ‘Transform malaria surveillance into a core intervention’

as the 3rd major pillar. Keeping in view the importance of surveillance, World Health Organization

(WHO) in collaboration with the Ministry of Health (MOH) organized a three days regional training

workshop on malaria M&E and surveillance. It aimed at training the malaria surveillance focal points in the

participated countries on the updated methods of collecting, analyzing, and evaluating data. From Pakistan

six participants attended this important training workshop including DMC Manager M&E, Provincial

Coordinators from KP-FATA and Balochistan and WHO Provincial Consultants.

8.3. WHO 9th Inter-country meeting of national malaria program managers from HANMAT

and PIAM-Net countries (Cairo-Egypt; Oct-2017)

WHO Regional Office for the Eastern Mediterranean convened the ninth inter country meeting of national

malaria program managers from countries in the Horn of Africa Network for Monitoring Antimalarial

Treatment (HANMAT) and Pakistan–Islamic Republic of Iran–Afghanistan Malaria Network (PIAM-Net),

two networks for monitoring antimalarial treatment efficacy, from 24 to 26 October 2017 in Cairo, Egypt.

8.4. WHO and University of Oslo mission visit to Pakistan for DHIS-2 (Dec-2017)

National TB Control Programme and DoMC under the auspices of MNHSR&C and in collaboration with

WHO, Global fund, University of Oslo, and NACP organized a technical assistance mission for integrated

management information system for HIV, TB and Malaria (HTM) using the DHIS-2 platform from 4-8 Dec,

2017. The mission presented the field findings and next planning in the debriefing meeting involving all the

key stakeholders.

8.5. Procurement & supply Chain

Directorate of Malaria control Pakistan is responsible for the procurement of Pharmaceuticals and Health

products. The pharmaceutical and health products are procured internationally with the help of Pooled

Procurement Mechanism of The Global Fund. The pharmaceutical products are delivered by air and stored

at the central warehouse in Islamabad for onward distribution. The health products based on the volume

are delivered via sea and stored at central level in Islamabad except LLINs. LLINs are stored at regional

level warehouse of DOMC.

DOMC is managing warehouses at central level for the storage of AMDs and HP. Regional level

warehouses are maintained for storage of LLINS. Two provincial level warehouses One at Peshawar and

second in Quetta is managed by DOMC. Two regional level warehouses were established in 2017 at

Thatta and Mirpurkhas for storage of LLINs.

9. ANNEXURES

9.1. List of the Global Fund grant supported districts

Names and details of the grant supported districts with PRs and SRs is given in the table below:

The Global Fund grant supported districts of Pakistan during 2017

S# Districts

(alphabetically)

Province Principal Recipient

(PR)

Sub-Recipient

(SR)

1. Awaran Balochistan DOMC NRSP

2. Badin Sindh DOMC NRSP

3. Bajaur KP-TD DOMC ACD

4. Bannu KP IHN/TIH FPHC

5. Barkhan Balochistan DOMC BRSP-DOMC

6. Buner KP DOMC ACD

7. Chagai Balochistan DOMC BRSP-DOMC

8. Charsadda KP IHN/TIH FPHC

9. Dera Bugti Balochistan DOMC BRSP-DOMC

10. Dera Ghazi Khan Punjab DOMC PLYC

11. Dera Ismail Khan KP IHN/TIH FPHC

12. FR Bannu/Lakki Marwat KP-TD DOMC ACD

13. FR D.I.Khan/ Tank KP-TD DOMC ACD

14. FR Kohat/Peshawar KP-TD DOMC ACD

15. Gwadar Balochistan DOMC NRSP

16. Hangu KP DOMC ACD

17. Harnai Balochistan IHN/TIH BRSP-TIH

18. Jaffarabad Balochistan DOMC BRSP-DOMC

19. Jhal Magsi Balochistan DOMC BRSP-DOMC

20. Kachhi/Bolan Balochistan DOMC BRSP-DOMC

21. Kambar Shahdad Kot Sindh DOMC PLYC

22. Karak KP DOMC ACD

23. Kech Balochistan DOMC NRSP

24. Khairpur Sindh DOMC PLYC

25. Kharan Balochistan DOMC BRSP-DOMC

26. Khuzdar Balochistan DOMC BRSP-DOMC

27. Khyber KP-TD DOMC ACD

28. Killa Abdullah Balochistan DOMC BRSP-DOMC

29. Killa Saifullah Balochistan IHN/TIH BRSP-TIH

30. Kohat KP DOMC ACD

31. Kohlu Balochistan DOMC BRSP-DOMC

32. Kurram KP-TD DOMC ACD

33. Lakki Marwat KP IHN/TIH FPHC

34. Larkana Sindh DOMC PLYC


Page | 41

35. Lasbela Balochistan DOMC NRSP

36. Loralai Balochistan IHN/TIH BRSP-TIH

37. Lower Dir KP DOMC ACD

38. Mastung Balochistan IHN/TIH BRSP-TIH

39. Mardan KP IHN/TIH FPHC

40. Mirpur Khas Sindh DOMC PLYC

41. Mohmand KP-TD DOMC ACD

42. Musa Khal Balochistan IHN/TIH BRSP-TIH

43. Nasirabad Balochistan IHN/TIH BRSP-TIH

44. Naushahro Feroze Sindh DOMC PLYC

45. North Waziristan KP-TD DOMC ACD

46. Nushki Balochistan IHN/TIH BRSP-TIH

47. Nowshera KP IHN/TIH IHN/TIH

48. Orakzai KP-TD DOMC ACD

49. Panjgur Balochistan DOMC NRSP

50. Pishin Balochistan IHN/TIH BRSP-TIH

51. Quetta Balochistan DOMC BRSP-DOMC

52. Shangla KP DOMC ACD

53. Sherani Balochistan IHN/TIH BRSP-TIH

54. Sibi Balochistan IHN/TIH BRSP-TIH

55. South Waziristan KP-TD DOMC ACD

56. Sujawal Sindh DOMC NRSP

57. Sukkur Sindh DOMC PLYC

58. Swat KP DOMC ACD

59. Tando Allahyar Sindh DOMC PLYC

60. Tando Mohammad Khan Sindh DOMC NRSP

61. Tank KP IHN/TIH FPHC

62. Tharparkar Sindh DOMC PLYC

Thatta Sindh DOMC NRSP

63. Umer Kot Sindh DOMC NRSP

64. Washuk Balochistan DOMC BRSP-DOMC

65. Zhob Balochistan IHN/TIH BRSP-TIH

66. Ziarat Balochistan DOMC BRSP-DOMC


Page | 42

9.2. DOMC procured AMDs and HP during 2017 (for both PRs)

S# Description Unit Quantity

1

Artesunate+Sulfadoxine/Pyrimethamine 50mg+500/25mg, tablets,

Blister 25 x 6+2 Tabs Doses 33,675.0

2

Artesunate+Sulfadoxine/Pyrimethamine 100mg+500/25mg, tablets,

Blister 25 x 6+3 Tabs Doses 42,800.0

3 Artemether/Lumefantrine 20/120mg, tablets, Blister 30 x 12 Tabs Doses 6,210.0



6

Chloroquine 250mg (phosphate) (155 mg base), Blister 10 x 10

Tabs Tablets 2,500,000.0

7 Primaquine 7.5mg, tablets, Blister 10 x 10 Tabs Tablets 10,657,400.0

8

Artesunate 60mg, powder for injection, 1 vial co-packed with 1

ampule of sodium bicarbonate injection (1ml:50mg) and 1 ampule

of sodium chloride injection (5ml:45mg). Vial 5,000.0

9 Quinine sulphate 300mg, coated tablets, Blister 10 x 10 Tabs Tablets 400,000.0

10 Malaria Antigen P.f / P.v, HRP2, pLDH, Kit, 25 Tests Kit 1,632,125.0

11 Microscope 179.0

13 LLINS (DOMC+ IHN) 4,244,667.0

Directorate of Malaria Control (DOMC), Islamabad

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