EPIDEMIOLOGICAL DETERMINANTS OF MALARIA IN DISTRICT LOWER DIR, PAKISTAN: A SYSTEMATIC REVIEW
Abstract
Malaria is still a serious public health concern in Pakistan, particularly in endemic districts such as Lower Dir. This systematic review investigates the malaria prevalence and its determinants. Following PRISMA guidelines, we searched the following databases: PubMed, ScienceDirect, Embase, Emcare, and Google Scholar for articles regarding malaria in Lower Dir published between January 2013 and July 2026. Eligible studies reported laboratory-confirmed (microscopy and/or RDT) malaria prevalence stratified by demographic or environmental variables. Nine studies met inclusion criteria. Positivity ranged from 12.2% to 39.5% in community/hospital populations (median 15%), with a higher rate (81.3%) in a pediatric cohort. Male positivity exceeded female positivity (ratios of 1.2:1 to 1.6:1). Age-related risk varied, with peaks in young children (<10–11 years) or adults (11–40 years) across studies. Transmission peaked in the period of June–October and decreased during the months of December–February. The highest prevalence was recorded in Timargara, whereas Samarbagh recorded the lowest prevalence. Plasmodium vivax was predominant in all studies (71–99.5% of cases), followed by Plasmodium falciparum (0.5–23.8%); mixed infections were rare (≤8%), with no Plasmodium malariae or Plasmodium ovale detected. Important socio-economic factors for transmission at this location were low education, joint-family pattern, low income, as well as poor sanitation conditions. The results confirm moderate endemicity of Plasmodium vivax malaria in Lower Dir, mainly determined by sex, age, seasonality, geography, and socioeconomic factors.
Keywords
- Malaria; Plasmodium vivax; prevalence; determinants; Lower Dir
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