Malaria vector control strategies in Pakistan: a scoping review

Malaria remains a significant public health concern in Pakistan due to its subtropical climate and diverse array of vectors, which contribute to periodic outbreaks and challenges in disease control. Recent outbreaks-particularly in 2022-along with the rising incidence of Plasmodium falciparum and growing resistance of Anopheles mosquito vector to existing control methods, highlight a critical gap in understanding the effectiveness of current malaria vector control strategies. This article is a scoping review of published literature on malaria prevention methods with a focus on World Health Organization (WHO) outlined interventions in the endemic region of the lower middle-income country, Pakistan.

Relevant articles published in all languages before September 2023 were reviewed. All the articles were obtained from PubMed, Scopus, CINAHL, Embase and Google Scholar. Four independent reviewers performed the selection and characterization of articles based on defined inclusion criteria. The data collected were extracted and analyzed by province, vector, and vector control methods according to WHO recommendations.

A total of 46 articles reporting surveillance findings on vector control methods in Pakistan were found. Based on WHO recommendations, the reported strategies included insecticide-treated nets (ITN) (29.79%), indoor residual spraying (IRS) (29.79%), spatial spraying (12.77%), spatial/airborne repellents (4.26%), larval source management (4.26%) and house modifications (4.26%). In contrast to Khyber Pakhtunkhwa, which employs ITN (55%) as the primary vector control method, Punjab was found to use IRS as the main method of vector control (50%).

This review highlights the current strategies for controlling malaria vectors and the strategies used in the past for outbreaks in Pakistan. This review identifies a notable increase in the use of insecticide-treated nets (ITNs) over time and highlights differences in the implementation of vector control strategies across provinces in Pakistan. Current practices and their contrast to WHO guidelines are illustrated. It helps us understand the need for improved research and development with precise reporting. These findings can serve as a reference for guiding policy decisions and improving malaria control efforts in endemic regions.