PREVALENCE AND CLINICAL PRESENTATION OF GLUCOSE-6-PHOSPHATE-DEHYDROGENASE DEFICIENCY IN PAKISTANI PATHAN AND AFGHAN REFUGEE COMMUNITIES IN PAKISTAN - IMPLICATIONS FOR THE USE OF PRIMAQUINE IN REGIONAL MALARIA CONTROL PROGRAMS

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency surveys in Afgha n refugees and a local community in the North-West Frontier Province, Pakistan, showed that this trait was most common among Pathan and Uzba k refugees (15.8% and 9.1% respectively). The prevalence among Pakista ni Pathans was 7.0%, and that in Tajik and Turkoman refugees was 2.9% and 2.1% respectively. Hospital studies showed that the type of G-6-PD deficiency in Pathans could cause severe haemolytic crises. The poten tially fatal side effects of primaquine treatment in the Pathan commun ities, and the high risk of re-infection, render the anti-relapse trea tment policy for Plasmodium vivax obsolete. However, epidemic conditio ns of P. falciparum malaria may justify the use of primaquine as a gam etocidal drug, administered as a single dose, during the transmission season. These findings necessitate revision of the recommendations for the use of primaquine in the area.