Malaria
Also called: malarial fever, vivax malaria, falciparum malaria, severe malaria, cerebral malaria
Malaria is an infection caused by a parasite that spreads through the bite of infected Anopheles mosquitoes. It causes fever, chills and headache. It can be cured with the right medicines, but falciparum malaria can become life-threatening quickly, so a blood test and early treatment matter.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Malaria is caused by tiny parasites called Plasmodium. Five types infect people. Plasmodium falciparum causes the most dangerous illness, while Plasmodium vivax is the most common type in most countries outside Africa, including South Asia. The parasite is passed on when an infected female Anopheles mosquito bites, mostly in the evening and at night. It does not spread from person to person like a cold, but it can rarely pass through blood transfusion or shared needles.
After the bite, the parasites first grow in the liver and then attack the red blood cells. Symptoms usually start about 10 to 15 days later. Fever, chills and headache are the most common signs, and they can look like many other fevers. Without treatment, falciparum malaria can turn severe within a day and damage the brain, kidneys, lungs and blood. Vivax and ovale parasites can hide in the liver in a dormant (sleeping) form and cause the illness to come back months or even years later.
Malaria is preventable and curable. Every suspected case should be confirmed with a blood test before treatment. The medicine chosen depends on the type of parasite, where the infection was caught, how ill the person is, their age or weight, and whether they are pregnant. In Pakistan most malaria is caused by P. vivax, but falciparum malaria is also found, especially in Balochistan, parts of Sindh and areas of Khyber Pakhtunkhwa.
In Pakistan: what studies show
Pakistan reported 2,726,489 confirmed malaria cases in 2023, far more than the 399,097 cases reported in 2021, before the 2022 floods. Sindh had 49.4% of the 2023 cases. Most infections are P. vivax (64.2% in 2023), but P. falciparum made up 32.1%.
- In 2023, health facilities across Pakistan reported 2,726,489 confirmed malaria cases.[1] (surveillance, data 2023)
- Of the confirmed malaria cases reported in Pakistan in 2023, 64.2% were caused by P. vivax and 32.1% by the more dangerous P. falciparum.[1] (surveillance, data 2023)
- Sindh reported the most malaria in 2023: 49.4% of all confirmed cases in Pakistan (1,346,210 cases), with Balochistan next.[1] (surveillance, data 2023)
- WHO reported that malaria cases in Pakistan peaked at 2.7 million in 2023, compared with 399,097 in 2021, after the 2022 floods.[3] (surveillance, data 2021-2023)
- During the 2022 flood outbreak, in Sindh confirmed malaria cases reached 69 123 in August 2022, compared with 19 826 in August 2021.[2] (outbreak report, data August 2021 and August 2022)
- In 2022, Sindh and Balochistan, the provinces worst hit by the floods, together accounted for 78% of all confirmed malaria cases reported in Pakistan.[2] (outbreak report, data January - August 2022)
- From January to August 2022, over 170 000 malaria cases in Pakistan were confirmed by a laboratory test; 77% were P. vivax and 23% were P. falciparum.[2] (outbreak report, data January - August 2022)
- A review that pooled 45 published Pakistani studies from 2006 to 2021 found malaria in 23.3% of the people tested in those studies.[4] (systematic review/meta-analysis, data 2006-2021)
Pakistan guidance: National Plan for Malaria Elimination in Pakistan, 2021-2030 (strategic plan, not a treatment guideline) (Common Management Unit for AIDS, TB & Malaria / Malaria Technical Unit, Ministry of National Health Services, Regulations and Coordination, 2021)[1]; National treatment guidelines for malaria (launched 2003, revised 2006; described in a 2016 JPMA article, no formal title given) (Malaria Control Programme Pakistan, developed with WHO, 2006)[5]
What we do not know yet: Sources disagree on the species mix: national data for 2023 put P. vivax at 64.2% of cases, while a review of studies from 2006-2021 found a clearly higher P. vivax share and WHO said in 2022 that P. vivax is over four-fifths of cases, so P. falciparum may have become more common since the 2022 floods. We could not open a current national malaria treatment guideline (the newest one we found described dates from 2006), a list of high-burden districts with case counts, or WHO World Malaria Report estimates of deaths for Pakistan.
Pakistan studies cited
- Common Management Unit for AIDS, TB & Malaria (Malaria Technical Unit) Malaria Technical Unit (programme page with 2023 national malaria data). Common Management Unit for AIDS, TB & Malaria, Ministry of National Health Services, Regulations and Coordination, Government of Pakistan undated page (2023 data). Open source
- World Health Organization Disease Outbreak News: malaria in Pakistan (item 2022-DON413). World Health Organization 2022 (17 October 2022). Open source
- WHO Regional Office for the Eastern Mediterranean (WHO Pakistan) WHO and Pakistan warn climate change is worsening malaria amid 2 million annual cases. WHO EMRO, Pakistan news 2025 (24 April 2025). Open source
- Khan MI, Qureshi H, Bae SJ, et al. Malaria prevalence in Pakistan: A systematic review and meta-analysis (2006-2021). Heliyon 2023;9(4):e15373. doi:10.1016/j.heliyon.2023.e15373. Open source
- Waqar T, Khushdil A, Haque K Efficacy of Chloroquine as a first line agent in the treatment of uncomplicated malaria due to Plasmodium vivax in children and treatment practices in Pakistan: A Pilot study. Journal of the Pakistan Medical Association 2016;66(1):30. Open source
Symptoms
- Fever, often high, which may come and go
- Shaking chills (rigors) followed by heavy sweating as the fever breaks
- Headache
- Muscle aches and a general flu-like feeling
- Tiredness and weakness
- Nausea, vomiting or diarrhoea
- Yellowing of the skin or eyes (jaundice)
- In children: drowsiness, vomiting and tummy pain, often without other clear signs
- An enlarged spleen or liver, which a doctor may feel during an examination
Causes and risk factors
Causes
- Infection with Plasmodium parasites: P. falciparum, P. vivax, P. ovale, P. malariae or P. knowlesi
- The bite of an infected female Anopheles mosquito, which picks up the parasite from an infected person and passes it on
- Rarely, a transfusion of infected blood or a shared, contaminated needle
- Return of the illness from dormant liver parasites (relapse) in vivax and ovale malaria, even without a new bite
- Illness coming back soon after an incomplete course of treatment
What makes it more likely
- Living in or travelling to an area where malaria is common
- Being outdoors or sleeping without a net in the late evening and at night, when Anopheles mosquitoes bite
- Young children, especially those under five years old
- Pregnancy, which raises the risk of severe malaria and harm to the baby
- Having little or no past exposure to malaria, such as travellers, refugees and people returning home after living abroad
- Living with HIV
- Not taking preventive medicine when advised before travel
Complications
Most complications come from falciparum malaria that is not treated quickly. Cerebral malaria (malaria affecting the brain) causes confusion, fits and coma, and is the main cause of death, especially in young children. Other serious problems include severe anaemia (a big drop in red blood cells), low blood sugar (hypoglycaemia), breathing failure from fluid in the lungs, kidney failure, abnormal bleeding and collapse of the circulation. Rarely, red blood cells break down so fast that the urine turns dark, a condition called blackwater fever. In pregnancy, malaria can cause anaemia in the mother, miscarriage, stillbirth, early birth and a low birth weight baby. Vivax and ovale malaria can relapse many times if the dormant liver forms are not treated.
When to see a doctor
- Confusion, extreme drowsiness, fainting or difficulty waking up
- Fits (convulsions) of any kind
- Fast or difficult breathing
- Dark, cola-coloured or bloody urine, or passing very little urine
- Yellow eyes or skin together with high fever
- Unusual bleeding from the gums, nose or skin
- Any fever in a pregnant woman or a young child in a malaria area, or in anyone who has travelled to one in the past year: get tested the same day
Diagnosis
Malaria cannot be diagnosed safely from symptoms alone, because many fevers look the same. The World Health Organization advises that every suspected case is confirmed with a blood test before treatment is given. The standard test is a blood smear (thick and thin films stained and looked at under a microscope). It shows whether parasites are present, which type they are and how many there are. A rapid diagnostic test (RDT) uses a finger-prick of blood and gives a result in minutes, which is useful where a laboratory is not nearby. One negative smear does not fully rule out malaria, so the test is usually repeated after 12 and 24 hours if the doctor still suspects it. PCR (a test for parasite genetic material) can find very low parasite numbers and confirm the species.
In people who are unwell, doctors also check a full blood count (anaemia and low platelets are common), kidney and liver tests, blood sugar and sometimes a chest X-ray. Before a medicine to clear dormant liver parasites is given, a blood test for G6PD deficiency (an inherited enzyme problem) is advised.
Treatment
- Get a blood test (microscopy or a rapid test) to confirm malaria and its type before starting any antimalarial medicine.
- For uncomplicated falciparum malaria, an artemisinin-based combination therapy (ACT) is used for three days. Your doctor decides which ACT and the dose, based on age, weight and pregnancy.
- For vivax, ovale and malariae malaria, an ACT or, where the parasite still responds to it, chloroquine is used to clear the blood stage.
- To stop vivax or ovale malaria coming back, a course of primaquine is usually added to kill the dormant liver forms. A G6PD test is advised first, and it is not given to pregnant women, babies under six months or women breastfeeding a baby under six months.
- In pregnancy, the doctor chooses medicines carefully according to the stage of pregnancy.
- Severe malaria is an emergency treated in hospital with injectable artesunate for at least 24 hours and until the person can swallow, followed by a full course of an ACT. People who are very unwell may need intensive care.
- If a hospital is far away, health workers may give one injection of an antimalarial (or rectal artesunate for young children) before transfer. Finish every course in full and return if fever comes back.
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Artemisinin-based combination therapies (ACTs) | first-choice treatment for uncomplicated falciparum malaria; also used for other types and to complete treatment after severe malaria; your doctor decides the dose | Artemether + Lumefantrine (382 brands), Artesunate + Amodiaquine (12 brands), Artesunate + Mefloquine (6 brands), Dihydroartemisinin + Piperaquine (27 brands), Artesunate + Sulfadoxine + Pyrimethamine (7 brands) |
| Injectable artemisinins | hospital treatment of severe malaria (artesunate first choice, artemether if artesunate is not available) and pre-referral treatment | Artesunate (59 brands), Artemether (133 brands) |
| 4-aminoquinolines | treat vivax, ovale and malariae malaria only where the parasite is still sensitive; not suitable for falciparum malaria in areas with chloroquine resistance | Chloroquine (92 brands) |
| 8-aminoquinolines | clear dormant liver forms to prevent relapse of vivax and ovale malaria; G6PD testing advised first; not for pregnancy or young babies | Primaquine phosphate (1 brand) |
| Cinchona alkaloids | older injectable option for severe malaria only when artesunate and artemether are not available | Quinine dihydrochloride (4 brands) |
Also used (not yet in our price list): Tafenoquine (an alternative medicine to prevent vivax relapse in some countries), Atovaquone-proguanil (used for treatment and travel prevention in some countries), Artesunate-pyronaridine (an ACT option)
Self-care and prevention
Self-care
- Take every dose of your antimalarial medicine until the course is finished, even if you feel better, because stopping early can let the infection return
- Tell your doctor if you are pregnant, breastfeeding or know you have G6PD deficiency, as this changes which medicines are safe
- Do not treat a fever yourself with leftover chloroquine or other antimalarials; get a blood test first
- Go back to the doctor straight away if you become drowsy, confused, breathless or pass dark urine
- If fever returns weeks or months later, get tested again, as vivax malaria can relapse
- Sleep under an insecticide-treated mosquito net and use repellent to protect yourself and your family from new bites
Prevention
- Sleep under an insecticide-treated net every night, and replace it when it is old or torn
- Support indoor residual spraying (spraying insecticide on inside walls) when health teams offer it
- Use insect repellent containing DEET, IR3535 or icaridin, and wear long sleeves and trousers in the evening and at night
- Fit screens on windows and doors, and use mosquito coils or vaporisers
- Travellers to malaria areas should see a doctor several weeks before the trip about preventive medicine and keep taking it for the advised time after return
- Get any fever tested promptly, because quick diagnosis and full treatment also reduce spread in the community
Common questions
Is malaria contagious?
No. Malaria does not spread through touching, coughing, sharing food or sex. It spreads when a mosquito bites an infected person and then bites someone else. Very rarely it can pass through infected blood or shared needles.
Why can malaria come back after treatment?
Vivax and ovale parasites can hide in the liver in a dormant form and wake up months or even years later. A medicine such as primaquine is given to clear these liver forms. Malaria can also return quickly if the course of medicine was not completed.
Can I take chloroquine for any fever?
No. A blood test should confirm malaria and its type first. Chloroquine works only for some types of malaria, and in Pakistan many falciparum parasites no longer respond to it. Taking the wrong medicine can delay proper treatment of a dangerous infection.
How soon after a mosquito bite do symptoms start?
Symptoms usually start about 10 to 15 days after the infected bite. Some types can take a month or longer, and vivax malaria can appear months later. Anyone who has a fever within a year of being in a malaria area should mention this to their doctor.
Is there a malaria vaccine?
WHO recommends two malaria vaccines for young children living in areas with moderate to high falciparum malaria, and they are mainly being used in Africa. They work best alongside bed nets and other prevention. For most people, avoiding mosquito bites remains the main protection.
Sources
- WHO fact sheet. Malaria (2025).
- World Health Organization. WHO guidelines for malaria (2026).
- World Health Organization. WHO Guidelines for malaria - 16 February 2021 (2021).
- CDC. About Malaria | Malaria | CDC (2024).
- StatPearls (Buck E, Finnigan NA). Malaria - StatPearls - NCBI Bookshelf (2023).
- MedlinePlus. Malaria | MedlinePlus (2025).
- Malaria Journal (Khattak AA et al.). Prevalence and distribution of human Plasmodium infection in Pakistan (2013).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.