Malaria: A Rising Health Concern in District Lakki Marwat, Khyber Pakhtunkhwa, Pakistan

Background: Malaria remains a leading public health concern globally and is particularly endemic in Pakistan, where regional data on pediatric malaria prevalence are limited. Despite control efforts, children under five years remain the most vulnerable group, often due to weak immunity, environmental exposure, and inadequate health infrastructure. Understanding localized epidemiology is critical to improving targeted interventions in underserved areas such as District Lakki Marwat, Khyber Pakhtunkhwa. Objective: This study aimed to assess the prevalence and species distribution of Plasmodium infections among children in District Lakki Marwat using microscopy and rapid diagnostic testing, with the goal of informing future control and prevention strategies. Methods: A hospital-based cross-sectional survey was conducted involving malaria-suspected children aged ≤10 years (n = 815). Inclusion criteria included febrile illness or clinical suspicion of malaria, and exclusion criteria were prior anti-malarial treatment within the last two weeks. Blood samples were analyzed using microscopy and rapid diagnostic tests (RDTs) to identify P. vivax and P. falciparum. Ethical approval was obtained from the Department of Pharmacy, Kohat University of Science and Technology, in accordance with the Declaration of Helsinki. Data were analyzed using SPSS v27, applying descriptive statistics and chi-square tests to assess associations between infection status and demographic variables. Results: Among 815 children screened, 627 (76.93%) tested positive for malaria. Microscopy identified 406 (49.8%) positive cases, while RDTs detected 221 (27.1%) cases. P. vivax was the predominant species (98.72%), with a significantly higher infection rate in male children (81.98%) compared to females (69.57%, p < 0.001). The highest prevalence was observed in the 1–4-year age group and during the summer season, indicating environmental and behavioral risk factors. Conclusion: The study highlights a critically high prevalence of pediatric malaria in District Lakki Marwat, predominantly due to P. vivax. These findings underscore the need for intensified vector control, enhanced diagnostic accuracy, and public health education in endemic rural regions. Strengthening seasonal surveillance and integrating rapid and molecular diagnostic approaches are essential for early detection and intervention, particularly among vulnerable pediatric populations.