Outbreaks of malaria are being reported in various parts of the province of Sindh, with local people blaming the authorities for failing to carry out preventive measures, including the spraying of insecticide to kill mosquitoes during the pre-spring breeding season. In Shikarpur District, upper Sindh, Mohammad Thaaral Channa, malaria superintendent for the district health authorities, said over 100 positive cases of malaria had been reported in malaria centres in the district over the past three months, IRIN, the UN information unit quoted him as saying in a report. A large number of malaria cases have also been reported in Mirpurkhas District in the southern part of Sindh province. "At least 20 people have been hospitalised here with acute malarial symptoms. Dozens of others are affected,' said Naveed Ahmed, whose four-year-old son has also been suffering suspected malaria. A mayor of an administrative unit in Mirpurkhas told malaria was spreading, but added: "We have begun mosquito-spraying campaigns and other measures to control it. Things will be better now.' But such words bring little assurance to those suffering from malaria. "My one-year-old grandson died of malaria in 2002. Now we are told his brother, aged five, is infected. We are very scared,' said Aslam Chandio, 60, whose daughter and family live in the Mirpurkhas area. In early April, the Islamabad-based Directorate of Malaria Control (DOMC) said 130,000 cases of malaria had been confirmed in Pakistan in 2007. Faisal Mansoor of the DOMC told an English newspaper that many of the cases had been reported by the Lady Health Workers (LHW). According to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the number of reported malaria cases in Pakistan stood at 125,152, with 29 reported malaria-related deaths. In February this year, the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria approved a US$23 million, five-year grant to help control malaria in Pakistan. The grant will be used to try to reduce malaria cases by half in 19 districts of the country where it is endemic. The World Health Organisation (WHO), which is engaged in the Roll Back Malaria campaign in Pakistan, which supports the government's objective of bringing down malaria levels by half by 2010, says the estimated number of annual malaria episodes in Pakistan is more than 1.6 million. It points out that the number is hard to determine, as many cases go unreported. "Certainly, health workers active in the field believe this to be the case, said Maryum Fatima, who has carried out welfare work in several districts of Sindh', said adding that quite often one comes across serious patients, whose condition has never been diagnosed. When blood samples are tested, in many instances the malaria parasites is found', she said. The problem is also linked to the lack of access to basic health care. This means people who are sick often cannot gain access to a medical practitioner or a health facility. As Maryum points out, "this is all the more true when women are affected because their health is often not a priority for families.' Poor sanitation, erratic anti-mosquito campaigns and periodic rains that leave pools of stagnant water are all factors in the failure to control malaria in Pakistan. Outbreaks of the disease, such as those reported from Sindh, remain commonplace - with cases rising during the summer months, when mosquito population soars and people traditionally sleep outdoors, often without netting or other protection from insect bites.