Malaria Control In Saudi Arabia

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Malaria Control In Saudi Arabia

• By
• Suleiman M. Alseghayer
• Assistant Director General for Parasitic Diseases
  and Director of Malaria

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Malaria in the KSA

• Since 1948, anti-malaria activities started
  around the oil fields in the Eastern province by
  the ARAMCO (Arabian American Oil Company).
• In 1952, the governmental malaria control project
  was initiated and assisted by WHO, mainly for the
  protection of the pilgrimage routs.

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Malaria in the KSA

• In 1963, the government and WHO signed the first
  plan of protection as a pre-eradication program
  along the lines of the global malaria eradication
  program.
• In early 1970s, malaria transmission was arrested
  in the Eastern and Northern provinces .

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Malaria in the KSA

• In 1980, it was cleared from the pilgrimage area
  of the Western province and the main valley of
  Asir plateau. However, there are still residual
  foci inside the valleys of Hijaz-Asir mountains.

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Malaria in the KSA

• In 1974, malaria eradication program was
  converted to control as a result of the
  ecological and epidemiological changes in the
  country.
• In 1986, the malaria control program has been
  fully integrated with the primary health care
  system.

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MALRIA CONTROL PROGRAMME- 2002

• Population
  21,774,634
• Growth Rate 3.4
  
• Population at risk
  2,225,636
• Total No. of malaria cases 2612
• No. of Indigenous cases 1016
• Malaria Incidence per/10000 1.2

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Kingdom of Saudi Arabia
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Surveillance and Reporting system

• Collection of data
  PHC Hospital
• Diagnosis and treatment
• Epid. Investigation
  selected PHC
• Consultation Analysis of data
  Regional health feed
• Preventive control measures
  Directorate back
• 
  Vector control unit
• Interpretation dissemination
  MOH
• of data
  Malaria Dept.

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Malaria in the KSA

• The peak of malaria transmission occurs between
  October and April.
• The pattern of malaria transmission is unstable
  with seasonal variations.
• Malaria epidemics frequently occur after heavy
  rains (one such epidemic flared up in
  south-western Saudi Arabia during the 1997 and
  1998).
• 90 of malaria cases in the south-western region
  caused by P.falciparum.
• 50 of the malaria cases in the north-west caused
  by P. vivax
• P. malariae is scarce.

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Malaria in the KSA

• Present situation
• During 2002, a total of 2612 confirmed cases
  were reported, out which 1016 were locally
  transmitted. In the free areas only imported
  cases were reported.
• The country has a competent and adequately
  financed central malaria unit and an efficient
  information system on malaria.

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Malaria in the KSA

• Main achievements
• The MOH has taken the initiative for
  strengthening malaria control activities in the
  Kingdom, which is timely and concordant to the
  global initiative for Roll Back Malaria.
• A clear system to overcome the constraints and
  ensure rapid and timely implementation of the
  activities was developed.
• More support and strength have been provided to
  those working in areas with Afro-tropical
  malaria.

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Malaria in the KSA

• Main achievements
• The joined Saudi-Yemeni coordination committee on
  malaria control at the border areas agreed, at
  the last meeting held on the 1-4th. of February
  2003 at Sanna (Republic of Yemen), on the
  following points
• - integration of malaria control activities
  between the two countries to guarantee
  implementation of activities through mutual
  teams,
• - health education of the public and development
  of community participation,
• evaluation of vector and disease pattern changes,
  efficacy of control programs, study and
  implementation of amendments to improve results,

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Malaria in the KSA

• - Standardization of malaria drug policy in the
  two countries,
• Establishment of a joined team to evaluate the
  implementation of control activities at the
  border areas every three months,
• preparation of periodic and special reports for
  information purposes.

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Malaria in the KSA

• Future perspectives
• Develop an early warning system for malaria
  outbreaks based on a thorough understanding of
  malaria epidemiology and information on land-use
  patterns and climate at the Saudi-Yemeni border
  area (GIS, Computers, etc).
• Strengthen cooperation with The Republic of
  Yemen.
• Elimination of residual malaria foci through a
  strong, time limited attack measures.

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Malaria in the KSA

• Prevent mortality and reduce morbidity by 50
  within 5 years period in Jazan region.
• Support to eliminate malaria and prevention of
  introduction.
• Priority areas
• -to extend facilities for early diagnosis and
  prompt treatment of malaria in still endemic and
  border areas
• -to assure correct management of severe cases,
• -to detect early and manage outbreaks
• -to carry out selective vector control,
• -to strengthen surveillance in malaria free
  zones.

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Malaria in the KSA

• Applied research in epidemiology and control
  methods is needed to adapt the control strategies
  to the new epidemiological realities.

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Malaria in the KSA

• Factors influencing malaria transmission
• Environmental factors such as excessive
  rainfall, temperature, humidity.
• Introduction of CQ-resistant malaria by numerous
  immigrant workers.
• Vector resistance to some insecticides.

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Malaria in the KSA

• CQ resistance
• The national and regional Health authorities are
  fully aware of the problems posed by CQ
  resistance.
• Alternative treatments available
• CQ remains the first-line drug for uncomplicated
  malaria.
• Antimalarial measures, including prompt treatment
  of cases and implementation of large-scale
  vector control measures, have been intensified.

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Monitoring insecticide resistance

• The Scarcity of Adult anopheles mosquitoes in
  nature in the different biotopes of the kingdom
  of Saudi Arabia make it difficult to conduct
  monitoring pesticide resistance of those vector
  species of mosquitoes .
• The annoying mosquitoes species of culex are
  widely distributed in the Kingdom and comprises
  the highest population among the mosquitoes
  species .
• This species were incriminated as one of the
  vectors of Rift Valley Fever.
• Pesticide resistance monitoring was carried out
  by collecting and rearing larvae of culex
  mosquitoes and exposing the immerging adults to
  insecticides impregnated papers.

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Monitoring insecticide resistance

• Preliminary studies in Makkah area has shown that
  culex species are resistant to many groups of
  pesticides specially organophosphates .
• The pesticides effect on adult culex mosquitoes
  in decreasing order of abundance were
  Deltamethrin , lambdacyhalothrin ,Permethrin
  ,fenitrothion, Malathion and D.D.T. respectively
  Supplies for the collection ,rearing of
  mosquitoes and susceptibility test kits has been
  forwarded to endemic areas for rearing of
  mosquitoes specially vector species of anophles
  mosquitoes and monitoring resistance of those
  species towards different groups of pesticides .
  

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Monitoring Insecticide Resistance
Results of susceptibility test carried out in
Makkah area during the year 1423 HJ (Feb.2003) on
adult culex
T/N Total Number of mosquitoes N/D Number of
mosquitoes dead M/R Mortality rate
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Monitoring insecticide resistance
Summary of results of susceptibility tests of
anopheles larvae in Assir Region, Kingdom of
Saudi Arabia
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Indigenous Malaria Cases (1997-2002).
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Malaria Species, 2002
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Malaria Incidance/10000 (1997-2002)
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MALARIA CONTROL

• Objectives
• To maintain malaria free status in areas with
  absence of local transmission.
• To prevent/contain outbreaks timely.
• To further reduce malaria incidence in malaria
  core areas.
• Proper management of malaria cases

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Malaria Control Strategy

• The malaria control strategy in the kingdom
  agrees with most of the key elements of the
  strategy to Roll Back Malaria namely
• Early diagnosis and prompt treatment of cases.
• Effective management of outbreaks.
• Selective use of vector control methods.
• Applied research.
• Inter-sector cooperation.

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CONTROL MEASURES

• The areas are stratified into three
  epidemiological categories based on the Annual
  Parasite Incidence (API per 1,000) and / or
  positivity rate in some areas as follows
• Category A
• with continuous transmission. ( API
  2-6/ 1000)
• Category B
• with sporadic transmission ( low risk).
  ( API 0-2/ 1000)
• Category C
• calimed to be freed from malaria. (
  API0)
• Category D
• Initially non-malariuos areas. ( API0)

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Vector Control Measures according to Category
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Other Control Activities and Approaches

• 1. Source Reduction (limited).
• 2. Health Education.
• 3. Monitoring drug resistance.
• 4. Monitoring insecticide resistance.

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Thank you