Ministry Of Health

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Ministry Of Health Population
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Historical background for Malaria
        Malaria is endemic in Egypt since the
dawn of history as it is documented on the wall
of pharoanic temples. Epidemic wave for
Malaria (Anopheles gambia invasion)
On 1942 , a sever epidemic wave of
falciparum malaria took place in the southern
part of Egypt due to invasion of the country by
Anopheles gambia the most efficient vector for
malignant Malaria transmission coming from Sudan
led to thousands of fatality in 4 southern
Governorates. - Eradication campaign of An.
gambia was launched by M.O.H. The campaign
reached its goal, , on 4th January 1946 MOH and
WHO declared that An. gambia had been eradicated
from Egyptian territories
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Historical background for Malaria
- After that , there were some endemic
areas of Malaria which gradually decrease due to
strong national control program applied by MOH
Control strategy continue through
strengthening epidemiological surveillance
activities all over the country until all
Governorates became free except fayoum
Governorate for its special environmental and
geographical position as slope area lie under sea
level , which became free since 1998 .
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Major constrains
1. Insufficient legislation in ports , harbor and
quarantine activities with increase movement
activities all over the world to and from
Malarious areas . 2 . Presence of two vector for
Malaria transmission which are An.
Pharoensis scattered along Nile banks and
An. Segenti which Restricted in Fayoum a
nd Oases . This give long season for
transmission 3 . Long southern borders wit
h Sudan country which have a high incidence of
morbidity and mortality cases of falciparum
Malaria between inhabitant with presence the
most efficient vector for malignant Malaria which
are Anopheles gambia spread all over the African
content and Sudan country . ,
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National GOAL
1. Strengthening active surveillance activities
for malaria control program. 2. Strengthening tr
ans-border cooperation project with Sudan in
surveillance activities for interruption of
transmission. 3. Strengthening building capacity
and infrastructure program.
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Strata
1. Large artificial Naser lake in the southern
part of Egypt 500 km., between Egypt and Sudan
which may considered as a good breeding places
for mosquitoes and become as a receptive area for
Malaria 2. Previous Malaria area , Egypt are free
from Malaria since 1990 except one Governorate
which is Fayoum with strong past history for
Malaria transmission till 1998 where it became
free 3. Increase tourism and working activities
to and from endemic Malaria countries
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Objective

• To detect malaria cases through ACD, PCD. by
  strengthening epidemiological activities in
  vulnerable and high risk areas.
  
• To survey anopheles mosquitoes fauna to identify
  potential malaria vector (s) by strengthening
  entomological activities
  
• 3. To sustain and upgrade the all ready
  establishment active surveillance program in the
  cross border project areas.
  
• 4. To train personnel acting in different
  categories in malaria unit on all aspect as
  vector identification and control measures.

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Situation analysis FOR Malaria in Egypt 2004
 - The last focus for Malaria was in Fayoum
which became free from transmission of Malaria
since 1998 . -  There were annual imported Malari
a cases from 1998 up till now according to the
following table which show the number of examined
persons for Malaria from ship passengers
traveling between Aswan Wady Halfa harbors (
Egypt Sudan countries ) and the other imported
Malaria cases discovered by Any other rout .
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Situation analysis FOR Malaria in Egypt
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Control strategy in Egypt
- Applied through 250 Malaria units subunits
scattered allover the country headed by p
hysicians and Malaria staff (Agricultural
engineer, Laboratory technicians ,scouts ,
field workers and others about 4859 healt
h staff . - Aim to make the country free fro
m all secondary cases for Malaria
which occurs from imported cases
- Environmental sanitation control program for
vectors of transmission all over the countr
y . - We can summarize the strategy of RBM in Eg
ypt according to our program as follows
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Activities for control program of Malaria
(1) Entomological survey ,Vector control activ
ities
During 2004 ( routine activities )

• 1. Integrated vector control
• In Fayoum Governorate, where the vector
  Anopheles sergenti is dominate, integrated vector
  control activities were applied during 1994 and
  2004 in Yosef El-Sedik district with the
  cooperation of Ministry of Agriculture, local
  counsel including
• Biological agents such as Gambusia fish, bacteria
  Bacillus thuringiensis.
  
• Chemical control, using insecticides that
  susceptibility tests proved effective.
  
• Environmental measures including clearing
  irrigation canals from vegetation, land filling
  and reclamation of several swamp areas to reduce
  breeding sites.

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Activities for control program of Malaria
(1) Entomological survey Vector control activiti
es
2. Entomological surveys continued monthly for
the mosquito vectors all over the country
especially in new large agriculture projects,
rice fields and areas under construction.
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Activities for control program of Malaria
(2) Epidmiological survey
2. Training activity during 2004.
         Strength training capability for Malaria
staff especially those working in fever hospitals
about management of Malaria cases and microscopic
examination of Malaria parasite during 2004
a. Annual training courses for training
of Malaria staff distributed all over the country
. ( 6 training courses and about 200 trained
persons from health cadres for one two month
for each rounds ) b. 4 refreshing t
raining courses 5 day for each 2 rounds for
training 50 physicians, agricultural engineering
and chemists, and 2 rounds for training
laboratory technicians and scouts for laboratory
diagnosis of Malaria parasites .
c. refreshing training courses 4 day
for each round for training agricultural
engineering and chemists ,and rounds for training
scouts for integrated vector control
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Activities for control program of Malaria
(2) Epidmiological survey
3 . Establishment of Malaria units in Cairo and
in areas of new agricultural project .
for 2006 . 1. Malaria vigilance in Cairo
Governorate for facing increase
construction projects in many localities in
satellite town . 2.  Malaria vigilance i
n areas of great agricultural project in
Toshky , Shark El awinate , Teraa EL
Esmaeillia . 3.  Providing these Malaria
units with all facilities required for
epidemiological survey
(microscopes,.. ) for diagnosis of the
Malaria parasite through ACD PCD
and supply these units with vehicle , ap
paratus , insecticides needed for vector
control measures ,.
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Activities for control program of Malaria
(2) Epidmiological survey
4 . Strengthening Surveillance activity
in the 3 critical areas in Egypt whi
ch are

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Activities for control program of Malaria
(2) Epidmiological survey
A - Fayoum Governorate ( Integrated vector
control 2004 )    Integrated vector control Be
gin to Apply during 1994 due to fulminating of
malaria cases in endemic foci in Fayoum
Governorate, with cooperation of Ministry of
Agriculture , Land reclamation and Local counsel,
put strategy for control program to strengthen
integrated vector control measures aim to
overcome the appearance of breading places with
early detection of cases until Fayoum Governorate
became free from Malaria in 1998 .
This program continued , it aim to environmental
sanitation with early detection of cases to
prevent re-appearance of Malaria with radical
treatment for cases if present.
During 2004 an Integrated vector control measures
applied in Yosif El Sedik district Fayoum
Governorate to overcome the environmental and
geographical changes occurs led to formation of
many breading places with increase vector density
of Malaria transmission till the control program
reached its goal .
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Activities for control program of Malaria
(2) Epidmiological survey
B - Protect the country from invasion of exotic
vector of malaria transmission from south border
(Governorate 2004 ) . - Egypt Sudan Cooperatio
n In 1970 after construction of high Dam, Ther
e are Health agreement signed between Egypt and
Sudan aimed to make the area between the two
countries (350 km in Egypt and 650 km in Sudan)
free from both vectors and parasites .
- According to this agreement between Sudanese
Egyptian Governments, 2 joint expeditions from
the two countries carry out annual coverage of an
area of 850 Km. Alongside the High Dam Lake (350
Km in Egyptian territories 500 Km in Sudanese
territories) to ensure that it is free from both
vector of transmission An. gambia and plasmodium
falciparum which cause malignant Malaria .
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Activities for control program of Malaria
(2) Epidmiological survey
An epidemiological control measures
takes place through medical and epidemiological
team for ship passengers traveling between Aswan
and Wady Halfa Harbors , also Passengers through
the high way road between Egypt and Sudan .
For early discovered of Malaria cases with
treating all positive one , with apply control
measures for vector on ships with suitable
insecticides before leaving Wady also for
transporting methods in high way
- supply the area of the project with all f
acilities required for control
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Activities for control program of Malaria
(2) Epidmiological survey
C. Cairo Governorate 2004 - Malaria vigila
nce in Cairo due to their position as a Capital
with great number of passengers coming fr
om an endemic countries . either for work ,
education in Al Azhar university
We strengthened the integrated vector
control measures to over come
the environmental changes in satellite
towns as El Mokattum city through
environmental sanitation , also
strengthening ACT and PCD for
students in Al Azhar university side by
side with integrated vector
control measures in these areas .
- Issues for establishment malaria control
units during 2006 .
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•    4 . Introduce new strategy for diagnosis of
  Malaria
  
• during 2006 we will try to Use
  dipsticks serological methods for Malaria
  diagnoses especially those coming from endemic
  areas and apply PCR technique in vulnerable
  Governorate among school children .
• 5 - Cooperation with other national health
  sectors 2004
  
• Cooperation between Malarial department
  in MOHP and fever hospitals and quarantine
  sectors in harbors and ports present all over
  the country .
• 6 - Cooperation with other national sectors
  sharing in integrated vector control program as
  ministry of agriculture and land reclamation ,
  ministry of environment , local councils .

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Activities for control program of Malaria
(2) Epidmiological survey
6 . Supply malaria units with anti-malarial
drugs 2004 1. Supply main malarial uni
ts and fever hospitals in all Governorates with
1st and 2nd line of treatment ( Fansidar ) and
and drugs require for treatment of cerebral and
complicated malaria cases ( as emergency and for
imported cases .) 2. Mefloquine as prophyl
actic treatment for travelers go to endemic
countries . 3. Prepare guideline chart for
travelers to endemic countries for methods of
self protection
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• W.H.O change their strategy from control
  programme and began to apply RBM on all
  endemic country for
  
• Create political awareness and
  commitment on dangerous of Malarial
  disease .
  
• -         Strengthening health sector .
• -     Co-ordinate efforts of country
  partnerships by promoting concreted action
  and sharing information on Malaria programme , in
  order to improve resource allocation and
  utilization .