Malaria and its Treatment in KSA

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Malaria and its Treatment in KSA

• Kingdom of Saudi Arabia
• MOH
• Malaria department

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Malaria in KSA

• Since 1948 anti-malaria activity 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 KSA

• In 1963 the government and WHO singed the first
  plan of protection as a pre-eradication program
  along the line of the world wide malaria
  eradication program.
• In early 1970s, Malaria transmission has been
  halted in the Eastern and Northern provinces .

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Malaria in KSA

• In 1980, it was cleaned out from the pilgrimage
  area of the western province and the main valley
  of Asir plateau. however there still residual
  transmission foci inside valleys of Hijaz-Asir
  mountens.

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Malaria in KSA

• In 1974, the malaria eradication program has been
  shifted to control as a result of the ecological
  and epidemiological situation in the country.
• In 1986, the malaria control program has been
  fully integrated in the primary health care
  units.

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Kindom of Saudi Arabia
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MONTHLY MALARIA CASES IN KINGDOM OF SAUDI
ARABIA1990-1995
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Comparison between local malaria cases in Jazan
and the rest of the region in the KSA 1994-1998
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(No Transcript)
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Annual Malaria Cases Reported from Border
Provences Related to Total Malaria Cases in Jazan
Area
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Guidelines for Treatment of Malaria in The KSA

• The drug policy is based on practical issues so
  as to meet the following
• 1- Early treatment.
• 2- Stop or delay the spread of P. falciparum
  resistance to choloroquine.
• 3- Prevent resumption of transmission to areas
  free of local transmission.
• 4- prevent relapse in P.vivax P.ovale
  infection.

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Guidelines for Treatment of Malaria in The KSA

• Dependant on the malaria case being
  uncomplicated, complicated or sever the following
  management policy is adopted
• First line
• 1- for uncomplicated P.falciparum malaria
  cases are given a three day curative treatment
  with chloroquine 1st 2nd day 10mg base/kg and
  5mg base/kg for the 3rd day a single dose of
  primaquine 0.5mg/kg or 0.75mg/kg

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Guidelines for Treatment of Malaria in The KSA

• 2- A follow-up parasite count should (if
  possible) be made 72 hours after initial
  choloroquine dose to determine whether symptoms
  and/or parasitaemia have disappeared.
• for P.vivax P.ovale infection chloroquine is
  given as P.falciparum.

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Guidelines for Treatment of Malaria in The KSA

• Second line
• For resistant P.falciparum infection Fansidar
  (sulfadoxine 25mg/kg Pyremethamine 1.25mg/kg)
  is given in a single oral dose.

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Guidelines for Treatment of Malaria in The KSA

• Third line
• - For P.falciparum infection if there is no
  response to Fansidar then shift to Mefloquine
  15mg/kg single or better split oral dose.
• If no response then shift to Quinine
  dihydrochloraide 10mg/kg every 8 hours for 7 days
  accompanied by Tetracycline 4mg/kg every 6 hours
  for 7 days.

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Guidelines for Treatment of Malaria in The KSA

• For complicated and sever cases patients should
  be treated in hospital parentrally as follows
• - Quinine dihydrochloride 20mg/kg as a loading
  dose over 4 hours, in 5 dextrose solution
  followed by Quinine dihydrochloride 10mg/kg as
  maintenance dose over 4 hours repeated every 8-12
  hours until the patient can take oral medication.

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Resistance of P.falciparum in KSA

• The result of the annual random screening
  indicate that P.falciparum strains showing CQ
  resistance in vitro become increasingly common in
  the Jazan region of south-west SA between 1986
  and 1998.

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Resistance of P.falciparum in KSA

• SA was considered to be in zone A (CQ sensitive)
  till 1997.
• In 1997 in vitro studies in NCTR in Jazan Area
  show 38 of P.falciparum resistant to CQ.

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Resistance of P.falciparum in KSA
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Resistance of P.falciparum in KSA

• In SA the CQ resistance fully aware.
• Alternative treatment have been made available.
• Although CQ remains the first line drug for
  uncomplicated malaria.

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Thank you