Antimalarial Drug

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Malaria at Border areas between Saudi Arabia and
Yemen
By Sulaiman K. Alfaify Director of Malaria
Department
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Malaria in KSA

• Situation analysis
• Malaria is still endemic in some parts of the
  country.
• The population living in relatively
  hyper--endemic areas is 1,11 million (about 5 of
  the countries population).
• During the last five years a significant
  reduction in malaria incidence has been achieved
  and malaria control efforts will be directed
  towards elimination of the disease.

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• In early 1970s , malaria was eliminated from
  the Eastern, Central and Northern regions.
• Malaria is still endemic in the South-western
  part of the altitudes below about 2000m.,
  especially in Jazan region.
• P. falciparum is the dominant parasite and
  An. Arabiensis is the main vector.
• Malaria cases reduced from 1232 in 2004 to
  1054 in
• 2005 ( 14.4 reduction).
• Dramatic reduction of indigenous cases from
  308 in
• 2004 to 204 in 2005( 34 reduction).

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• The peak of malaria transmission occurs between
  October and April.
• The disease annually follows a seasonal and
  unstable pattern of transmission.
• Micro-epidemics frequently appear after heavy
  rains, the last one occurred during the years
  1997 - 1998 in the South- Western Areas..

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Reported Malaria Cases by Year , K.S.A (1998
2005)
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Malaria Control Strategy

• Epidemiological micro-stratification .
• Disease surveillance through (PCD), proper
  treatment and epidemiological investigation of
  positive cases.
• Vector control is practiced according to type of
  endemicity.
• Surveillance in areas free of local transmission
  .
• 5. Surveillance and occasional control in areas
  at risk of
• transmission resumption.
• Early warning and preparedness system .
• 7. Collaboration with involved parties .

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National programme objectives

• Early diagnosis and prompt treatment of malaria
  cases.
• 2. To prevent local transmission in areas where
  malaria
• transmission has been interrupted ( Eastern,
  Northern and
• Central regions ) .
• 3. To prevent outbreaks timely .
• 4. Elimination of the disease in a period of 5-8
  years.

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Main achievements

• Malaria control activities are timely and
  concordant to the
• global initiative for RBM .
• More support and strength have been provided to
  the
• programme .
• More support and strength have been provided to
  the malaria control activities at the border
  areas by providing of vehicles, insecticides,
  spray machineries and training Yemeni health
  personnel at Jazan national training centre (
  Collaboration with the Republic of Yemen ) .
• Evaluation of vector and disease pattern changes
  .
• Updating of malaria drug policy .
• Serological and entomological activities are
  regularly carried out to detect cases and
  positive breeding sites .

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Arabian Gulf
JAZAN
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Factors Favoring Malaria Transmission In the
south-western region

• Climate
• hot humid suitable for both Parasite vector
• Summer Winter rains
• Topography
• flat plain, foothill, mountains creating
  different Altitudes
• Numerous breeding places
• Valleys their tributaries ( 2207 Km total
  length )
• Local agricultural practices
• Massive continuous uncontrolled Population
  movements
• To from neighboring Republic of Yemen .

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Elimination has been Launched since June 2004

• Justification
• Strong political commitment
• Remarkable success in malaria control
• Rapid Development Urbanization
• Higher standard of living socio-economic
  status
• Increasing collaboration intersectorial
  cooperation
• Joint co-operation with neighboring Yemen in
  Controlling border malaria

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Action taken on the border areas

• Malaria treatment units
• Most of the imported malaria cases were
  diagnosed (ICts) at the malaria units established
  in the border areas and were treated radically on
  the spot.
• Residual House spraying (3 rounds).
• Health education.

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Intersectoral Collaboration (Jazan region)

• - A joint committee between Ministries of Health
  , Agriculture and Municipality.
• - Regular monthly meetings to
• - exchange information.
• - present and discuss reports.
• - organize joint efforts regarding integrated
  vector control (aerial larviciding of swamps,
  joint space spraying of towns, mechanical
  clearing of expanses of breeding sites).

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Joint Saudi-Yemeni Coordination Committee

• The joint 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,

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• evaluation of vector and disease pattern changes,
  efficacy of control programs, study and
  implementation of amendments to improve results,
• Establishment of a joined team to evaluate the
  implementation of control activities at the
  border areas every three months.
• The joint Saudi-Yemeni coordination committee
  agreed, at the last meeting held on the
  25-26/4/2006 at Riyadh on the unifying the
  treatment policy on both sides.

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• preparation of periodic and special reports for
  information purposes.
• Serological and entomological activities were
  carried out to detect cases and positive
  breeding sites.
• The combined teams applied space spraying and
  residual house spraying in the same border
  villages.

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• Implemented joint anti malaria measures on the
  both side of the border in 2003-2005,
  particularly in Al Khouba and in adjoining areas
  of Yemen, brought about a tremendous reduction of
  local transmission. This could be seen from
  following table , showing the impact of anti
  malaria operations in Al Khouba.

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Malaria Incidence, Al Khouba, 2000 -2005
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• Tentative epidemiological data from Yemeni side
  demonstrates similar reduction in malaria
  incidence, although at a lesser than in Al
  Khouba, scale, which is understandable
  considering the high level of malaria
  transmission in Yemen. This is being further
  confirmed by the fact, that importation of cases
  from border Governorates into Gizan region
  demonstrates also declining trend.

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• Thus, reciprocal reduction of malaria incidence
  on both sides of the border indicates the
  validity and effectiveness of applied control
  measures and necessitates the expansion of joint
  activities in other border areas of Gizan region,
  namely Ayban, Ardah and Samthah districts on the
  Saudi side and in adjoining areas of Yemen.

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Thank you