Dr Hoda Atta

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Malaria in EMR
Dr Hoda Atta Roll back Malaria WHO/EMRO
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Burden of malaria in the Eastern Mediterranean
Region

• PUBLIC HEALTH THREAT
• 287 million live under risk (60 of EMR
  population)
• 15 million estimated cases per year
• 47 thousand estimated deaths per year
• Disability from severe form of the disease
• Serious outcomes due to malaria in pregnancy

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Socioeconomic burden

• Economic burden
• Malaria has slowed economic growth in African
  countries by 1.3 per year.
• Households spend up to US 3.84 per capita per
  year to prevent and treat malaria.
• Social burden
• Negative impact on the individual
• School absenteeism and low productivity

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Malaria and population

• Population Movement
• Migration -Afghan refugees, refugees from South
  Sudan to Khartoum area, from Somalia to Yemen
• Problems even in affluent countries in EMR - job
  seekers from abroad is a problem in the Gulf
  countries
• Human developments
• Insecure human development activities
• ( irrigation , agricultural , industrial,
  tourism )

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Distribution of EMR population by risk of malaria
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Current operational situation

• Group 1 Malaria free countries
• Group 2 Countries targeting malaria eradication
• Group 3 Countries with low/moderate endemicity
  and relatively well established control
  programmes
• Group 4 Countries with severe malaria problem
  and/or threatened by epidemics and complex
  situations

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Group 1 Malaria free countries

• Cyprus (1953)
• Lebanon (1963)
• Palestine (1965)
• Jordan (1970)
• Qatar (1970)
• Libya (1973)
• Bahrain (1979)
• Tunisia (1979)
• Kuwait
• UAE (1998)

7 of the population
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Group 2 - Malaria under eradication

• Egypt
• Morocco
• Oman
• Syria

24 of the population
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Indigenous cases in group 2 countries
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Objectives of RBM in group 1, 2 countries

• Prevent re-establishment of malaria transmission
  in malaria free areas
• Support elimination of residual foci

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Priority interventions for group 1, 2

• Strong surveillance
• Advice to international travelers
• Entomological monitoring
• Rationalization of vector control
• Elimination residual foci of malaria transmission
  through a strong, time-limited attack according
  to the principles of malaria eradication

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Group 3 Low/Moderate endemicity

• Pakistan
• Saudi Arabia
• Iran
• Iraq

53 of the population
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Indigenous cases in group 3 countries
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In 2002 94 of local cases are are in Jizan
area
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74 of cases in Dahuk GOV.
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Reported Malaria Cases by Parasite in I.R.IRAN in
2002
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(No Transcript)
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Group 4 With intense malaria transmission
(chronic, complex emergencies)

• Afghanistan
• Djibouti
• Yemen
• Sudan
• Somalia

16 of population 95 of the cases
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Estimated and reported number of cases in GP 4
(million/year) in 2002
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RBM objectives in group 3, 4
Global target halve malaria burden by 2010y

• halve the malaria burden (incidence, severity and
  mortality) by 2010
• - In the countries with severe malaria problem
• Prevent malaria mortality and 50 reduction of
  morbidity by 2010
• - In countries wit low/moderate endemicity

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Priority interventions in group 3, 4

• Prompt effective case management
• Multiple prevention measures
• -Scale up the use of ITNs
• - integrated VC
• - IPT in pregnancy where appropriate
• Epidemics preparedness and response
• Strengthen surveillance activities

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Results in high burden countries

• Strategic plans are developed and are being
  implemented
• Sudan
• Special project for Khartoum Gezira States is
  being implemented with promising results
• Yemen
• Special project for Tihama and Socotra is
  proceeding successfully

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in Yemen Malaria incidence has demonstrated a
remarkable reduction in all governorates under
the RBM support, especially in the Socotra
Island
Impact
The RBM evaluation mission concluded that
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in Khartoum State Malaria incidence in in 2002
has recently dropped to less than 50 of its
previous level, and also the mortality rate has
shown a significant reduction by 17 .
In Gezira State the share of malaria in the
total attendance level of the health care
services shows a significant reduction
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Challenges in high burden countries

• Low coverage and poor quality of curative and
  diagnostic
• Very low coverage of ITNs in endemic areas
• Weak epidemiological and entomological
  surveillance
• Human resource needs
• Low coverage and poor quality of case management

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Global Fund ATM- 2nd round