Antimalarial Drug

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Roll Back Malaria in Saudi Arabia
By Suleiman M. Alseghayer Assistant Director
General for Parasitic Diseases and Director of
Malaria Mohammed S. Alattas Director Endemic
Disease Control Department
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Situation analysis

• 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.
• The population living in relatively hyper
  endemic areas
• is 1.15 million ( about 5 of the country's
  population ).
• In 2004 , a total of 1232 cases were reported ,
  out of witch
• (308) local cases .

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Malaria in KSA

• 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 occur 1997 - 1998 in the
  South- Western Areas, JAZAN.

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Malaria Control Strategy

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

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National programme objectives

• To prevent local transmission in areas where
  malaria
• transmission has been eliminated ( Eastern,
  Northern and
• Central regions ) .
• To prevent outbreaks timely .
• 3. To reduce the number of indigenous cases by
  50 from
• the total cases in 2004 as a first phase of
  malaria
• elimination programme ( 2005-2007 ) .
• To reduce the number of indigenous cases by 100
• during the second phase of the programme (
  2008-2010) .
• To establish maintenance phase by the end of the
  year
• 2010 ( third phase ) .

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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 in the border
  areas ( Collaboration with Republic of Yemen ) .
• Evaluation of vector and disease pattern changes
  .
• Updating of malaria drug policy .
• Serological and entomological activities were
  carried out
• to detect cases and positive breeding sites .

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Challenges

• Develop an early worning system for malaria
  outbreaks .
• Strengthen cooperation with the Republic of
  Yemen .
• Elimination of residual malaria foci .
• Prevent mortality and reduce morbidity by 100
  within ( 5 ) years period in Jazan region .
• Support to eliminate malaria and prevention of
  introduction.

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Priority areas

• To extend facilities for early diagnosis and
  prompt treatment
• in border areas .
• To assure correct management of severe cases .
• To detect early and manage outbreaks .
• To carryout selective vector control.
• to strengthen surveillance in malaria free
  zoones.
• Applied research in epidemiology and control
  method is
• needed to adapt control of strategies to the
  new
• epidemiological realities .

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Malaria Control in Jazan, KSA
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Malaria in Jazan Area

• CONTROL Activities
• 1970 - 2003
• ELIMINATION Program
• 2004 - 2010

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Jazan Area, KSA

• Position
• KSA
• South-western corner
• Surface Area 16000 SQ Km
  
• ( 0,6 of KSA total
  surface area )
• Global
• Latitudes 16,5 17,5 N
• Longitudes 42 43,5 E
• ( Subtropical )

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JAZAN
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Jazan Area, KSA

• Topography divided into 3 Zones
• Plain Land 47 of Surface Area
• Foot Hills 37 - -- --
• High Mountains 16 - -- --
• The foot hill and mountain areas are intersected
  by numerous valleys , carrying water all the year
  round

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Jazan Area, KSA

• Climate ( HOT Humid )
• Average Temp. 25 C - 35 C
• Average Relative Humidity 60 - 90
• Average Rainfall 500 mm.

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Jazan Area, KSA

• Demography
• Total Population 118613 ( KSA, National
  Census,2004 5,2 of the
  total population of KSA
• Nearly 40 of them live in rural areas
• Scattered inhabitants ( lt 3000 villages )
• Occupations
• Agriculture , Animal rearing , Trade
• Socioeconomic Status
• High ( Urban Areas )
• Moderate ( Rural Areas )

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Jazan Area, KSA

• Health Facilities
• MOH
• Primary Health Care Centers 134
• General Hospitals 15
• Central Hospital 1
• Specialized Hospitals 2
• Malaria Diagnosis Treatment Units 20
• Private
• Polyclinics 22
• Hospital 1

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Border units for malaria diagnosis and treatment
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Malaria in Jazan

• 45 - 55 of the total malaria cases in KSA

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Malaria in Jazan

• 60 - 70 of the Local malaria cases in KSA

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Malaria in Jazan

• Continuous decline in malaria incidence

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Malaria in Jazan

• Parasite
• lt98 of malaria cases in Jazan are due to
  Plasmodium falciparum.
• Main Vector
• Anopheles arabiensis is the principle malaria
  vector in Jazan.
• Perennial Transmission
• peak ( December - February )
• least ( Summer Months )

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Factors Favour Malaria Transmission In Jazan

• 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
• Population movements
• To from neighboring malarious areas is
  relatively high

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Malaria Control Strategy in Jazan

• Objectives
• To keep malaria free areas safe of local
  transmission.
• To combat outbreaks timely.
• To reduce incidence in highly endemic areas.
• To manage malaria cases Properly

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Malaria Control Strategy

• Components
• Early diagnosis and prompt
• treatment.
• Vector control.
• Entomological studies.
• Personal Protection measures.
• Health education.
• Training and research.

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Results

• Malaria Indicators in Jazan ( 2000 2004 )

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Results Continuous decline in Malaria
Prevalence Incidence ??

• CONTROL
• vs.
• ELIMINATION

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Elimination was Launched on 2004

• Justification
• 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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Malaria Elimination Program

• Objectives
• To eliminate malaria in Jazan area during
• 5 to 7 years, starting 2004
• To stop local malaria transmission in
• malaria foci
• TO establish permanent surveillance
• and maintenance system

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Malaria Elimination Program

• Strategy
• Stratification
• Increasing the capability of early diagnosis
  effective treatment of malaria cases in all areas
  
• Vector control measures with selective
  intensification according to level of endemicity
  and amenability
• Individual and community participation
• collaboration with involved parties
• Early warning and preparedness system

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Malaria Elimination Program

• Early diagnosis prompt treatment
• Enhancement of PCD to detect all infected
  Individual
• Increasing the ability of all health facilities
  to confirm malaria diagnosis
• Establishment of malaria diagnosis treatment
  units
• Intensification of ACD to detect all asymptomatic
  pts. gametocytes carrier

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Malaria Elimination Strategy

• Stratification
• High endemic areas
• Medium endemic areas
• Low endemic or malaria free area

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Vector Control

• 1. Larviciding
• - throughout the year.
• - coverage according to detailed precise
  mapping of the breeding sites GR part of
  GIS.
• - weekly application temephos dimilin
  sumilarv
• temephos replaced by Bti
  / etofenoprox

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Vector Control

• 2. Residual house spraying
• according to stratification
• - low and medium transmission areas (Aldarb
  Baysh Sabya Haroob Abuarish) one round-
  Oct / Nov.
• - high transmission areas (Samtah Alkhobah
  Alardah Ayban) two rounds - Aug Nov / Jan.
• - insecticide Deltamethrin 25 WP WG .

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Vector Control

• 3. Space spraying
• - timing (Sept April) to coincide with the
  transmission season.
• - vehicle-mounted machines and hand-held
  sprayers used for outdoor (ULV and fogging) and
  indoor (ULV) coverage.
• - special attention given to
• - urbanized localities.
• - highly endemic areas.

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Intersectoral Collaboration

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

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Outcomes

• Intensive training and refresher courses were
  conducted for all categories invloved in the
  malaria programme.
• reduction in malaria cases from 630 in 2003 to
  483 in 2004 ( 23 reduction).
• Dramatic reduction of indigenous cases from 374
  in 2003 to 126 in 2004 ( 66 reduction).
• Most of the positive malaria cases diagnosed in
  the border areas during the last 6 months of the
  year 2004 were diagnosed and treated in the
  malaria border units.

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Outcomes

• The vector density was kept under control, the
  average adult density per room was 0.03 (0.0
  0.15) while the average larval density per unit
  was 0.03 (0.01 0.3).
• Population covered by indoor residual spraying
  was 73912 in the first round and 133142 in the
  second round.
• Total number of insecticide treated nets
  distributed by the programme was 119924 (10000 in
  low transmission areas, 41424 in the medium
  transmission areas and 78000 in the high
  transmission areas).

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Thank you