Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000–2014

Abstract

BackgroundThe draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014.MethodsData were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan.ResultsBetween 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010–2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall.ConclusionsJazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen.

The changing malaria landscape in Aseer region, Kingdom of Saudi Arabia: 2000–2015

“…The focus of the revised plan was on preventing re-introduction of malaria into regions since declared malaria free, eliminating foci of transmission in the Mecca and Medina areas and a concerted effort, using foci surveillance and control, to eliminate malaria from the regions of Jazan and Aseer. Details of progress made in the Jazan region to 2014 have been presented elsewhere [6]. This paper describes activities, progress and possible contributions towards malaria elimination in the Aseer Region since 2000, with a more detailed analysis of the spatial location of locally acquired case incidence since 2012.…”

Blood donors screening for malaria in non-endemic area in the Kingdom of Saudi Arabia: Is it necessary to introduce immunological testing?

“…At present, there are conflicting views about the need to add immunoassay and molecular screening tests for blood donors in non-endemic areas, such as the Middle East countries, including Saudi Arabia, because many of these countries still depend on screening donors using a questionnaire, and, in many countries, this is the only step in the prevention of TTM. Although the overall prevalence rate in the Kingdom is very low (13, 14) and additional screening does not appear to be cost effective, it is our opinion that the introduction of screening for malaria in the blood banks is appropriate in order to screen high risk groups and due to the presence of as many as two million expatriates in the Kingdom from different countries, including areas that are known to have a high prevalence of malaria. Although the results we reported do not show any significant difference in the prevalence of malaria between donors from Saudi Arabia and other donors, the fact that most of the non-Saudi donors come from malaria endemic areas seems to make it reasonable to conduct routine testing of these donors for malaria since they may have resided in areas where malaria is prevalent for a long time, allowing them to develop immunity.…”

“…The malaria burden has been quite low since 2000 with the majority of cases, both local and imported, occurring in Asir and Jazan Provinces along the southwestern border with Yemen (14, 15). The main risk at the present time is the potential introduction of malaria parasites into the blood supply in KSA, and this risk is associated with semi-immune people.…”

An Overview of Sixteen Years Control Program against Rift Valley Fever in Saudi Arabia: A Review Study

“…A significant decrease in malaria incidence: From 2000 to 2014, efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases, particularly in locally acquired cases wherein a significant decline was observed from (2756 cases; 35.3 per 10,000 population) in 2000 to (15 cases; 0.11 per 10,000 population) in 2014 Figure 5. This reduction attributed to coincidental expansion of control efforts including RVF vector control program that targeted outdoor habitats [18].…”