The Malaria Transition on the Arabian Peninsula: Progress toward a Malaria-Free Region between 1960–2010

Abstract

The transmission of malaria across the Arabian Peninsula is governed by the diversity of dominant vectors and extreme aridity. It is likely that where malaria transmission was historically possible it was intense and led to a high disease burden. Here, we review the speed of elimination, approaches taken, define the shrinking map of risk since 1960 and discuss the threats posed to a malaria-free Arabian Peninsula using the archive material, case data and published works. From as early as the 1940s, attempts were made to eliminate malaria on the peninsula but were met with varying degrees of success through to the 1970s; however, these did result in a shrinking of the margins of malaria transmission across the peninsula. Epidemics in the 1990s galvanised national malaria control programmes to reinvigorate control efforts. Before the launch of the recent global ambition for malaria eradication, countries on the Arabian Peninsula launched a collaborative malaria-free initiative in 2005. This initiative led a further shrinking of the malaria risk map and today locally acquired clinical cases of malaria are reported only in Saudi Arabia and Yemen, with the latter contributing to over 98% of the clinical burden.

World Malaria Day: Our story with malaria in Oman

“…4 Moreover, in the 1950s and 1960s, almost one-third of the Omani population had malaria. 5 Parasitological surveys conducted in the 1970s revealed that much of the northern areas of the country were mesoendemic for malaria, with the highest rates reported in the Al Batinah region where parasite rates of 13% were detected among Omani schoolchildren. 5 In 1975, a malaria control programme was initiated in Oman with financial assistance from the United Nations Development Programme; by 1979, 17 malaria units and a malaria training centre had been established.…”

“…5 Parasitological surveys conducted in the 1970s revealed that much of the northern areas of the country were mesoendemic for malaria, with the highest rates reported in the Al Batinah region where parasite rates of 13% were detected among Omani schoolchildren. 5 In 1975, a malaria control programme was initiated in Oman with financial assistance from the United Nations Development Programme; by 1979, 17 malaria units and a malaria training centre had been established. 5 This first malaria control programme had several key objectives, although it was aimed principally at source reduction via the biological control of the indigenous larvivorous fish Aphanius dispar.…”

“…In collaboration with the Ministry of Education, schoolchildren in certain highly endemic areas were given weekly chloroquine prophylaxis treatments between 1973 and 1979. 5 However, this was discontinued in 1980, due in part to fears of emerging drug resistance, with chloroquine thereafter reserved for use among pregnant women and young children. In 1976, dichlorodiphenyltrichloroethane (DDT) residual spraying was implemented, but was replaced with phosphorothioate insecticides in 1993 following the emergence of DDT-resistant vectors in 1980.…”

“…Unfortunately, this strategy showed only partial success and was replaced by widespread use of larvicides containing temephos between 1977-1979. 5 In addition, the detailed mapping of highrisk areas with aerial photography to keep track of larval control was a key feature of the vector control programme. In collaboration with the Ministry of Education, schoolchildren in certain highly endemic areas were given weekly chloroquine prophylaxis treatments between 1973 and 1979.…”

“…5 In 1975, a malaria control programme was initiated in Oman with financial assistance from the United Nations Development Programme; by 1979, 17 malaria units and a malaria training centre had been established. 5 This first malaria control programme had several key objectives, although it was aimed principally at source reduction via the biological control of the indigenous larvivorous fish Aphanius dispar. Unfortunately, this strategy showed only partial success and was replaced by widespread use of larvicides containing temephos between 1977-1979.…”