A Country on the Verge of Malaria Elimination – The Kingdom of Saudi Arabia

Abstract

Significant headway has been made in the global fight against malaria in the past decade and as more countries enter the elimination phase, attention is now focused on identifying effective strategies to shrink the malaria map. Saudi Arabia experienced an outbreak of malaria in 1998, but is now on the brink of malaria elimination, with just 82 autochthonous cases reported in 2012. A review of published and grey literature was performed to identify the control strategies that have contributed to this achievement. The number of autochthonous malaria cases in Saudi Arabia decreased by 99.8% between 1998 and 2012. The initial steep decline in malaria cases coincided with a rapid scaling up of vector control measures. Incidence continued to be reported at low levels (between 0.01 and 0.1 per 1,000 of the population) until the adoption of artesunate plus sulfadoxine-pyrimethamine as first line treatment and the establishment of a regional partnership for a malaria-free Arabian Peninsula, both of which occurred in 2007. Since 2007, incidence has decreased by nearly an order of magnitude. Malaria incidence is now very low, but a high proportion of imported cases, continued potential for autochthonous transmission, and an increased proportion of cases attributable to Plasmodium vivax all present challenges to Saudi Arabia as they work toward elimination by 2015.

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

“…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. This recommendation is compatible with those of other researchers (19–22, 31). Another consideration is that there is increasing travel by the Saudi population into areas where malaria is prevalent, which means that the number of donors with potential malaria risk is likely to be increasing.…”

“…The prevalence of malaria infection is variable in different regions of the KSA, with the vast majority being generally very low since 2000. Most of the cases, both local and imported, occur in Asir and Jazan Provinces (22). In 2005, in Prince Sultan Military Medical City (PSMMC), KSA began to include routine screening for malaria in the blood donor screening program by examining samples for malaria parasites by thick and thin smear techniques using standard methods (12).…”

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

“…For 20 years, following the launch of Saudi Arabia’s elimination programme, rapid progress was made in shrinking the geographic extent of malaria nationwide [2–4]. However, by the 1980s malaria remained an intractable problem in the southwestern regions of Jazan and Aseer.…”

“…However, by the 1980s malaria remained an intractable problem in the southwestern regions of Jazan and Aseer. Emerging chloroquine resistance [5] and El Niño rains during the late 1990s led to severe epidemics in this region [2–4]. In 1998, the Government substantially increased the funding required to contain the epidemics in the southwestern regions of the Kingdom.…”

The path to eradication: a progress report on the malaria-eliminating countries

“…8 While escalating political instability in Yemen has prevented the country from improving its malaria situation, Saudi Arabia reported only 34 local cases in 2013. 11,30 In the Asia Pacific region, several regional bodies support malaria elimination. The first, the Asia Pacific Malaria Elimination Network (APMEN), was launched in 2009 as a network of countries, institutions, and stakeholders working together to eliminate malaria by facilitating collaboration and knowledge sharing, conducting training and research, increasing malaria program capacity and leadership, and building the evidence base for a regional elimination framework.…”