Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia

Abstract

Detailed description of malaria in low transmission areas is crucial for elimination. The current study aimed to provide a comprehensive description for malaria transmission in Jazan, a low transmission district, southwestern Saudi Arabia. Patients at a tertiary care hospital were recruited in our study between August 2016 and September 2018. Malaria diagnosis was performed through a species-specific nested polymerase chain reaction (nested PCR), microscopy and Paramax-3 TM rapid detection test (RDT). Malaria was detected in 30 patients by the PCR, with point prevalence of 10.9%. Of these malaria infections, 80% was imported, 26.6% was asymptomatic and 23.3% was sub-microscopic. Malaria was reported throughout the year, with February/March and September/October peaks. Infection was significantly more in males than in females (P = 0.01). Likewise, infections were detected more in febrile than in non-febrile patients (P = 0.01). Adult aged 15-24 years, fever and travel were identified as high-risk factors. Malaria was primarily attributed to Plasmodium falciparum mono-infections, followed by P. vivax mono-infections and lastly to falciparum/vivax mixed infections accounting 76.6%, 16.6%, and 6.6% of PCR-confirmed malaria cases, respectively. The nested PCR was superior to the smear microscopy (sensitivity 76.6%; specificity 100%) and the RDT (sensitivity 83.3%, specificity 94.2%). The overall percent agreement between microscopy and the RDT was 92.7% (kappa= 0.63). High proportion of imported malaria including sub-microscopic and sub-patent cases were described. We suggest that incorporation of molecular tool into the conventional malaria diagnosis is beneficial in Jazan district.

Decreasing trend of imported malaria cases but increasing influx of mixed P. falciparum and P. vivax infections in malaria-free Kuwait

“…in locally acquired malaria cases while an increasing proportion of imported cases were caused by P. vivax in Saudi Arabia [7,20,24]. Mixed P. falciparum and P. vivax infections occurred in only~7% of malaria cases in one study [8], while in another study, nearly 2% of PCR-confirmed malaria cases (n = 369) were due to mixed infections that were missed by microscopic analysis alone [34].…”

“…There have been no reports of local malaria transmission in most of the Middle eastern countries including Kuwait, except few reports from Saudi Arabia and Oman [7][8][9][10][11][12]. However, imported malaria was a major public health problem during the 1990s in Kuwait as >700 cases were detected annually among migrant workers from malaria-endemic countries [12].…”

Systematic analysis of disease‐specific immunological signatures in patients with febrile illness from Saudi Arabia

“…2,16 Malaria, caused by the protozoan parasite Plasmodium, is mostly concentrated in the south-western parts of Saudi Arabia, Aseer and Jazan. 18,19 While malaria has been reported in Saudi Arabia since the 1940s, 20 DENV and CHIKV emerged only recently. The first DENV outbreak in Saudi Arabia was in 1994 with 289 confirmed cases, 21,22 while the first autochthonous case of CHIKV infection was in 2013.…”

Epidemiological trends of malaria in the Western regions of Saudi Arabia: a cross sectional study

“…Alshahrani [13] studied the risk associated with malaria infection in Asir region. Hawash et al [14] described comprehensively the transmission of malaria in Jazan province. Many factors affect the process of malarial transmission.…”