Distribution and Determinants of Malaria, Kingdom of Saudi Arabia, 2002-2011 Público

Abstract

Background: Malaria is a leading cause of illness and death. Each year, 300 to 500 million cases of malaria are reported worldwide. Malaria occurs mostly in poor tropical and subtropical areas of the world. KSA is a non-endemic country, though the southwestern area is at high risk of imported malaria, with the greatest number of cases reported from Jizan and Asir regions. The aims of this study were to investigate the incidence rates (IRs) of reported cases of malaria from 2002 - 2011 stratified by administrative region and age, Plasomdium species, and mode of transmission in KSA; make recommendations for further investigation; and offer options for policy change.

Methods: We estimated the IRs and 95% confidence Intervals (CIs) using the number of cases per year over the total population per 100,000 individuals in the 13 KSA administrative regions from 2002 - 2011. We further investigated the proportion of malaria cases by age category, species (Falciparum, Vivax, Quartan, and Oval) and modes of transmission that included local, imported local (reported in one area of KSA but originally transmitted in another area of KSA), outside (imported from abroad), unclassified malaria parasite species, and illness by relapse or acquired by blood transfusion.

Results: The greatest IRs occurred in 2002 (12.1, 95%CI = 11.6 - 12.6) and 2007 (11.8, 95%CI = 11.4 - 12.2). We observed the greatest IR in Jazan out of all the regions. Tabuk, Jawf, and Eastern Region had consistently lower IRs than other regions. The proportion of infected persons was consistently much greaterhigher for individuals > 15 years of age than those younger. In 2012, the proportion of malaria cases due to P. falciparum was much lower than that due to P. vivax. In addition, the results showed that a large proportion of malaria cases were imported.

Conclusion: The major source of reported malaria were imported cases from outside the Kingdom. Reports of local cases are very few currently, which reveals that control measures put in place have been effective in controlling the disease. However, testing is recommended for visitors who wish to travel to the KSA and pilgrims. It is also recommended that immigration into the country be regulated and that screenings occur before entry is allowed.

Table of Contents

Chapter 1 - Introduction. 7

Global Snapshot of Malaria. 7

Places with the Highest Burden of Malaria. 8

Cost of Malaria. 8

Chapter 2 - Literature Review. 10

Introduction. 10

Global Epidemiology. 10

Regional Epidemiology. 13

KSA Epidemiology. 14

Case Definition. 16

Malaria Surveillance in KSA. 17

Risk Factors for Imported Malaria. 19

Border with Yemen. 19

Hajj and Malaria. 20

Foreign Workers and Malaria. 22

Best Practices for Prevention. 23

Indoor Spraying. 24

Malaria Prevention in KSA. 25

Challenges of Malaria Elimination. 27

Chapter 3 - Manuscript. 31

Introduction. 31

Methods. 32

Discussion. 38

Chapter 4 - Conclusions and Recommendations. 41

Conclusion. 41

References. 43

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Literature, General
Palavra-chave	Malaria
Committee Chair / Thesis Advisor	McNabb, Scott JN, Emory

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