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Current status of the malaria situation in Syria SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cai

Current status of the malaria situation in Syria SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006 National Malaria Control Programme MOH, SYRIAN ARAB REPUBLIC. Syria. Turkey. Total population at risk 426 000. Iraq. Mediterranean Sea.

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Current status of the malaria situation in Syria SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cai

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  1. Current status of the malaria situation in Syria SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006 National Malaria Control Programme MOH, SYRIAN ARAB REPUBLIC

  2. Syria Turkey Total population at risk426 000 Iraq Mediterranean Sea Lebanon Total population 17 980 000 Jordan Palestine

  3. Country Profile • Total area : 185 180 km2 • Total population : 17 980 000 • Population density : 85 Person/ km2 • Population in rural areas : 47.6 % • Population in urban areas : 52.4 % • Syria lies on the eastern coast of the Mediterranean Sea , bounded by Turkey to the north , Iraq to the east , Palestine and Jordan from the south and Lebanon and the Mediterranean Sea to the West . • Syria is divided administratively into 14 provinces . • Al Hasakeh province , which has all indigenous Malaria cases has an area of about 23 150 km2, and total population of 1 326 000 ( 11.3 % of total population ) • The population at risk is estimated 426 000, living in 110 villages in Al Hasakeh province. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  4. Distribution of indigenous malaria cases in Syria during (1950 s) ِAl Hasakeh Aleppo AlRaqqa Edleib Lattakia Deir El Zour Tartous Hama Homs Damascus DamascusRural AlQuneitera Dara’a AlSwieda SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  5. Historically, Syria had suffered from endemic malaria. Up to the 1950s, malaria was endemic throughout the country, except deserts and mountains above 1100 m, both P.vivax and P. falciparum were present with predominance of the latter . Malaria eradication programme started in 1956,led to an interruption of transmission of P. falciparum during the 1960s, in the course of a campaign using indoor DDT spraying, with the cooperation with WHO. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  6. Distribution of indigenous malaria cases in Syria (1990- 2000) 6 cases in 2000 966 cases in 1993 582 cases in 1995 ِAl Hasakeh Aleppo AlRaqqa Edleib Lattakia Deir El Zour Tartous Hama Homs Damascus DamascusRural AlQuneitera Dara’a AlSwieda SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  7. However, transmission of P.vivax continued at varying degrees, mostly along the Turkey and Iraq borders. After 1990s, the maximum incidence of indigenous malaria was recorded in 1993 (966 case), these cases were recorded in tow provinces (Aleppo and Al Hasakeh) , a downward trend of malaria in Syria was observed from 582 cases in 1995 to 6 cases in 2000. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  8. Distribution of indigenous malaria cases in Syria (2001- 2005 ) 2001 Al Malkeih district (8cases) 2001 Ras El Ain district (55cases) ِAl Hasakeh AlRaqqa Aleppo Edleib Lattakia Deir El Zour Tartous Hama Homs Damascus Damascus Rural Al Quneitera Dara’a Al Swieda SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  9. An outbreak of 63 local cases occurred in 2001 mainly in Ras El Ain district (55cases) and Al Malkeih district (8cases)of Al Hasakeh province bordering Turkey, then few sporadic cases were found in communities along the borders with Turkey and Iraq.In 2004, only one indigenous malaria case was reported in Al Malkeih district.In 2005, No indigenous malaria case. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  10. Distribution of malaria cases in Turkey and Iraq Turkey ِAl Hasakeh Aleppo Iraq AlRaqqa Edleib Lattakia Dier El Zour Tartous Hama Homs Damascus Damascus Rural Al Quneitera Dara’a Al Swieda SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  11. Distribution of indigenous & imported malaria cases in Syria according to years ( 1996 – 2005 ) Fig(1): Distribution of indigenous & imported malaria cases in Syria according to years ( 2000 – 2004 ). SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  12. Distribution of indigenous malaria cases in Syria according to areas( 1996 – 2005 ) SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  13. No of blood samples ( negative and positive detection) in Syria ( 2000-2005 ). SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  14. Distribution of imported malaria cases in Syria according to type ( 2005). SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  15. Distribution of imported malaria cases in Syria according to the country and type (2005 ). SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  16. Distribution of imported malaria cases in Syria according to the Nationality, Death & Hospitalized (2005 ). SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  17. Distribution of 4000 ITN s. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  18. Insecticide impregnated bed nets aren’t used as an adopted strategy to control malaria vector, but ordinary bed nets used separately by individuals, to protect them selves from insect bites in rural areas where people are used to sleep out doors during hot months. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  19. National drug policy Chemoprophylaxis: * Chloroquine 300 mg or * Mefloquine 250 mg. - One tablet before travel to epidemic area. - One tablet every week during staying in epidemic areas. - One tablet for 4 weeks After returning back. Treatment: * P. vivax, P. ovale and P. malariae: (Chloroquine & Primaquine) * Uncomplicated P. falciparum malaria: І-Sulfadoxine 500mg+Pyrimethamine 25mg(SP) tablets (Fansidar). П -Quinine & Doxycycline (tablets). * Severe P. falciparum malaria: - Quinine dihydrochloride (Amp). 2006 : Artesunate + SP. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  20. The usage of Insecticide in Syria ( 2005 ) In 2005: 13083 housed sprayed, 89161 people protected. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  21. Distribution of Anopheles in Syria ِAl Hasakeh Aleppo AlRaqqa Edleib Lattakia Deir El Zour Tartous Hama Homs An. sacharovi An. claviger Damascus An. sergenti DamascusRural An. superpictus AlQuneitera Dara’a AlSwieda SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  22. Distribution of Anopheles in Syria Malaria vectors are 4 species of Anopheles ( of 9 species found in Syria ): - Primary malaria vector is: Sacharovi. - Secondary malaria vector is: Claviger. 1- An. sacharovi: Al Hasakeh, Deir El Zour, Al Raqqa, Latakia, Tartous, Aleppo, Hama, Homs Al Qunaitara and Dara’a. 2- An. Claviger: Latakia, Aleppo, Hama, Rural Damascus and Al Qunaitara . 3-An. Sergenti: Dara’a. 4- An. Superpictus:Al Hasakeh, Deir El Zour, Al Raqqa, Latakia, Tartous, Aleppo, Hama, Homs Al Qunaitara and Dara’a. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  23. National Malaria Reporting System MOH Environmental and Chronic Disease Directorate Malaria & Other Parasitic Diseases Department Malaria Control programme Leishmania Control programme Schistosomia Control programme 14 health Governorate Malaria,Leishmania and Schistosomia Control Centre (14 centers). SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  24. There is a centre for malaria control in each province (14 centers) to implement the plan of MOH. All these centers are supervised by the central department in the MOH. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  25. Malaria control programme aims to - Prevent of re-introduction of malaria and reduce number of indigenousmalaria cases. - To control imported cases and prevention of mortality due to P. falciparum. - Keeping state of preparedness to contain probable outbreaks. - Strengthening entomological activity to identify potential vectors. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  26. Strategies &Activities1-Early case detection:-Early passive case detection:through conducting surveillance in highly endemic areas and case close- contacted individuals, especially in March and September . -Negative case detection:through examined blood slides from patients suffering from unknown high fever, or travelers coming from endemic areas.2-Diagnosis &Treatment:Confirmed laboratory diagnosis .It is conducted in specialized centers concerned in diagnosis and treatment, till complete cure is achieved. Treatment & Diagnosis free of charge for all patients. Treatment depends on WHO protocols . SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  27. 3- Entomological survey and vector control: - Insecticides used for indoor residual Spraying: throughout two insecticides spray campaigns, using various kind of insecticides belong to Organophosphor (OP) or Pyrethroids (P).Recently we used Carbamate (as : WP). - Chemical larviciding (Temephos), every 7-10 days, it begins from 1st of April to the 1st of November. - Larvivorous fish (Gambusia) it’s cultured in Al hasakeh, Latakia, Tartus & Dara’a, Where we didn’t use larvacidis. -Using insecticide treated nets ( 4000 INTs). - Environmental management. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  28. 4- Improvement of data collection.5- Forecasting, detection & control of outbreaks.6- Capacity building.7- Control of individual movement to Turkey & Iraq (illegal).8- Health education and community participation.9- Cooperation and coordination with other concerned sections and authorities.10- Operational research. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  29. Problems & Constraints 1- Non existence of insect laboratory. 2-Lack of well trained technical personal. 3- Non existence of monitoring for insecticide resistance. 4-No recent data on insect vector. 5- Multipurpose workers at PHC level. 6-Lack of No of spray workers when they are needed at the proper time ( all of them are students ). 7- Lack of community health education resulting in refusing of spraying house by domestic people. 8- Lack of spare parts, and maintenance for spray pumps. 9- Difficulties of choosing the proper insecticides, because it depends on it’s price and available offers. 10-Weak inter-sect oral cooperatation and co ordination. 11- Population movement. 12- Irrigation projects. No cases = Not a health problem = Not a priority SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  30. Needed - Support ( technical, financial ) for free of malaria countries support in IVM to assure sustainability - Training in countries having malaria transmission . - Equipment and experts to update entomological information. - Resistance monitoring and GIS for vectors . - New drugs for Chemoprophylaxis & Treatment (Amp & Sup). - Spare parts and spray pumps. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

  31. Thank you For attention Dr Atef AL Tawil National Malaria Control Programme Manager MOH, Syria. SIXTH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS Cairo, Egypt, 3 – 6 July 2006

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