Director General of National Malaria Control Program:Climate changes lead to high proliferation of malaria in Yemen [Archives:2008/1150/Health]

April 28 2008

Sarah Wolff
Malaria still kills more than 1 million people every year, said U.N. Secretary-General Ban Ki Moon on Friday, April 25, which is marked as World Malaria Day. The United Nations is calling for the elimination of all malaria-related deaths by the end of 2010, which is less than 1,000 days from now.

Malaria is one of Yemen's most serious health problems, according to the World Heath Organization, which estimates between 800,000 and 900,000 malaria cases in Yemen.

Sarah Wolff interviewed Dr. Adel Al-Jasari, the Director General of the National Malaria Control Program in the Ministry of Public Health & Population about what Yemen is doing to fight the disease , to review the malaria sitution in Yemen and the national program's efforts to distribute mosquito control equipment to curb the disease.

How many people in Yemen currently are infected with malaria?

There were 233,000 malaria cases (clinically diagnosed and confirmed by laboratory investigation) reported in Yemen in 2007; however, numerous factors indicate that the estimated number of malaria cases is more than that.

Access to public health facilities is 60 percent, but only half of these facilities report regularly. Many patients seek treatment in private health facilities, which also don't report. For this reason, WHO estimates that the annual malaria incidence in Yemen ranges between 800,000 and 900,000 malaria cases.

How many people annually die of malaria in Yemen?

Studies indicate that annual deaths from malaria are approximately 1 percent of the abovementioned figures. Consequently, the national malaria strategy has emphasized forming a medical committee in each governorate to investigate any malaria deaths. Results reveal that some cases were misdiagnosed, while in others, death was due to a different disease or complications unrelated to malaria.

Which Yemeni regions are most vulnerable to malaria?

Sixty percent of Yemen's population is prone to malaria infection in the coastal plains and in the valleys from the mountains to coastal areas. The inhabitants in these two areas comprise 30 percent of Yemen's total population.

Thirty percent of the nation's population inhabits mountainous areas between 500 and 1,500 meters above sea level, where the prevalence is lower at such higher altitudes.

Malaria is rare in those areas between 1,500 and 2, 000 meters, while areas above 2,000 meters, as well as the deserts, are free of malaria.

Which groups of Yemenis (such as children, farmers, the elderly, etc.) are at most risk of contracting malaria?

Pregnant women and children under age 5 are the most affected groups, whereas all age groups are at great risk in those areas prone to epidemic.

Will malaria increase with climate change?

Definitely. Unusual climatic changes such as heavy rainfall, unexpected warming and increased humidity are followed by an extreme increase in malaria epidemics; thus, climate changes lead to a high proliferation of malaria.

What other organizations partner with the ministry to help fight malaria in Yemen (i.e., non-governmental organizations, the World Health Organization, etc.)?

WHO, the Global Fund to fight AIDS, Tuberculosis and Malaria – often commonly called the Global Fund – and Gulf Cooperation Council states are the primary supporters helping us fight malaria in Yemen.

In addition to the Global Fund's valuable support, Yemen also receives substantial support from Saudi Arabia. Cooperation between our two nations' malaria control programs has led to joint implementation of malaria control interventions along our borders. Such cooperation, which began after signing a border determination agreement, has been supported by strong political will and continuous follow-up by their two ministers.

Technical representatives from the two countries meet twice annually to coordinate mutual activities such as household indoor residual spraying, which has expanded extraordinarily, joint supervision missions, implementing entomological and parasitological surveys and sharing information and epidemiological data.

This distinguished cooperation between the two malaria programs is a unique experience within the Eastern Mediterranean region and, in fact, in the world. We're proud of this experience, believing that we've achieved the awareness goal and the key message of World Malaria Day – “Malaria, a disease without borders” – through our cooperation with Saudi Arabia along our border regions.

Yemeni-Saudi cooperation to fight malaria and numerous success stories from the field have led to creating the “Arabian Peninsula Free of Malaria by 2015” initiative, called for by WHO's Eastern Mediterranean regional director, Dr. Hussein Abdulrazzak Al-Gezairy.

Our main local partners are the Yemeni Parliament, the Shoura Council, governors and local councils, development-related ministries such as the Ministry of Finance, Public Health and Population, Planning and International Cooperation, Agriculture and Education offices within the governorates, health colleges and training institutes and local NGOs.

How does the National Malaria Control Program obtain funding for its projects?

Part of the funding comes from internal public budgeting in terms of salaries, operation costs for the program and its governorate branches, as well as implementing all malaria control interventions.

However, outside funds are crucial to expand malaria control projects throughout all regions of the nation. Limited resources have forced us to prioritize our plans for the most-affected regions, restricting our intervention to those particularly burdened areas.

So, advocating the program's support is one element. Additionally, two national conferences were held during the past seven years to draw the attention of policymakers and international donors about the burdens of malaria and the necessity of funding this program.

Due to growing demands and a financial gap periodically analyzed within the framework of malaria project expansion, with full support from the minister and deputy minister of health, the malaria issue was placed atop the ministry's agenda during discussions with regional and international funding agencies, as well as through the national coordinating mechanism to fight AIDS, TB and malaria.

During the past seven rounds of Global Fund support, Yemen submitted four proposals regarding malaria and two were accepted. The “Arabian Peninsula Free of Malaria by 2015” initiative and the promised support from GCC nations will enable us to fill the financial gaps and finance all planned projects.

The private sector, which we seek to attract to work with us, is considering partnering with us and negotiations have begun with trade, industrial and oil companies.

Did the National Malaria Control Program launch any programs or awareness campaigns to mark the first-ever World Malaria Day?

Yes, there was coverage on Yemen's television channel, as well as newspaper coverage. There also will be an exhibit on malaria control efforts in Yemen during a multi-sectoral workshop next week on using DDT to control vector-born diseases. Several activities also will be organized in the governorates in this regard.

What types of programs has the Public Health and Population Ministry undertaken recently to prevent the spread of malaria and are there any notable upcoming projects?

One notable upcoming project is the commencement of the seventh round of Global Fund support for the National Malaria Control Program from June 2008 to May 2013 at a total cost of $27 million.

Also this week is the beginning of a short training course for 20 participants on applied epidemiology organized in cooperation with the Liverpool School of Tropical Medicine in Sana'a as part of the program's human resources development strategy.

This is the second course organized in conjunction with the Liverpool School; the first occurred earlier this month at Abyan's Malaria Center, training 39 laboratory technicians for a month regarding quality assurance.

Additionally, a regional meeting of malaria control program managers will convene in Sana'a June 1-4, followed by the annual meeting of HANMAT (the Horn of Africa Network for Monitoring Anti-Malarial Treatment) research group.

The program also has conducted entomological and epidemiological surveys in Wadi Zabid, Raymah and Siham and we're embarking on similar surveys in Ibb, Al-Dhale' and Taiz within the next three weeks. The results of these surveys will contribute to developing action plans for indoor residual spraying and long-term mosquito net distribution campaigns.

Regarding malaria detection and appropriate treatment, a refresher course for 120 lab technicians will be conducted with support from the World Bank.

The program also is embarking on publishing the newly endorsed policy for managing malaria cases using the new Anti-malaria Combination Therapy. A summary of this policy and its treatment protocols will be printed as a guide to be distributed to doctors and health staff. Additionally, the first shipment of 200,000 co-blisters of Anti-malaria Combination Therapy, or ACT drugs, also is due to arrive in Yemen.

What can everyday Yemenis do to help protect themselves from malaria?

Educate themselves and their families about malaria prevention and treatment, having at least the key elements of prevention. Avoid any actions or behaviors that can lead to malaria such as storing water in open containers either inside or outside the house, which can lead to manmade malaria.

Additionally, listen to doctors' instructions regarding the use of anti-malaria medicine, taking the complete dose, as inappropriate use of such drugs may lead to developing a resistance to them.

It's well known that malaria medication has side effects such as hallucinations, nightmares and extreme dizziness. Are there any new medications available in Yemen to protect people from malaria without these strong side effects?

New ACT drugs have fewer complications; however, while the safety of their ingredients is higher and efficacy is greater, they still should be used according to a doctor's guidelines.