Malaria Situation in Yemen [Archives:2001/34/Health]

August 20 2001

Prepared for publishing: 
Ismael Al-Ghabery 
Yemen Times 
The malaria situation in Yemen is alarming in certain highly endemic areas. It is estimated that 50-60% of the population is at risk. Malaria in Yemen is epidemiologically classified as “Afrotropical” which is the worst epidemiological malaria situation worldwide having the faciparum malaria and the Anopheles arabiensis as the predominant parasite species and malaria vector respectively. It is estimated that children, especially under five, and pregnant women are the major toll of malaria in Yemen. 
The malaria has been proven to be a major impediment of development both socially and economically, and it is high time to intervene to interrupt the malaria transmission and alleviate the historical suffering of the Yemeni people from this health problem. 
The Yemeni government is very much appreciating and considering the situation and in this context the government has already taken very crucial and important actions and decisions to establish a strong anti-malaria program. The political commitment is there and the inter-sector collaboration has been built through the formation of the Supreme National Malaria Control Committee by the Prime Ministerial Decree No. 18 for the year 2000. The committee is chaired by HE the Minister of Health and fifteen miniseries are represented by their deputy ministers besides the representation of the different organizations, private sector and the medical educational institutions. 
Another Prime Ministerial Decree No. 19 for the year 2001 was issued announcing the year 2001 a year of Roll Back malaria and making the anti-malaria program a vertical program under the direct supervision of the Minister of Public Health and Population. 
A new National Malaria Control Center has been recently established in Sana’a to be the head office responsible for planning, monitoring, follow-up, training and evaluation processes for the whole country. The organogram and the job descriptions have been set and the plans started to be implemented in the field. Examples of success started to emerge. A great success has been achieved in Socotra island where the citizens already reported a major and significant decline in the incidence of malaria after a successful start of a well organized anti-malaria control program in the island during the last quarter of the year 2000. 
All these are promising and encouraging indicators which make optimistic that the Roll Back malaria program in Yemen is going to succeed. 
Malaria has been always the top priority health problem in the Republic of Yemen, whose population is about 18 million, particularly during the eighties and nineties of the twentieth century. The epidemiological situation of malaria deteriorated in the nineties due to different factors including political, economical and meteorological factors. It is estimated that 60% of the Yemeni population are at risk of malaria. The MOPH reported 1,8000,000 malaria cases in 1997 and the malaria mortality is about 1% of the recorded malaria cases. Malaria in Yemen is classified peidemiologically as Afrotropical with Plasmodium falciparum as the predominant species of malaria parasites accounting for about 90-95% and Anopheles gambiae, the most dangerous malaria vector, as the predominant vector. The endemicity is not the same all over the country. It is meso to hyperendemic along the coastal belt (with a length of 2000 km and a breadth of 30-60 km) extending from the Yemeni-Omani border in the east to Bab-Al-Mandab in the west along the Indian ocean and from Bab-al_mandab to the Yemeni-Saudi border in the north along the red sea (about 500 km) where the season of transmission is mainly during the winter i.e. from October to march. The altitude in Tihama (the western coastal areas) reaches up to 200 meters over the sea-level towards the east. It is meso or hyperendemic in the foothills and middle heights (400-2000 meters high) where the transmission is all the year round or following the rainy season which is mainly during summer with epidemics of malaria recurring after heavy meteorological changes, while it is almost malaria free in the mountainous areas above 2000 meters high, where it is expected that the longevity of the Anopheline vectors is too short to complete the sporogonic cycle, but again malaria transmission and even malaria epidemics are expected following heavy climatic and meteorological changes e.g. global warming and the rise in the humidity together with heavy rainfalls. It is also malaria free in the deserts (Al-Robea-AlKhali). Malaria is meso to hyperendemic in Soqotra island where the transmission season is also from October to March or April, while it is too windy and dry from May to August in the island. Malaria is epidemiologically classified as Oriental in Socotra with the Anopheles culicifacies as the main predominant vector. 
This epidemiological information needs to be confirmed by extensive studies and by improving the information system which is currently one of the priorities. 
Extensive entomological studies and surveys are also needed to have a complete epidemiological picture. Rolling back malaria started practically in Yemen in the year 2000 when a “Statement of Intent” was issued in January 2000 by the WHO malaiologist and a “Supreme National Malaria Control Committee SNMCC” was formed by a prime ministerial decree reflecting the high “political commitment” to roll back malaria. While the year 2000 can be considered the turning point during which the preparatory phase has been initiated, the year 2001 is planned to be officially announced as the year of “Roll Back Malaria”. 
The political commitment to roll back malaria is very clear and has been strengthened during the last quarter of the year 2000 especially following the outbreak of Rift Valley Fever which hit the western part of the country, especially the Tihama areas. Well-organized, sustainable and integrated vector control operations have become a must. 
It is predicted that an efficient NMCP will definitely have a positive impact on the important health indicators in the country to improve the public health standard in general and the mother and child health in particular by significantly improving the maternal mortality rate (MMR), which is currently about 1400/100,000 live births and the infant mortality rate (IMR) which is currently about 75-83/1000 live births. 
Principles of Roll Back Malaria in the Republic of Yemen 
1- Political Commitment. 
2- Intersectoral Collaboration. 
3- Health Education. 
4- Community Participation. 
5- Partnership with international organizations and NGOs. A special collaboration is existing between the Ministry of Health of the Republic of Yemen and the World Health Organization. 
The overall and ultimate goals of the 5-year plan 2001-2005 
– To establish a strong and well organized national center for the National Malaria Control Program (NMCP) in the Republic of Yemen based at Sana’a with a strong infrastructure to be the headquarters capable of planning, executing, monitoring, supervising and evaluating the different malaria control activities. 
– To develop and build national centers capable of planning, running, supervising and evaluating the different malaria control activities. 
– To reduce the mortality rate by 80% by the end of the 5-year plan 2001-2005. 
– To reduce the morbidity rate by 50% by the end of the 5-year plan 2001-2005. 
– To achieve the eradication of malaria from Socotra island by the end of the 5-year plan 2001-2005. 
Specific Objectives of the 5-year plan 2001-2005 
– To furnish the rented house for the malaria control program so that it starts functioning during January 2001. 
– To best use the budget allocated for the National Malaria Control Program NMCP for the interest of the program (the local budget for the year 2001: YR465,520,000). 
– To standardize the national policy for the management of malaria cases all over the country during the year 2001 and 2002. 
– To implement the plan of health education (already prepared and approved during the year 2000) during the year 2001 to ensure the community participation during the next five years. 
– To define and specify referral malaria laboratories technicians and microscopists in each governorate during the year 2001. 
– To define and specify referral and focal physicians on malaria in every hospital and health center in Hodeida governorate, al Qafr district in Ibb governorate, Khamis Bani-Saad in Mahweet governorate, Aslam district in Hajja governorate, Socotra island, Wadi Al-Ein and Hora district in Hadramawt governorate, Al-Selw district (Wadi Warazan) in Taiz governorate and Wosab Al-Safel district in Dhamar governorate besides Abyan governorate during the years 2001 and 2002. 
– To intensify the field operations in the governorates and districts already selected to be the pilot project areas for malaria control. 
– To intensify the field supervisory and evaluation visits during the next five years. 
– To activate the role of the Supreme National Malaria Control Committee (SNMCC). 
– To coordinate with the private sector to strongly involve them in the implementation of the program. 
– To coordinate with the international organizations and the NGOs and to make sure the international aids and donations are best used for the interests of the program.