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Ministry Of Health & Population

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Malaria is endemic in Egypt since the dawn of history & as it is documented on the wall of pharoanic temples. Epidemic wave for Malaria (Anopheles gambia invasion) On 1942 , a sever epidemic wave of falciparum malaria took place in the southern part of Egypt due to invasion of the country by Anopheles gambia the most efficient vector for malignant Malaria transmission coming from Sudan & led to thousands of fatality in 4 southern Governorates. - Eradication campaign of An. gambia was launched by M.O.H. The campaign reached its goal, , on 4th January 1946 MOH and WHO declared that An. gambia had been eradicated from Egyptian territories Historical background for Malaria

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- After that , there were some endemic areas of Malaria which gradually decrease due to strong national control program applied by MOH Control strategy continue through strengthening epidemiological surveillance activities all over the country until all Governorates became free except fayoum Governorate for its special environmental and geographical position as slope area lie under sea level , which became free since 1998 . Historical background for Malaria

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1. Insufficient legislation in ports , harbor and quarantine activities . 2 . Presence of two vector for Malaria transmission which are An. Pharoensis scattered along Nile banks and An. Segenti which Restricted in Fayoum and Oases . This give long season for transmission 3 . Long southern borders with Sudan country which have a high rates of morbidity and mortality cases of falciparum Malaria between inhabitant , the percentage of infection may reach about 25 % of total population . Major constrains

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4. The most efficient vector for Malaria transmission which are Anopheles gambia spread all over the African content and Sudan country . 5. Increase movement activities all over the world to and from Malarious areas with increase number of Egyptians working in these countries . Major constrains

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1. Strengthening active surveillance activities for malaria control program. 2. Strengthening trans-border cooperation project with Sudan in surveillance activities for interruption of transmission. 3. Strengthening building capacity and infrastructure program. National GOAL

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1. Large artificial Naser lake in the southern part of Egypt 500 km., between Egypt and Sudan which may considered as a good breeding places for mosquitoes and become as a receptive area for Malaria 2. Previous Malaria area , Egypt are free from Malaria since 1990 except one Governorate which is Fayoum with strong past history for Malaria transmission till 1998 where it became free 3. Increase tourism and working activities to and from endemic Malaria countries Strata

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To detect malaria cases through ACD, PCD. by strengthening epidemiological activities in vulnerable and high risk areas. To survey anopheles mosquitoes fauna to identify potential malaria vector (s) by strengthening entomological activities 3. To sustain and upgrade the all ready establishment active surveillance program in the cross border project areas. 4. To train personnel acting in different categories in malaria unit on all aspect as vector identification and control measures. Objective

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- The last focus for Malaria was in Fayoum which became free from transmission of Malaria since 1998 . -  There were annual imported Malaria cases from 1998 up till now according to the following table which show the number of examined persons for Malaria from ship passengers traveling between Aswan – Wady Halfa harbors ( Egypt – Sudan countries ) and the other imported Malaria cases discovered by Any other rout . Situation analysis FOR Malaria in Egypt 2004

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Situation analysis FOR Malaria in Egypt

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- Applied through 250 Malaria units & subunits scattered allover the country headed by physicians and Malaria staff (Agricultural engineer, Laboratory technicians ,scouts , field workers and others about 4859 health staff . - Aim to make the country free from all secondary cases for Malaria which occurs from imported cases - Environmental sanitation & control program for vectors of transmission all over the country . - We can summarize the strategy of RBM in Egypt according to our program as follows : Control strategy in Egypt

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1. Integrated vector control In Fayoum Governorate, where the vector Anopheles sergenti is dominate, integrated vector control activities were applied during 1994 and 2004 in Yosef El-Sedik district with the cooperation of Ministry of Agriculture, local counsel including Biological agents such as Gambusia fish, bacteria Bacillus thuringiensis. Chemical control, using insecticides that susceptibility tests proved effective. Environmental measures including clearing irrigation canals from vegetation, land filling and reclamation of several swamp areas to reduce breeding sites. Activities for control program of Malaria (1) Entomological survey ,Vector control activities During 2004 ( routine activities )

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2. Entomological surveys continued monthly for the mosquito vectors all over the country especially in new large agriculture projects, rice fields and areas under construction. Activities for control program of Malaria (1) Entomological survey Vector control activities

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2. Training activity during 2004.          Strength training capability for Malaria staff especially those working in fever hospitals about management of Malaria cases and microscopic examination of Malaria parasite during 2004 : a. Annual training courses for training of Malaria staff distributed all over the country . ( 6 training courses and about 200 trained persons from health cadres for one – two month for each rounds ) b. 4 refreshing training courses 5 day for each 2 rounds for training 50 physicians, agricultural engineering and chemists, and 2 rounds for training laboratory technicians and scouts for laboratory diagnosis of Malaria parasites . c. refreshing training courses 4 day for each round for training agricultural engineering and chemists ,and rounds for training scouts for integrated vector control Activities for control program of Malaria (2) Epidmiological survey

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3 . Establishment of Malaria units in Cairo and in areas of new agricultural project . for 2006 . 1. Malaria vigilance in Cairo Governorate for facing increase construction projects in many localities in satellite town . 2.  Malaria vigilance in areas of great agricultural project in Toshky , Shark El awinate , Teraa EL Esmaeillia . 3.  Providing these Malaria units with all facilities required for epidemiological survey from , vehicle , apparatus , insecticides , for vector control measures , microscopes for diagnosis of the Malaria parasite . Activities for control program of Malaria (2) Epidmiological survey

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4 . Strengthening Surveillance activity : in the 3 critical areas in Egypt which are : Activities for control program of Malaria (2) Epidmiological survey

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A - Fayoum Governorate ( Integrated vector control 2004 )    Integrated vector control Begin to Apply during 1994 due to fulminating of malaria cases in endemic foci in Fayoum Governorate, with cooperation of Ministry of Agriculture , Land reclamation and Local counsel, put strategy for control program to strengthen integrated vector control measures aim to overcome the appearance of breading places with early detection of cases until Fayoum Governorate became free from Malaria in 1998 . This program continued , it aim to environmental sanitation with early detection of cases to prevent re-appearance of Malaria with radical treatment for cases if present. During 2004 an Integrated vector control measures applied in Yosif El Sedik district Fayoum Governorate to overcome the environmental and geographical changes occurs led to formation of many breading places with increase vector density of Malaria transmission till the control program reached its goal . Activities for control program of Malaria (2) Epidmiological survey

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B - Protect the country from invasion of exotic vector of malaria transmission from south border (Governorate 2004 ) . - Egypt Sudan Cooperation In 1970 after construction of high Dam, There are Health agreement signed between Egypt and Sudan aimed to make the area between the two countries (350 km in Egypt and 650 km in Sudan) free from both vectors and parasites . - According to this agreement between Sudanese & Egyptian Governments, 2 joint expeditions from the two countries carry out annual coverage of an area of 850 Km. Alongside the High Dam Lake (350 Km in Egyptian territories & 500 Km in Sudanese territories) to ensure that it is free from both vector of transmission An. gambia and plasmodium falciparum which cause malignant Malaria . Activities for control program of Malaria (2) Epidmiological survey

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An epidemiological control measures takes place through medical and epidemiological team for ship passengers traveling between Aswan and Wady Halfa Harbors , also Passengers through the high way road between Egypt and Sudan . For early discovered of Malaria cases with treating all positive one , with apply control measures for vector on ships with suitable insecticides before leaving Wady also for transporting methods in high way - supply the area of the project with all facilities required for control Activities for control program of Malaria (2) Epidmiological survey

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C. Cairo Governorate 2004 : - Malaria vigilance in Cairo due to their position as a Capital with great number of passengers coming from an endemic countries . either for work , education in Al Azhar university We strengthened the integrated vector control measures to over come the environmental changes in satellite towns as El Mokattum city through environmental sanitation , also strengthening ACT and PCD for students in Al Azhar university side by side with integrated vector control measures in these areas . - Issues for establishment malaria control units during 2006 . Activities for control program of Malaria (2) Epidmiological survey

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4 . Introduce new strategy for diagnosis of Malaria during 2006 we will try to Use dipsticks serological methods for Malaria diagnoses especially those coming from endemic areas and apply PCR technique in vulnerable Governorate among school children . 5 - Cooperation with othernational health sectors 2004 Cooperation between Malarial department in MOH&P and fever hospitals and quarantine sectors in harbors and ports present all over the country .

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6 . Supply malaria units with anti-malarial drugs 2004 : 1. Supply main malarial units and fever hospitals in all Governorates with 1st and 2nd line of treatment ( Fansidar ) and and drugs require for treatment of cerebral and complicated malaria cases ( as emergency and for imported cases .) 2. Mefloquine as prophylactic treatment for travelers go to endemic countries . 3. Prepare guideline chart for travelers to endemic countries for methods of self protection Activities for control program of Malaria (2) Epidmiological survey

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THE END

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Control strategy all over the world ( WHO )

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W.H.O change their strategy from control programme and began to apply RBM on all endemic country for : * Create political awareness and commitment on dangerous of Malarial disease . -        * Strengthening health sector . -    * Co-ordinate efforts of country partnerships by promoting concreted action and sharing information on Malaria programme , in order to improve resource allocation and utilization .

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