بسم الله الرحمن الرحيم. جمهورية مصر العربية وزارة الصحة والسكان. Egypt MINISTRY OF HEALTH & POPULATION . Egypt MINISTRY OF HEALTH & POPULATION . GENERAL DEPARTMENT OF MALARIA FILARIA & LEISHMANIASIS.
بسم الله الرحمن الرحيم
EgyptMINISTRY OF HEALTH & POPULATION .
Situation Analysis Egypt is one of African countries , it occpies the east northen corner of the Africancontent with an extension across the Gulf of Sues into Senai region with political frontiers on the east with Palastine and Israel , its boundaries are Mediterranean basin in the north , Res Sea in the east , Lybian from the west and Sudan in the south .
Demography- The total population reach about 70 millions according to the latest census .- The area of Egypt exceed one million square km. ( about 1,002,000 ) - About 57.6 % of population lives in rural area and 42.4 % in urban area .- Femal / male raio is about 48.8 – 51.2 % .- population growth rate is incrasing by 20.7/1000 .
Geography - The plan area is formed the largest percentage of area in Egypt , the delta region found around the banks of the longest River Nile which extend through many African countries until reach Oghanda .- The Nile valley formed 6 % of the area , it extend from 2-15 km. Around the Nile banks where it formed the main resident and cultivated area in Egypt .
Climate and agriculture - Egypt have a moderate climate all over the year the temperature varies from 30 + 15 , the humidity range about 60 + 10 and it increase in costal areas .- The rainfall during months of December , January , February and increase in costal areas - Egypt has a great agricultural project , all types of crops are present all over the year by using recent technological methods.
EgyytMOH &P 1st US for 1ry health &preventive sectorUS of Endemic disease G.D.Mal.,Fil., & Leish.,control depatment.US &GD of health directorates ( at Gov.level)Director of Endemic diseasesDirector of health district.Mal.&Fil. Control units (205) & PHCu(4000)
Health care systemThere are about 250 general and central hospitals for health services and refer cases from from rural hospitals supplied with all measures , equipment with an efficient medical staff and 4000 PHCu scattered all over the country for early diagnosis of disease and family planning and maternal health care.
Malaria Control Programme.It apply through 102 units & 205 sub- units distributed all over the country and four training centers supplied with all facilities recommended for continue preparation of new Malaria staff . The Malaria units supplied with all measures for early diagnosis ( ACD&PCD)with proper treatment and facilities for vector control measures .
MALARIA IN EGYPTMalaria is present in Egypt since dawn of history , as evidenced by the document hieroglyphics on wall of temples .- The anti Malaria work in Egypt started by Ross 1903 in Canal zone . He reported that Malaria cases were corresponding to about 1/3 of the population of that locality at that time . The first step towards Malaria contol in Egypt was taken in 1914 , were Malaria control was assigned to the control and prevention of infectious disease section of the department of public health .
- High Malaria committee was formed of represetatives of different Government department with the objective of organizing a Malaria control program focused its interest on the Canal zone , the main activities filling in , drainage or clearance of vegitation of stagnant water sites and ponds, borrow, pits or swamps , the use of larvicides as paris green and oil , in addition the prohibition of rice cultivation within a radius of 2 km. From town .
-The mosquitoes were surveyed by Kirk Patric , 1925 and his valuable monogragh still remains an important reference . In 1927 , the 1st Malaria station began to operate in Edkou Behera Governorate under the supervision of the control and prevention of infectious disease section . In 1930 , the 1st Malaria control and research station was established in Khanka . Shousha 1948 recorded that Malaria cases were estimated as 150,000 cases with 12,000 deaths . Farid 1980 reported that 180,000 deaths were recorded in fulminating Malaria epidemic 1946 .
Malaria EpidemicOn 1942 – 1946 a sever epidemic wave of Malaria had been started in upper Governorate extend from south of Asswan to south of Assiout (500 km.)duo to invasion of Anopheles Gambia mosquitoes coming from Sudan leading to fetalities of thousands of the residents. An strong eradication campaign was done against parasite and vector to cut man vector contact with participating of WHO untile complete eradication of Anopheles Gambia from upper Egypt and had been declared on January 1946 .
Present Malaria Situation1. Malaria parasite- All Egyptian Governorates are free from Malaria parasite except some imported cases from other endemic countries . - The tables(1&2) shows the Malaria cases since 1960, the numbers of plasmodium vivax, plasmodium falciparum were present and the imported Malaria cases 2001-2002. - These imported cases must be put under control program to exclude of 2ry Mal. cases.
2002 1141767 000 000 000 000
Recorded Imported Malaria cases 2001-2002(No. of slides Taking from ship passengers travelling between Asswan- wady Halfa with no. of positive cases.. 2001 –2002 respectively No of examined positive PF. PV. 2237 9 9 - 2398 10 8 2
The annual imported Malaria cases return to increase movement of the resident to other countries with Malaria trannsmission activity also increase migration to and from endemic areas either to work or learn in AL Azhar university.- There is no resistance of plasmodium falciparum strain to anti Malarial drugs . -The surveillance system for Malaria aim to protect Egypt from any unexpected Malaria foci by collection of all relevant information and any change in localities from monthly existing reports.
2. Anopheline species in EgyptKenawy 1990 mentioned that 11 indigenous Anopheline mosquitoes in Egypt of which two are still questionable , A . (Cellia ) hispaniola,Theobald in Sini needs further confirmation whether it is the Meditterranean hispaniola or A.(Cellia ) turhudi , and A.(Cellia stephensi , which has been recorded for the first time in one area only ( Shokeir ) on Gulf of Sues . The other nine species can be generaly classified according to their role in Malaria transmission in Egypt as follows:.
1.Proven vectors : A.(Cellia) pharoensis Theobald and A.(Cellia) sergenti,Theobald.2. Suspected vectors:A.(Cellia) multicolor, Cambouliu , A.(Cellia) superpictus, and A(Cellia) d,thali,3. Non vector playing no role in Malariatransmission : A.(Anopheles) algeriensis, Theobald , A.(Cellia) turkhudi , A.(Anopheles ) tenebrosus.and A.(Cellia) rupicolous .
- Senai is the richest area in the number of species present .- Three species which are , A.pharoensis , A. Sergenti and A.multicolor are generally the common anophelines in Egypt .- Fayoum is secod in importance having 4 species , A.pharoensis ,A.segenti , A.multicolor and A.tenebrosus . The occurrence of the first two vectors together is responsible for Malaria transmission in Fayoum.
Roll Back Malaria in EgyptIntroduction :We are aware of the value of RBM to initiate political , social and technical movement to support and strengthening the information and surveillance system aim to prevent introduction of Malaria parasites through gametocyte carriers coming from endemic countries to maintain freeness of the country from indigenous cases , this will be achieved through intersectorial and interministrial co-operation .
National goal :Maintain Egypt free from Malaria and prevent of reintroduction of gamitocyte cariers. Strata :1. Large artificial Naser lake in the southern part of Egypt 500 km. Between Egypt and Sudan which may be considered as a good breeding places for mosquitoes and become as a receptive area for Malaria .2. Previous Malarious area , Egypt are free from Malaria since 1990 except one Governorate which is Fayoum with strong past history for Malaria parasite transmission till 1998 where it become free . .
3. Presence of vector for Malaria transmission ( A.pharoensis , A.sergenti ), it is distribution every where in the Nile valley , Delta, Oases, Fayoum .4. Increase tourism activity to and from Malairious country .
Obiective .:1. Maintain negativity in risky areas ( Fayoum Governorate )2. Prevent occurance of Malaria epidemic in country as a receptive area.3. Protection of the country from introducing Malaria cases or entry of exotic efficient vector.4. Interrupting transmission along national terriotory .
3Activities .:- Provision and distribution of diagnosis and treatment guide line charts for health units and fever hospitals and quarantine sectors in harbours and airport . - Refreshing training courses on management and examinaing Malaria cases.- Strengthening of surveillance system for early case detection with distribution of proper radical treatment . - Regular entomological observation with applying control measures for positive areas. suspected Malaria vector .
- Develop and disseminate the definition of suspected Malaria cases .- Inter sectorial co-operation between Malaria department , fever , quarantine sectors to protect the country against imported cases ( protocol for observation , notification , management and follow up Malaria case. - Inter countries and bilateral co-operationn between Egypt and Sudan( in 1970 an agreement was established ) to prevent the entry of exotic & efficient vector An. Gambia from Sudan to Egypt.
African Malaria Day .- Egypt conducted 1st African Malaria day in Cairo at 20 May 2001 aiming to :. Create political awareness and commitment .. Intersectorial workshop with openion leaders. Support Government and country partnerships.. Strengthen health sector .. Coordinate efforts of country partnerships by promoting concreted action and sharing information on Malaria program , in order to improve resource allocation and utilization .
- African Malaria day April 2003-Egypt will conduct 2 nd. African Malaria day during April 2003 aiming to :. Strengthen activities towards imported Malaria cases through quarantine sectors and fever hospitals in ports .. Record and follow up all feverish cases coming from outside the country to confirm its diagnosis with the issues required for every cases .. Supply fever hospitals and quarantine sector with proper anti Malarial drugs .
National strategy to prevent reintroduction of Malaria.:We can summarize the strategy of Malaria control program activities in Egypt according to our RBMproject in the following ceitical areas.1. Fayoum Governorate .For their strong past history as Malariogenic area by strengthening the control measures all over the villages of the two previous positive districts for Malaria cases,with the remaining 3district as a control aspect
The monitoring program will include the epidemiological and entomological aspect .- The epidemiological survay will identify the Malaria cases throw (ACD&PCD ) and entomological one will collect aquatic and adult stages of the vectors present and identify its species with applied control measures for positive areas .
2. Asswan Governorate : As a high Malariogenic potential area for its long territory borders with Sudan . We will support the regular laboratory investigation from the ships passengers coming to Asswan from Sudan along or from the passengers coming through Camel trade route to Asswan ( Darb El Arbein ) .
Also stress the entomological investigation for vector of Malaria present all over the Governorate . - Residual spraying for the ships travel between Asswan and Wady Halfa harbours . Foging spraying for the Camel collecting and trading site . -In 1970, an agreement was established betwwen the Sudan and Egypt Governments , to mount regular joint expeditions to carry out annual coverage of a length of 1000 km.along high dam lake .
3. Cairo Governorate :Malaria vigilance in Cairo due to their position as a capital and for great number of passengers coming from other countries especially from African countries either for work or education in Al Azhar university .- Strengthening epidemiological and entomological efforts from sporadic satellite tawon as El Mokatum city, from foreigners students in Al Azhar university coming from Malarious countries .With applying control measures for parasite and vector .
Constrains1. Due to population :- Random extension of population and urbanization led to presence of many localities and target people out side the limit of control activities done by Malaria control measure .2. Due to incentives :- The low incentives paid for the field workers do not encourage them , so these led to shortage in the field labours .
3. Introduction of gametocyte carriers .Many cases are expected to enter the country either by illegal routs from Sudan or even through legal ports not detected due to insufficient legislation in the ports . ( all prophylactic measures are done in southern borders with Sudan .)
TREATMENTREGIMEN1.4-Aminoquinoline (Risochine , chloroquinetablets 150 mg . With total dose 1500 mg.2. 8-Aminoquinoline tablets 15 mg for 5 days inP.f. & for 14 days in P.v.,p.o. and P.m.