Expat dating Hudaydah Yemen
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From , IRS was gradually replaced, following detection of DDT resistance, by the detection of vector-breeding sites and their weekly or fortnightly treatment with temephos, including later with larvivorous fish A. In , a more intensive case-register surveillance system was introduced combining active and passive-case detections, treatment of confirmed malaria cases, epidemiological investigation of cases and foci, and posttreatment follow-up of the malaria cases.
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Active case detection was gradually phased out as comprehensive health facility coverage across the country became established. The proportion of cases originating from autochthonous malaria transmission in was 0. Despite the heavy rainfall in and across the receptive central plateau region, no local transmission occurred. In , the national malaria plan was redesigned from the one supporting control to elimination, and within a few years the CMD staff across the country was full-time employees with 47 based at the headquarters in Sharjah.
The last case of locally acquired malaria was vivax and reported in UAE was certified malaria-free in Annual population estimates derived from UAE National Bureau of Statistics and all noncensus years have been estimated using intercensal growth rates. UAE managed to escape the threats posed by chloroquine resistance elsewhere, and given the increasing numbers of P.
In , the drug policy changed to support the use of artemether-lumefanthine for uncomplicated falciparum imported malaria cases, in-line with regional policy, while chloroquine and primaquine continued to be used for vivax cases. Strategies to maintain the malaria-free status in the UAE from included surveillance at clinics runs by both the public and private sectors, detailed case investigation, traveller advisory awareness on the need for prompt fever investigation, vector-breeding surveillance including a detailed GIS reconnaissance, continued use of temephos and larvivorous fish, the monitoring of insecticide resistance and high profile, politically supported malaria-free awareness days on 28 December.
A request for the certification of malaria-free status in the UAE was submitted in There followed three review visits by the WHO, which included a review of records, programme efficiencies including the ability to detect all cases and other supporting data.
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This official approach for certification stimulated a renaissance in the certification process for the WHO. On 27 March , UAE was declared malaria-free, with a cautionary note that while UAE had managed to reduce its receptivity of local transmission, by targeting the larval stages of the vector and rapid urbanisation, vectors had not been eliminated and combined with high vulnerability risks from imported infections meant that the CMD needed to remain vigilant.
A framework was proposed for the postelimination phase including continued notification of all imported cases, free diagnosis and treatment including prophylaxis for travellers outside of UAE , toll-free help lines, case and breeding site epidemiological investigations and sustained public awareness campaigns. Muharraq Island is much more barren and smaller in size and the only fresh water supply comes from the Zimma Spring near Hidd village. After protracted periods of international disagreement and national unrest, the Emirate of Bahrain became a self-governed nation state in The oil boom of the s led to rapid financial prosperity and a period of diversification of its economy into offshore banking facilities.
In , Bahrain had 1. Malaria is likely to have existed on the islands for hundreds of years.
Belgrave wrote that in , Portuguese men stationed at Manama Fort suffered from an epidemic of fevers. Data on malaria cases between and presenting to the Victoria Memorial Hospital at Manama were assembled as part of a detailed malaria survey across Bahrain by the Malaria Institute of India, indicating at least cases per year up to when cases began to rise to over by Afridi and Majid, The malaria survey identified An. In , recommendations were made by the survey team to improve drainage, manage the irrigations systems, ban water storage tanks around households and introduce larvivorous fish.
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DDT was introduced for adult vector control in and led to a dramatic decline in malaria incidence within a year and expanded in to cover all towns and villages across the islands. By An. In , there were only locally acquired cases dropping to 38 cases by ; however, an epidemic occurred in due to flooding resulting in cases Hamza et al.
The systematic documentation of imported malaria cases began in Amin, and was recognised early on as a major threat to effective control in Bahrain. Twice yearly, DDT IRS remained the main vector control measure for many years, despite growing reluctance of the population to allow spray men into their houses Delfini, Locally acquired malaria cases dropped to single digits by In , there was an interruption in the downward trend, an epidemic of 35 P.
Under the guidance of WHO, the Ministry of Health began its elimination phase in with the introduction of active case detection and investigation to compliment the passive case-detection methods, presumptive treatment of immigrant labour and radical treatment of all parasite positive detected cases using chloroquine and primaquine Delfini, In , , inhabitants were protected by bi-annual house spraying with fenitrothion, and diesel oil was used for larval control every 8—10 days and occasional space spraying with pybuthrin in densely populated areas, which had started in Coincidental with vector control, rapid urbanisation across the island was felt to contribute to the decline in larval breeding sites Oddo and Payne, The last autochthonous case was identified in Throughout the elimination attack phase malaria was integrated within other departments and divisions of the Ministry of Health; for example, epidemiological surveillance was part of the communicable disease section and vector control initiative as part of environmental health section — latterly a unit of malaria, insects and rodent control managed from six regional centres.
As such, at no time was there a single malaria control or eradication department. Data assembled from Amin Bahrain was declared malaria-free in Population data sourced from census years between and State of Bahrain Central Statistics Organization, Intercensal growth rates used to compute noncensus year population size. From , all fever cases screened at health clinics, the Salmaniya Medical Centre and the Public Health Laboratory cases were investigated by a health inspector including the screening of household and neighbourhood contacts.
From , imported cases remained relatively stable between and cases each year, mostly from India. Imported cases were detected at a time coincidental with returning travel to and emigration from the sub-continent during peak months of transmission in India Fernandes and Mahmood, Between and , no cases of indigenous malaria in Bahrain were reported, and the number of imported cases began to show a steady decline from to 54 cases by with five countries, India, Pakistan, Sri Lanka, Bangladesh and Sudan, as the major importation origins Ismaeel et al.
Between and , there have been imported infections — from India and Pakistan. The predominance of latent P. Between and , active breeding sites were identified, despite regular larval control activities and thus there remains a potential for the reintroduction of indigenous malaria transmission Ismaeel et al. Currently, vector control is maintained using diesel oil and where this is not appropriate temephos has been used since Amin, ; Alsitrawi, There are also reports of continued use of IRS.
Bahrain has been malaria-free since but has not sought certification from the WHO. Qatar has a small land border with Saudi Arabia but is otherwise surrounded by the Gulf.
Combined with several islands, Qatar covers approximately 11, km 2 , with a hilly region known as the Dukhan hills in the west and salt flats along large parts of coastline. Oil was discovered in s and the off-shore natural gas field is largest in the world. Not much is known about the historical risks of malaria in Qatar. In the early s, the WHO classified Qatar as at risk of malaria. The principal vectors have been identified as An. In , only cases were reported to the central laboratory, and most were thought to be imported although there was little systematic investigation or follow-up of detected cases during this period Shidrawi, Artesian wells, irrigation areas, swamps and farms investigated for breeding sites in identified very few vectors, and it was felt that overall conditions were not favourable to dominant vectors of the region so while imported infections were high receptivity remained low Shidrawi, In the early s, a malaria unit was established under the division of infectious diseases and epidemic control.
Their functions were to survey and control vector-breeding sites and undertake insecticide spraying in areas where Anopheles larvae were identified, mostly at farms in the northern reaches of the peninsula El Manieh, It is not clear when local transmission was interrupted but it is likely that there were no locally acquired malaria infections since the s and the Qatari government has never sought the official WHO certification.
Imported infections varied between and cases per year since Al-Kuwari, Presently, there is no well-formed national strategy to maintain a malaria-free status. Responsibilities for malaria are integrated across departments of preventative health and primary health care in the ministry of public health, the ministry of municipal affairs and the Hamad Medical Corporation, based in Doha that diagnoses all cases, maintains register of imported cases and advises on drug policy Kondrachine, Despite attempts to include the private sector in case detection and reporting these have been inadequate and many cases are thought to go undetected and not radically cured.
Immigrants from 46 malaria endemic countries and blood donors are screened and radically treated, including chloroquine and primaquine for vivax cases. By , there was no evidence of active case detection or epidemiological investigation of passively detected cases. Vector control is under the responsibility of the ministry of municipal affairs, which employs the varied agriculture and pest control departments to supervise the weekly identification and elimination, using temephos, of larval breeding sites, largely with a focus on swamp areas on periphery of Doha.
The last reported observation of An. Kuwait covers approximately 18, km 2 and is mostly a desert. Its oil fields were discovered in the lates and today has the fifth largest oil reserves worldwide. After Kuwait gained independence from the United Kingdom in , the country witnessed rapid economic growth. Some reports suggest that malaria transmission has never occurred in Kuwait Hira et al. Malaria cases reported between and showed that approximately cases were identified and investigated each year but that none of the cases were locally acquired infections and the Ministry of Health reported that malaria vectors were absent from Kuwait Al-Kilidar, However, the presence of An.
Screening of larval habitats is the responsibility of the Medical Insects Division of the Ministry of Public health, who rarely identify malaria vector-breeding sites, and any suspected sites are treated with temephos Salem, At no time has there been a malaria control department. More than , immigrants come to Kuwait every year for residence or work and all checked for infectious diseases including malaria.
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Of , slides taken during screening between and , were positive 0. Of patients screened as acute febrile admissions to Al-Jahra hospital between and , P. For centuries, malaria has plagued large parts of the Arabian Peninsula although the likelihood of natural, uncontrolled transmission has been governed by the abilities of dominant vectors to maintain transmission under harsh environmental conditions. The intensity of malaria transmission has varied enormously across the peninsula from a likely absence of transmission in Kuwait to an intense parasite exposure, similar to conditions in many parts of Africa, among residents of the south western reaches of the peninsula in Saudi Arabia and Yemen.
The spatial extents of malaria risk have contracted through aggressive control and elimination efforts beginning during the s but only managing to dramatically reshape national risk profiles since the s, a period coincidental with rapid economic growth.
Using the information provided in narratives of published and unpublished reports, it is possible to map the changing margins of malaria risk from its likely natural extent Fig. Temperature, aridity and population density masks are applied according to the rule outlined in text and legend to Fig.
Yemen: During the s, it was documented that local transmission was absent from the Aden Colony and the only cases detected were imported cases found on the ships entering the port or from surrounding areas WHO-Aden, By , Aden remained a town thought only to report cases of malaria acquired outside the limits of the town MoPH, By early late s, active transmission in the north western areas was interrupted by the eradication of An. All central areas were free of active transmission by before Qatar: Probably malaria-free from Shidrawi, Jazan city and Farasan Island were also reported malaria-free at this time Farid et al.
Oman: Muscat city limits were free from active transmission in , respectively. In Dhofar, epidemiological surveys between and included slides taken from 15, individuals of whom only one was found positive Delfini and Abdel-Majeed, and a survey of three areas in October among people found no one positive Muiz, During the s, the WHO regarded the border area with Yemen as malaria-free Anon, ; however, sporadic epidemics from imported infections were reported in initiated by infected Somali immigrants Baomar and Mohamed, While reasonable to presume that this area was malaria free in the s, it does have a receptive risk making it vulnerable to imported infections.
Operation Raahat was an operation of the Indian Armed Forces to evacuate Indian citizens and More than 4, Indian citizens in Yemen were evacuated along with foreign advisories on 21 January to Indian expatriates in Yemen to leave the country. 2 April, Al Hudaydah, Sumitra, 3 April, , 11, "The coalition's restrictions on imports and access to Al-Hudaydah (Hodeidah) port have contributed to shortages of fuel and other necessities.
UAE: In , there were no locally acquired cases in Dubai and all of the cases detected in Abu Dhabi Emirate were classified as imported in Farid, In November , no infant was found positive for malaria infection and a survey of 6—9 year-old school children identified 26 children with enlarged spleens and the three P. Bahrain: was reported as malaria-free in Oman: Risks only in most northerly coastal governorates. Oman: By , foci in the five most northerly provinces; UAE: Last locally acquired case detected in and by malaria-free.
Yemen: The last reported case on Socotra Island was in and regarded malaria-free since this date. In these regions, the elimination of transmission was rapid. By , Qatar, Bahrain and the eastern and central provinces of the Kingdom of Saudi Arabia were malaria-free following intensive control efforts mounted over a relatively short period.
Over the same period, malaria remained entrenched along the western and southern reaches of Saudi Arabia and Yemen and notably along their borders. On the Gulf during this time, the UAE and Oman continued to struggle with risks posed by local transmission in difficult foci and along their respective borders. The An. It is not surprising therefore that the most southerly provinces of Saudi Arabia only began to witness real success in shrinking the extents of malaria with a recognition of the national economic potential of the region and a need for investment.
Yemen has been less fortunate. Despite a concerted effort to contain and control the epidemic resurgence of malaria during the s that affected the entire sub-region following exception rainfall patterns and emerging chloroquine resistance, Yemen remains one of the poorest countries in the region that continues to suffer a civil conflict making concerted and ubiquitous control efforts difficult.
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There are several features related to the organisation of malaria control that characterise the elimination success where this has occurred on the peninsula. First, areas that responded most rapidly to increased investment in vector control were areas already under rapid economic and urban growth. The expanding modern cities along the Gulf transformed the natural ecology and receptivity of malaria risk. It is hard to imagine that cities such as Abu Dhabi and Doha would experience the same risks of malaria transmission today compared to 30 years ago.
The rapid decline in malaria incidence in Bahrain, Qatar and UAE is likely to have been a combined result of urban growth, social investment of oil revenues and vector control. Second, a political commitment was necessary to move from a status quo of sustained control to one that embraced an ambition of elimination.
Control programmes in the UAE, Oman, Yemen and south western Saudi Arabia met with only limited success during the s when political commitment was lacking resulting in inadequate funding and staff for control programmes. Progress towards elimination was reversed when a commitment was revived. This may seem an obvious prerequisite but it is worth highlighting as an essential part of elimination success.
Thirdly, at different stages in the control to elimination pathway, attempts have been made to integrate malaria activities into broader primary health care initiatives in every country on the peninsula. However, during maintenance phases, postelimination the detection of malaria cases and their investigation becomes a broad health service and infectious disease surveillance agenda as is currently the case in Qatar and UAE.
Maintaining political interest and dedicated malaria staff with adequate resources postelimination is harder to sustain, with some fears that malaria-free certification promptly leads to the demise of any malaria programme. It is notable that resurgent risks in the s in UAE and dramatic epidemics in the mids in Saudi Arabia and Yemen were necessary to refocus government support around malaria. Ironically, epidemics galvanise political commitments to malaria-specific initiatives.
Fourth, the success of elimination depended heavily on a mapped intelligence of risk. The UAE, Oman and Saudi Arabia developed an early malaria risk cartography based on vectors, intensity of transmission and ecology. These national atlases and stratification served as frameworks to develop a nationally staggered approach to shrinking the limits of transmission and defining appropriate combinations of intervention. The resolution of this risk mapping intensified as vector control was mounted sub-nationally, and detailed maps were developed of regions and locations of households to mount targeted IRS and larval control.
As the target of elimination approached, the precise mapping of cases became imperative to contain the onward transmission. Geographic reconnaissance was used to guide all levels of control to elimination from national to village scales and the skill and use of malaria risk mapping to guide elimination strategies contributed to its success.
Finally, and perhaps uniquely to this region, larval control appeared to be a successful means of reducing vector abundance and remains widely practised.
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Attribution of individual vector control approaches to declining malaria incidence is not possible with the data available. Nevertheless, the use of temephos linked to the high-resolution reconnaissance of breeding sites dominated much of the elimination efforts in all countries on the peninsula. With the exception of An. Where vectors are no longer present, the receptive risks have been diminished to such low levels that these areas are no longer vulnerable.
The threats posed by imported infections remain significant. A large immigrant labour force travels to and from their home countries and the Arabian Peninsula every year. This work force comes predominantly from India, Pakistan and Bangladesh with lesser representation from other nations across the malaria endemic world.