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Four countries in the Eastern Mediterranean Region have successfully demonstrated viable, sustainable and cost effective alternatives to DDT use.

Sudan

Sudan has investigated the impact of insecticide resistance on the effectiveness of malaria vector control, the burden of malaria, and determined the effects of different insecticide-based vector control intervention strategies, such as indoor residual spraying (IRS) and combined IRS and long-lasting insecticide-treated bednets (LLINs) on the development and management of insecticide resistance.

Four study sites - El-Hoosh, Hag Abdullah, Galabat and New Halfain - were chosen across the three states of Kassala, Sennar and Al Qadarif.

Morocco

Morocco explored the feasibility and effectiveness of alternative vector control methods as a part of the integrated vector management (IVM) approach to reduce transmission of anthroponotic cutaneous leishmaniasis.

The effectiveness of IRS combined (disease incidence and sandfly density) with environmental management was compared to environmental management alone.

The effectiveness of LLINs (disease incidence and sandfly density) combined with environmental management was compared to environmental management alone.

Islamic Republic of Iran

The project in Iran aims to investigate the efficacy of covering breeding places with natural materials (mat made of leaves), compared to synthetic materials (man-made materials, tile). The results will be compared to regular larviciding activities by Bacillus thuringiensi. The cost-effective analysis, sustainability of interventions community acceptance and participation will be assessed.

Yemen

Yemen will compare the efficacy of LLINs alone and the combination of LLINs and IRS on the malaria burden measured by malaria prevalence and passive case detection at health facilities. The project also assesses the impact (insecticide resistance) of the two study arms on the malaria vectors and monitors the malaria vector behaviour between the two interventions.

Egypt

Egypt, Jordan and Djibouti strengthened their national capacity on IVM by re-establishing a statutory IVM steering committee, conducted comprehensive vector surveillance/mapping activities and monitored insecticide resistance.

Vector surveillance and insecticide resistance monitoring was conducted in sentinel sites in Qena, Sharqiya, Kafr El Sheikh, North Sinai, Suez, El Fayoum, Alexandria and Damietta.

Countries at the stage of malaria control

Malaria is considered to be an important health problem in countries at the stage of malaria control. Inadequacy, or in some instances, lack of human resources capacity and appropriate infrastructure are the main obstacles for development, implementation and sustainability of malaria control interventions. Malaria control activities should be implemented in synergy with other major health programmes, particularly those for other vector-borne diseases, maternal and child health, routine immunization, HIV/AIDS and tuberculosis. Achieving universal coverage of effective preventive measures, reliable diagnosis and treatment of malaria requires strengthening coordination mechanisms with all partners, including nongovernmental organizations, the community and the private sector, and developing a national strategic plan focused on results.

Countries at the stage of elimination

The strategy of malaria elimination in countries at the stage of elimination is a time-limited exercise to be carried out in a phased manner. The first phase will consist of activities aimed at strengthening the malaria control programme in terms of ensuring properly-trained or retrained personnel, with the necessary resources and logistics to provide a firm and sustainable foundation for the successful achievement of malaria elimination. During the second stage, implementation of selective anti-malaria interventions will be carried out in targeted areas of the country, in cooperation with neighbouring countries sharing a border.

Islamic Republic of Iran | Saudi Arabia

Malaria-free countries

Malaria-free status will be maintained through a well-developed network of basic health services in all countries of this group. Malaria surveillance as part of the general surveillance system is based on reporting of malaria cases and deaths attributed to malaria by space and time. Free access to health services and selective screening for certain high-risk populations in high-risk areas is extremely important. To be able to cope with the potential threat of imported cases, personnel of governmental and private health care institutions will need to be trained and retrained in diagnosis, clinical management and chemoprophylaxis of malaria. In an integrated approach with other vector-borne disease control, staff of specialized services should be trained on malaria prevention through the use of targeted vector control and environmental management. It is equally important to maintain malaria awareness among members of the community, particularly among those individuals regularly travelling to malaria-endemic countries.

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