Despite progress, malaria remains a serious threat

With 60 percent of Yemen's population at risk of malaria, the disease represents one of the biggest health challenges for the country's 19.7 million people. A three-day seminar on malaria and other diseases that wrapped up on Tuesday in Sana, the Yemeni capital, called for more cooperation and support to confront the disease, as well as increased political commitment to ensure sustainability in the fight against it. "Malaria has been a major health challenge for some decades, " said Yemeni Public Health and Population Minister Mohammed al-Nomi at the seminar. The minister said that Yemen had made progress its fight against the disease. The epidemic infection in the Tihama region, some 226 km west of Sana, had dropped from 46 percent to 11 percent, for example. In Socotra, an island in the Indian Ocean, the prevalence rate had fallen from 36 percent to less than 1 percent. Still, Yemen is one of the most malaria-affected countries in the Middle East, with an estimated 800,000 cases per year, according to Dr Mohammed Khalifah, an expert on malaria from the UN World Health Organization (WHO). A global problem Malaria is an acute and chronic infectious disease caused by parasites and spread through the bite of the female Anopheles mosquito. Symptoms of the illness include chills and a high fever. Untreated, malaria can result in death. The disease is widespread in tropical regions and affects one in every 12 people globally. The Plasmodium falciparum parasite causes 90 percent of the malaria cases in Yemen. Internationally, it causes 120,000,000 new cases and up to 1,000,000 deaths per year. It is this deadly species that has given rise to the formidable drug-resistant strains of malaria emerging in Asia, according to WHO reports. The seminar's 300 participants, including staff from Yemeni hospitals and medical colleges as well as international health experts, emphasised the urgency of reviewing the current antimalaria drug policy. Because studies indicate that Plasmodium falciparum malaria has a high level of resistance to chloroquine treatment, they proposed shifting to artemisinin-based combination therapy, according to Khalifah. The seminar also recommended that all insecticides and drugs be ordered and delivered according to WHO specifications. A shared responsibility Funded by the World Bank and UNDP, the seminar highlighted the achievements made so far and stressed the importance of collaboration with all partners - public, private and local and international NGOs. "Malaria and other vector-borne diseases like dengue fever are not the mere responsibility of the ministry of health but should be the joint responsibility of different public and private sectors," Khalifa said. He noted that since 2001 the government of Yemen had invested US $18,814,443 per year in the fight against malaria. Yemen was hard-hit by the disease in 1997-1998 after an extremely heavy rainy season. The number of annual cases during that time soared from 1.5 million to three million, with a mortality rate of between 15,000 and 30,000. Following the Gulf War of 1991 and the cessation of the Gulf countries' support to Yemen, antimalaria programmes suffered. With guidance from WHO, the government of Yemen established its National Malaria Control Programme (NMCP) in 2001. The NMCP's strategy includes measures for capacity building, early and correct diagnosis, prompt and effective treatment, integrated vector management, surveillance and information systems, community participation and prevention of malaria during pregnancy, according to Khalifa. Through WHO, Yemen has built a strong partnership with neighbours Oman and Saudi Arabia. The Saudis committed themselves to providing Yemen with pesticides, space-spraying machines and vehicles to strengthen the transport system of the NMCP. There has also been support from Japan, the United Arab Emirates Red Crescent Society, the World Bank and the UN Children's Fund (UNICEF) among others. In 2002, WHO helped Yemen produce a proposal for the Global Fund for AIDS, TB and Malaria, which concentrated on capacity building, community participation and the provision of bed nets for pregnant women and children under age five, Khalifa said. The application was accepted by the fund and Yemen thereafter received $12 million for five years. The proposal also involved strengthening the infrastructure of the NMCP through building its headquarters in Sana and a sub-regional office in the western city of Hodeidah, which will be the best equipped malaria centre in the region and is due to open in 2006. Khalifa said, however, that financial support, affordability and compliance by the different sectors and the community were still major challenges to efforts to roll back malaria. "Resources and fundraising are among the main problems we face. Therefore, we have to look for new partners in the Gulf countries, Global Fund and ECHO [European Union Humanitarian Aid Office]," he stressed, adding that the support Yemen had received over the last few years had enabled the country to drop the incidents of malaria in all the areas in which the malaria control measures were implemented.