Toward malaria eradication in Saudi Arabia: evidence from 4-year surveillance in Makkah

BACKGROUND AND OBJECTIVES: Saudi Arabia has implemented strategies for the eradication of malaria. However, influx of people from countries endemic for malaria for either employment or Hajj makes the country highly susceptible to malaria importation. The Makkah region is known to host millions of immigrants yearly and has a surveillance system to monitor the incidence of malaria. The objective of this study was to examine malaria patients, nationality, and parasite type in Makkah region between 2008 and 2011. DESIGN AND SETTINGS: A retrospective analysis of all reported malaria cases from 19 sentinel sites in Makkah region, Saudi Arabia, for the period between 2008 and 2011. METHODS: Analysis of surveillance data were analyzed using SPSS software, version 15.0 (SPSS Inc, Chicago). RESULTS: A total of 318 malaria cases were reported in these 4 years, of which only 3.6% of cases were less than 10 years of age, including 2 cases below 5 years. Non-Saudis were 95% and Pakistanis, Nigerians, and Indians accounted for 62.0%. Plasmodium falciparum (67%). Plasmodium vivax (32%) and Plasmodium ovale (1.6%) were the notable parasites. CONCLUSION: The low frequency of malaria in Makkah suggests that Saudi Arabia is in the consolidation phase of malaria eradication. The absence of local transmission of malaria is indicated by low frequency of malaria in children less than 5 years of age, and high frequency of malaria in non-Saudis is evidence of malaria importation. Health workers attending to foreigners with febrile illness from Pakistan, Nigeria, and India should consider malaria as their first line of suspicion.