represents the population and Gross domestic product (GDP) per capita in 2008 reported by UN for each ECO country (7
). presents the total number of malaria cases notified in 2008 in each member of ECO according to World Malaria Report of 2009(5
) and regional office for the Eastern Mediterranean Region (EMRO)(12
). As we see in this table, the frequency of malaria has overall decreased in the countries of ECO. The malaria incidence is very heterogeneous among ECO countries, which differ less than 200 cases in total country in Kazakhstan, Kyrgyzstan, Turkey, Turkmenistan, Uzbekistan, and Azerbaijan to 82,564 cases (2,428/100,000) in Afghanistan and 59,284 cases (881/100,000) in Pakistan and about 18/100,000 in Iran in 2008.
Population and per capital Gross Domestic Product (GDP) of each member of Economic Cooperation Organization (ECO) countries reported by UN
Malaria cases from 1990 to 2008 for each member of Economic Cooperation Organization (ECO) countries*
Although there are no valid and comprehensive information about proportion of population in malaria-risk areas using effective malaria prevention and treatment measures indicators, all available data is demonstrated in . In this table, proportion of children under 5 who sleep under ITNs and proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs has been presented according to some existing reports from UN and WHO.
Proportion of children under 5 who sleep under insecticide-treated bed-nets and children under 5 with fever who are treated with appropriate anti-malarial drugs according to UN and WHO reports
Afghanistan is considered to have the fourth largest malaria burden worldwide of any country outside Africa and the second highest in the WHO Eastern-Mediterranean Region. Malaria is endemic in large areas of Afghanistan below 2000 meters above sea level and is highly prevalent in river valleys used for growing rice. Initial control effects brought a marked decline in the number of reported cases from 626,839 cases in 2002 to 271,763 in 2004, however from 2004, the number of reported cases increased to reach 433,412 cases in 2007 which means 19 cases per 1000 population. Population coverage of ITNs is very low. Only about 5% of the population used ITNs (less than 10% living below 1500m) (7
). Fortunately, according world malaria report 2009, reducing in the number of malaria cases has been realized in Afghanistan between 2000 and 2008 (decrease in cases > 50%)(13
WHO estimates that 80% of Azerbaijan population lives in areas prone to malaria risk. Therefore, the risk for malaria is existent. Azerbaijan faced a resurgence of malaria in the 90s due to displacement of people because of war and challenges the country faced at the time (5
). “Only 20 cases of Plasmodium vivax
malaria were reported in 1990 but this rose to over 13,000 in 1996. By the end of the 1990s, the rate had returned towards its earlier level, although transmission continues in some areas ” (16
Malaria is one of the major public health problems in Iran. The main malaria endemic areas of Iran are located in the southeastern part of the country, consisting of three provinces: the Sistan and Baluchistan province, the Hormozgan Province and the tropical part of Kerman province with a combined population of approximately 3 million and this region is considered “refractory malaria region”. The south-eastern provinces of Iran are less developed compared with the other parts of Iran; they are bordered in the east by Afghanistan and Pakistan; besides these two factors the ecologic and whether condition all together intensify the problem of malaria. Illegal traverse over southeastern borders especially by afghan and Pakistani people, behavior changes of parasite transmitters, reactivation of non-active centers, shortage of skilled personnel are some of the problems confronting malaria control in disease-localized regions. As Pakistan’s malaria epidemic especially at Baluchistan state has a negative impact over Sistan and Baluchistan province, this disease cannot be completely eliminated unless malaria control program gets improved in Pakistan.
Malaria is not a public health problem in Kazakhstan now while its incidence rate in Kyrgyzstan is low and it has some variations; the peak of morbidity happened in 2002.
Malaria has been a major public health problem in Pakistan and will continue to pose serious threat to millions of people due to poor environmental and socioeconomic conditions conducive to the spread of disease. Transmission is seasonal and large-scale epidemics have been reported in the past, the recent was during 1973 –77 when Annual Parasite Incidence (API) reached up 13 per thousand population. According to 1988 malaria review mission report; the disease incidence is at least five times higher than what is being currently reported. The main malaria endemic areas are located in the Baluchistan state. Following the resurgence of malaria after the eradication program of the 1970s, malaria has been a persistent problem in Pakistan. There were an estimated 1.5 million malaria episodes in 2006, accounting for one quarter of all cases in the WHO Eastern Mediterranean Region. Almost all are confirmed as malaria, and about 30% are due to P. falciparum.
The status of malaria control in Tajikistan is acceptable, especially after 1997 epidemic peak, and it is possible to reach MDG about this disease. It seems the strategies taken to control this disease in Tajikistan were effective. It is recommended to continue these strategies and control the program. According to reports of 2000 and 2005 the indicator of prevention /treatment (proportion of population in malaria-risk areas using effective malaria prevention and treatment measures) are low and there should be planning for their increase. However, this indicator is not meaningful for the whole country and it should be defined for high-risk areas.
In Turkey, in addition to economical factors, it seems that the strategies taken to control the environmental factors of malaria (Indoor Residual and Spraying) and case management policies were effective. It is recommended that more attention be paid to their sustainability. “Estimating malaria deaths and episodes has always been challenging because of inadequate health reporting systems, the co-incidence of malaria and other diseases, and the similarities of symptoms with those of other diseases (17
)”. Therefore, more attention should be paid to estimating malaria death and episode.
During the period 1965–1980 only 23 malaria cases were reported in Turkmenistan, but this number increased in late 1990s(18
). Still there is a very limited risk of malaria transmission in Turkmenistan (16
). As a result, not much data on prevention activities (such as ITNs) is available.
Malaria was eradicated in Uzbekistan in 1961. Since that time, the majority of cases are imported cases mostly from Tajikistan and Afghanistan. From the mid 1990’s to date, the number of imported malaria cases has continued to increase (21 cases in 1994 and 80 cases in 2000). In 1999, due to a steady increase in imported malaria cases and the presence of conditions favorable for malaria transmission, the first local cases of malaria, seven in all, were registered. By 2000, the locally transmitted cases have been increased to 46 (15
). Malaria is not a public health problem in the country now.