Malaria in Jordan
Malaria in Jordan
Malaria in Jordan
ABSTRACT
Objectives: To determine some epidemiological aspects of imported malaria cases among Jordanians and
non-Jordanians who returned to Jordan from endemic areas and to highlight the importance of compliance
with prophylaxis against this disease and identify the type of plasmodium species causing the disease.
Methods: This is a descriptive study of the imported malaria cases registered at Malaria and Bilharzia
Division, Ministry of Health in Jordan. The study included all people registered and tested for malaria at
Malaria Division between January 2000 and December 2005. All subjects gave a peripheral blood sample to
detect malaria parasite by thick smear method.
Results: From 2000 to 2005, out of 304,314 blood smears, 808 had positive results (detection of malaria
parasites) in their blood sample. Out of the total number of 808 cases 606 (75%) were infected with
plasmodium vivax, 201 (24.9%) with plasmodium falciparum, one (0.1%) subject had mixed infection. There
were no positive cases of plasmodium malarie in our study period. The geographic distributions of these
imported cases were mainly from East Africa (Sudan and Eritrea) and South East Asia (Timor). Jordanian
nationals constituted 589 (72.9%) cases and the majority of them were military personnel who participated in
Peace Keeping Forces all over the world.
Conclusion: The continued presence of imported malaria in Jordan calls for emphasis on effective
prophylaxis especially among Jordanian Peace Keeping Forces to prevent resurgence of this disease and to
keep Jordan at a low incidence of malaria.
Key words: Epidemiology, Imported, Malaria
JRMS December 2009; 16(3): 10-15
Introduction
Four species of the protozoan parasite plasmodium
infect humans. P. falciparum can cause a lethal
infection, whereas P. vivax, P. malariae, and P.
ovale cause milder but nonetheless debilitating acute
disease. P. vivax and P. falciparum are the most
abundant species; P. ovale is the rarest.(1) Beside the
clinical suspicion of malaria, the diagnosis is made
via microscopic examination of thick and thin blood
smears. The thick blood smear is more sensitive in
10
No. of
Samples
55279
59235
57700
54658
47363
30079
304314
No. of Positive
Samples
148
131
143
144
160
82
808
Type of Plasmodium
P.Falciparum
P.Vivax
42
105
50
81
31
112
26
118
41
119
11
71
201
606
24.9
75.0
Mixed
1
0
0
0
0
0
1
0.1
2000
44
79
22
3
148
2001
36
69
19
7
131
Year
2002
32
80
26
5
143
Methods
Malaria and Bilharzia Division is responsible for
planning and implementation of malaria control
programme, strategies and activities including
control of the mosquito vector, detection and
treatment of imported malaria cases and all other
cases (like introduce or injected). The Malaria and
Bilharzia Division has maintained continuous
surveillance of Plasmodium infections among
arrivals utilizing their teams at border entry stations
of the country. All entering subjects underwent a
thick blood smear test after verbal consent regarding
previous malaria infection, the endemic area they
arrived from, and their residency address to follow
them up, for treating them if they were infected.
A retrospective review over a period of 6 years,
from January 2000 to December 2005 was done,
during which all imported malaria cases were
followed closely with early diagnosis, proper
JOURNAL OF THE ROYAL MEDICAL SERVICES
Vol. 16
No. 3 December 2009
2003
41
78
20
5
144
2004
39
101
16
4
160
2005
23
40
17
2
82
Total
Number
Percent
215
26.6
447
55.3
120
14.9
26
3.2
808
Results
During the study period a total of 304,314 blood
samples were taken from individuals arriving in
Jordan from endemic areas. Eight hundred and eight
cases of imported malaria were identified. Out of
this number, a total of 201 (24.9%) cases were
caused by P. falciparum, 606 (75%) by P. vivax, one
(0.1%) case by mixed malaria infection. There was
no reported case of P. malarie in our study period
(see Table I).
There were 775 (95.9%) males and 33 (4.1%)
females with a mean age of 30.4 8.1 (range, 16
58) years as shown in Tables II.
Table III shows the geographic distribution of
imported cases, from a total number of 808 positive
samples: 72 (8.9%)cases were from West Africa ,
340(42.1%)cases from East Africa, 84(10.4%)
cases from Central Africa, 1(0.1%)cases from South
Africa, 3 (0.4%) cases from North Africa, 67(8.3%)
cases from south Asia,153(18.9%) cases from South
East Asia,47(5.8%) cases from Middle East, 2
(0.2%) cases from the Caribbean and 39 (4.8%)
cases had no available data for their source. There
were no documented cases from North Asia, East
Asia and Central\South America.
As shown in Table IV, Jordanians constitute 72.9%
(n=589) and 27.1% (n=219) were non-Jordanians.
The majority of Jordanians were participants in
11
Year
2000
12
22
2
14
77
17
4
148
2001
27
11
16
1
13
43
9
11
131
2002
2
73
18
1
8
25
9
7
143
2003
8
94
6
12
8
7
9
144
2004
15
104
17
15
6
160
2005
8
58
5
2
2
2
82
Total
Number Percent
72
8.9
340
42.1
84
10.4
1
0.1
3
0.4
67
8.3
153
18.9
47
5.8
2
0.2
39
4.8
808
100 **
#According to Centers for Disease Control and Prevention, Department of Health and Human Services division areas
*There are no documented cases from North Asia and Central / South America
**Totals do not add to 100%
Total cases
2000
2001
2002
2003
2004
2005
Total
148
131
143
144
160
82
808
Jordanian
Cases
92
95
106
107
121
68
589
Non-Jordanian
Cases
Percent
56
37.8
36
27.5
37
25.9
37
25.7
39
24.4
14
17.1
219
27.1
Percent
62.2
72.5
74.1
74.3
75.6
82.9
72.9
Discussion
Despite 50 years of eradication efforts, malaria
remains a major scourge throughout the tropics. The
disease is becoming increasingly common, with 300
million to 500 million new infections and 1.5 to 2.7
million deaths, mainly children, occurring every
year.(2,3) The geographic distribution of malaria
depends mainly on climatic factors such as
temperature, humidity, and rainfall. In warm regions
close to the equator transmission is more intense,
occurs around the year and is predominantly with P.
falciparum, while in cooler regions, transmission is
less intense and more seasonal and P. vivax prevails
because it is more tolerant of lower ambient
temperatures.(5) At least 90 countries in Africa,
Asia, the Caribbean, Central and South America are
officially considered malarious.(6) Ninety percent of
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Conclusions
Malaria with its different species is being imported
to Jordan by Jordanians participating in peace
keeping missions in different parts of the world,
mainly Africa and Asia and by non Jordanians
visiting Jordan for work or tourism. Caution must be
exerted to avoid the reintroduction of this deadly
disease which was eradicated in Jordan many years
ago.
The participants in peace keeping missions must be
properly educated about the seriousness of the issue
of taking prophylactic medications. It is also
important to remember the role of antimosquito
measures in preventing the disease. The possibility
of importation of malarious mosquitoes on aircraft
coming from endemic areas should also be
remembered.
Acknowledgement
Special thanks to the continuous efforts exerted by
the Ministry of Health, the Department of Malaria
and Bilharzia, to keep Jordan a malaria-free country,
14
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