Chapter Three - The Malaria Transition on the Arabian Peninsula: Progress toward a Malaria-Free Region between 1960–2010
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Background and Context
The Arabian Peninsula has a diverse malaria epidemiology and an important historical contribution to the understanding of successes and failures of malaria elimination. Writings from travellers to the Arabian Peninsula during the previous two centuries make reference to periodic fevers and deaths from fever at oases and along the inhospitable Tihama region on the western border with the Red Sea (Rogan, 2011). It is thought that during the Prophet Mohammad's migration from Mecca to Medina in the
Kingdom of Saudi Arabia
The Kingdom was established in 1932 and until the discovery of oil in 1941 was one of the poorest countries in the world. Oil now accounts for more than 90% of exports and 75% of government revenue that supports a free welfare state for its nationals and immigrant labour force including all funding for domestic malaria control and support for control activities in neighbouring countries.
In 1935, malaria accounted for 45% of all out-patient attendances in Jeddah (Buxton, 1944). It was not until
Republic of Yemen
The boundaries of the present day Republic of Yemen have changed subject to regional power struggles over the last 150 years. In 1937, the city of Aden and its surrounding villages was renamed the Colony of Aden and the remaining areas of South Yemen became the British Aden Protectorate (Gavin, 1975). In 1963, the Colony of Aden and Protectorate joined to form the Federation of South Arabia, and in 1967, became the independent country of the People's Democratic Republic of Yemen (PDRY) (Dresch,
Sultanate of Oman
The Sultanate of Oman is characterised by a large desert plain that covers most of central and southern regions of the country interspersed with wadis. Mountain ranges are found along the north (Al Hajar Mountains) and southeast coast, and the country's main cities are also located at high altitude including the capital city Muscat, Sohar and Sur in the northern mountain regions and Salalah in the south. The peninsula of Musandam is a strategic location on the Strait of Hormuz but separated
United Arab Emirates
UAE has approximately 200 small islands in the Gulf and a sea border of 650 km that encompasses coastal salt flats (‘sabkha’). Approximately 80% of the country is desert merging with the Rub' al-Khali of Saudi Arabia; however, there are oases, notably the large oasis settlements at Al Ain, Liwa and several others towards the borders of Qatar and Saudi Arabia. Fertile plains are fed by mountain ranges in Ras Al-Khaimah Emirate. The sea and the desert provide natural barriers to malaria
Kingdom of Bahrain
Bahrain is an archipelago of 33 islands, with the largest island of Bahrain Island being only 652 km2 where over 90% of the land mass is a low lying desert, with a single mountain, Jabal ad Dukhan, rising to 134 m above sea level. Bahrain Island is connected to Saudi Arabia by the King Fahd Causeway. Muharraq Island is much more barren and smaller in size and the only fresh water supply comes from the Zimma Spring near Hidd village. After protracted periods of international disagreement and
Qatar
Qatar has a small land border with Saudi Arabia but is otherwise surrounded by the Gulf. Combined with several islands, Qatar covers approximately 11,437 km2, with a hilly region known as the Dukhan hills in the west and salt flats along large parts of coastline. Oil was discovered in 1930s and the off-shore natural gas field is largest in the world. Of Qatar's 1.5 million people, 60% live in Doha, a large part of rest of population now live in the fast-growing cities of Al Khor, Ras Laffan and
State of Kuwait
Kuwait covers approximately 18,000 km2 and is mostly a desert. Its oil fields were discovered in the late-1930s and today has the fifth largest oil reserves worldwide. After Kuwait gained independence from the United Kingdom in 1961, the country witnessed rapid economic growth. In 2007, Kuwait's population is estimated to be between 3 and 3.5 million people, including 2 million foreign nationals.
Some reports suggest that malaria transmission has never occurred in Kuwait (Hira et al. 1985; EMRO,
Discussion
For centuries, malaria has plagued large parts of the Arabian Peninsula although the likelihood of natural, uncontrolled transmission has been governed by the abilities of dominant vectors to maintain transmission under harsh environmental conditions. The intensity of malaria transmission has varied enormously across the peninsula from a likely absence of transmission in Kuwait to an intense parasite exposure, similar to conditions in many parts of Africa, among residents of the south western
Acknowledgements
RWS is supported by the Wellcome Trust as Principal Research Fellow (# 079080) that also supports PA and CM. AMN is supported by the Wellcome Trust as an Intermediate Research Fellow (# 095127). The authors wish to acknowledge all the current and past malaria control programme managers of countries on the peninsula who have generously provided annual information to the WHO and have documented in detail their efforts towards elimination. We are also grateful to Nahla Ibrahim, Amir Kamal Aman and
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