title: Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000-2014.
abstract: BACKGROUND
  The draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014.
  
  
  METHODS
  Data were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan.
  
  
  RESULTS
  Between 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010-2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall.
  
  
  CONCLUSIONS
  Jazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen.
authors.affiliation: Faculty of Medicine, University of Jazan, Jazan, Kingdom of Saudi Arabia. ibrahimelhassan@iend.org.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: El Hassan
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. Sahly200265@gmail.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sahly
authors.affiliation: Public Health Directorate, Ministry of Health, Riyadh, Kingdom of Saudi Arabia. abuhassenm@yahoo.com.
authors.forename: Mohammed H
authors.initials: MH
authors.lastname: Alzahrani
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. alhakeem2000@yahoo.com.
authors.forename: Raafat F
authors.initials: RF
authors.lastname: Alhakeem
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. maalhelal@yahoo.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alhelal
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. aalhogail@yahoo.com.
authors.forename: Abdollah
authors.initials: A
authors.lastname: Alhogail
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. sdelalalsheikh@gmail.com.
authors.forename: Adil A H
authors.initials: AA
authors.lastname: Alsheikh
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. abduallahassirri@moh.gov.sa.
authors.forename: Abdullah M
authors.initials: AM
authors.lastname: Assiri
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. tajajmri@hotmail.com.
authors.forename: Tageddin B
authors.initials: TB
authors.lastname: ElGamri
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. ifaragalla@yahoo.com.
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Faragalla
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. attasms@yahoo.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Atas
authors.affiliation: Faculty of Medicine, University of Jazan, Jazan, Kingdom of Saudi Arabia. m.akeel@jazanu.edu.sa.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Akeel
authors.affiliation: Faculty of Medicine, University of Jazan, Jazan, Kingdom of Saudi Arabia. bani1984@gmail.com.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bani
authors.affiliation: Faculty of Medicine, University of Jazan, Jazan, Kingdom of Saudi Arabia. hageely@gmail.com.
authors.forename: Hussein M
authors.initials: HM
authors.lastname: Ageely
authors.affiliation: Ministry of Health, Riyadh, Kingdom of Saudi Arabia. aabinsaeed@moh.gov.sa.
authors.forename: Abdulaziz A
authors.initials: AA
authors.lastname: BinSaeed
authors.affiliation: Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. dkyalo@kemri-wellcome.org.
authors.forename: David
authors.initials: D
authors.lastname: Kyalo
authors.affiliation: Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. anoor@kemri-wellcome.org.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. anoor@kemri-wellcome.org.
authors.forename: Abdisalan M
authors.initials: AM
authors.lastname: Noor
authors.affiliation: Spatial Health Metrics Group, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya. rsnow@kemri-wellcome.org.|Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK. rsnow@kemri-wellcome.org.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
mesh_terms: D006801:Humans; D015994:Incidence; D008288:Malaria / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D012529:Saudi Arabia / Q000453:epidemiology