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					National Center For Infectious Diseases
        Prevention and Control




   DR :Ibrahim Kraza
   Damascus. June 2005
                  Background
 Malaria was endemic in libya until 1973 where it
 was declared by WHO to be a country free of
 malaria.
The situation continued like this unil 1976 where
 there was an epidemic of febrile illness among
 petroleum company workers in hoone ,clinical
 presentation was like malaria , blood slides of all 12
 cases (2 pakistanian ,10 libyan ) were positive for
 falciparum malaria ,reconfirmed in a referral lab. In
 Tripoli ,patients were treated ,and chemoprophylaxis
 given for the limited surroundings .
 No more cases reported in the whole country for 10
 years later.
Background cont..
 In 1986 only imported cases started to appear and
 most of them from african countries and bangladish,and
 india .
In 2003 in addition to 44 imported cases reported , few
 cases reported thought to be an indigenous in southern
 areas (sebha province) , as a responce to that
 symposium conducted in sebha with collaboration to
 advisors from endemic counries and professionals in
 malaria epidemiology, and after strict epidemiological
 investigations in the areas where the case reported ,
 concluded finally to be an introduced cases.
                                        
      Sebrata           
                Tripoli                 Tobruk
                               Benghazi
                      Sirt       




          Obari 
              Sebha




Malarial Cases Distribution in Libya during 2004
  60                    ___   Median : 27 Years
                        ---   Mean: 27.7 ± 12.9 Years
  50


  40


  30


  20


  10

   0
    N=                  15



Age Distribution of Malarial Reported Cases
  Gender: 12 M: 3 F.
 All cases confirmed microscopically.

 All cases are imported, except for one case
  thought to be an introduced.
     Nigerian
        2


                       Libyan
                          7
         Sudanian
            6




Nationality Distribution for Malarial
    Cases during 2004 in Libya
       Africa

      Sudan

Middle Africa

       Niger

       Benin

          No

                0       1   2   3   4   5   6   7

                Count

Travel History for Reported Malarial Cases in
                Libya in 2004
   5



   4                                         TRAVEL

                                               Africa
   3
                                               Sudan

                                               Middle
   2
                                               Africa

                                               Niger
   1
                                               No

   0                                           Benin
        P.Malari   P.Falciparum    P.Vivax

                   Parasite Type


Types of Malaria parasite in relation to travel
                  history
  3.0




  2.0




  1.0




  0.0
        1   2   3   4   5   6   7   8   9   10   11   12

                            Month

Distribution of Malarial Cases according to
        Months of the Year ( 2004 )
Elimination strategy by year 2004
   Training , retraining of personnel.
   Sensitization of medical decision makers &
    medical personnel as well towards malaria as it
    doesn’t create a problem at present time.

   Improving surviellance system.
    Elimination strategy objectives
   To prevent reemergence of malaria transmission
    in the country.
   To control imported malaria.
    Elimination Strategy Activities
   Activities of consolidation (in areas at risk):
    .Case detection (active + passive ).
    .Vector control measures.
 Prevention of imported malaria
    . Case detection .
    . chemoprophylaxis.
           Plan of action for 2004
                 Objectives

   To strengthen and maintain the stopping of the
    transmission in the high risk areas.
   To control imported malaria.
      Activities and achievements
   Intensifying the active case detection in areas
    at risk .
   National survey for (15) selected counties for
    one year to be conducted before the end of
    june 2006, for recent epidemiological and
    entomological map.
                                         Tripoli
                                                                                                     AL-ATroon
                          Shaksouk                         AL-Khms                                                Derna


                        Joush                                                                             Kersa
                                    Kasr Elhaj                                                       Ras Ahlal
                                                                                          Benghazi
            Tigi                                         Taurga


        Drej
                                                                                                                  A.Sergenti

                              GirriatGharbia
                                            Girriat Sharkiah                                                      A.Multicolor
                                                                                                                  A.Coustani
                                                                                            Zella

                                                                                          Medwin                  A.Gambiae
                       Uenzirickr
                                                 Aggar            Ishkida                                         A.Broussesi
                                                              Brack
                Idri      Berghin
                                  Guttai                     Ghorda
                                                                Duesa
                                                                                                                  A.Hispniola
                                Deisa   Techerciba

       Oubari                      Germa                              Sebha                                       A.Matasi
                                                 Gharagh              Guddwa
Ghat
                                                                  Traghen Zwela
                                                                                                                  A.Turkhudi
                       Serdalas
                                                                      Zizau
                        EL-Berket           Aggar Atabat
                                                             Fongur               Tmesa                           A.Superpictus
                                    Tessau                                Gawat
                                        UM EL-Hamam Mourzouk
                                                                                                                  A.maculipenis
                                          Ghatroun
                                                                                                                  A.Lambranchiae
                                                                                                                  A.Sacharrovi
                                                                                                                  A.maculipenis
        Activities and achievements
                  ( Conti.. )

    A represenative blood samples will be taken
    from population of 15 provinces including
    camps of immigrants from Chad, Niger,
    Muritania, and other African countries ,to be
    examined by rapid test for malaria to know the
    magnitude of the problem and to take action
    accordingly.
Activities and achievements cont.
      Strengthening the surviellance system in all 33
       provinces in the country.
      Training and retraining activities :
I.     condensed course for one week at December 2004
       conducted for laboratory diagnosis of malaria for
       16 lab. Technicians from 15 provinces at risk.
II.    condensed course for one week at December 2004
       for 16 health workers who will be involved in the
       survey mentioned earlier .
III.   continuous health education .
   Reduced sensibility of health managers and decision
    makers towards malaria .
   Less availability of professional personnel in clinical
    and laboratory diagnosis of malaria apart from
    main hospitals in big cities .
   Reduced public cooperation in taking
    chemoprophylaxis when travelling to endemic
    countries.
   Uncontrolled movement of immigrants from
    endemic countries through unpatroled boarders.

				
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