THE IMPLICATIONS OF HUMAN POPULATION MOVEMENT FOR MALARIA ELIMINATION IN SOUTHWEST BORDER OF SAUDI ARABIA

Abstract

These studies explore malaria on the southern border of Saudi Arabia, a region where malaria cases are resurging, and elimination efforts are stalled. Malaria is a major public health concern on the southern border due to the area’s favorable ecology, competent vectors, frequent transmission in active foci, population movements, and underserved mobile and migrant populations (MMPs), which may serve as a parasite reservoir. The geographic focus of this study is in Jazan province, located in Saudi Arabia’s border with Yemen, where security is unstable due to conflict and civil unrest in Yemen. Public health surveillance methods for implementing effective malaria elimination strategies in the region require knowledge and understanding of current epidemiological trends and human activities that contribute to sustained malaria transmission in the geographically, historically, and politically complex region. The objectives of this dissertation are to describe malaria trends at border areas; to assess surveillance current tools ‘travel history’, a criterion to classify cases; to assess human livelihood activities contributing to malaria transmission; to identify and understand attitudes about malaria held by Mobile and Migrant Populations (MMPs); to identify treatment and prevention seeking behaviors of these populations. This information is critical to prioritize interventions tackling border malaria and implementation of effective malaria elimination strategies in the border region. Study results showed that small-scale human movement within the region is more associated with a risk of malaria infection than factors such as socio–economic status, agricultural livelihood activities, rearing animals, and participation in daily or seasonal spiritual gatherings. The peer navigator recruitment method, which uses a standard chain referral approach, showed that MMPs in Jazan have high levels of malaria knowledge and risk perception but low levels of treatment-seeking behavior and access to prevention. The reliability of the current surveillance tools used to characterize and report malaria cases based on international travel history decreased in elimination settings located closer to the border. These results have significant implications for malaria elimination strategies, including identifying risk factors for malaria transmission, developing disease surveillance methods targeting hard-to-reach populations, and serving as a foundation and baseline data for future border health studies of malaria and another vector–borne disease in this region.