[Armenia: implementation of national program of malaria control].

Malaria has been existing in Armenia since antiquity. In the 1920"s to 1930s, thousands of people suffered from this disease in the country. Enormous efforts were required to prevent further spread of the disease. A network was set up, which consisted of a research institute and stations. A total of 200,000 cases of malaria were still notified in 1934. Rapid development of the health infrastructure and better socioeconomic conditions improved the malaria situation and reduced the number of cases in 1946. Malaria was completely eradicated in Armenia in 1963, and the malaria-free situation retained till 1994. During that period, comprehensive activities were undertaken in the country to prevent and control malaria. Since 1990, following the collapse of the Soviet Union, the situation became critical in many newly independent states. Economic crisis, human migration, worsening levels of health services, and the lack of necessary medicines, equipment, and insecticides significantly affected the malaria epidemiological situation in the country. Malaria cases started to penetrate into Armenia from neighboring countries. In 1994, a hundred ninety six military men contacted malaria in Karabakh, which was unfavorable in terms of malaria, as well on as the border with Iran and along the Araks river. The first cases recorded in Armenia were imported, afterwards they led to the incidence of indigenous cases, given the fact that all the prerequisites for malaria mosquito breeding and development were encountered in 17 regions and 3 towns of the country. In 1995, there were 502 imported cases and in 1996 the situation changed: out of 347 registered cases, 149 were indigenous. The Ministry of Health undertook a range of preventive measures. In 1997 versus 1996, the total number of malaria cases increased 2.3-fold: 841 registered cases of which 567 were indigenous (a 3.8-fold increase). The overwhelming majority of cases were recorded in the Ararat and Armavir marzes. In 1998, there were a total of 1156 cases, of them 542 being locally contacted. The situation became stable thanks to joint efforts of WHO, IFRX, the Armenian Red Cross Society, UNICEF, the Ministry of Health of Armenia and its Government. Under Minister's Decree No. 292 of May 17, 1999, a malaria project implementation office was established in the Masis Sanitary and Epidemiological Surveillance Center of Hygienic and Antiepidemic Surveillance to improve progress of the malaria control programme in Armenia. WHO allocated some 7,700 USD for 5-month maintenance and work of the office. Thus, analyzing the malaria cases registered in 1999 and 1998 indicates a 1.9-fold decrease (616/77). The setting up the malaria programme field office under the Minister's decree was instrumental in planning and implementing activities in situ. In 1999, four cases of tropical malaria were recorded in Armenia. The patients were Armenian pilots who contacted malaria during duty travels: 1 in Sudan and 3 in Congo. The list of pilots making flying to endemic countries was submitted to the Republican Center to implement preventive measures in the future. In Armenia malaria surveillance has been improved to ensure timely detection of all suspected cases and to carry out malaria control activities. In this regard, a seminar was held for 21 entomologists and 12 parasitologists. UNICEF and WHO Armenian offices provided a substantial support to organize seminars. To facilitate the seminars, the manual "Malaria parasitology and entomology" was published and distributed among their participants. On April 19, 1999, the session of the Ministry's Executive Board (Collegium) gave recommendations to reinforce malaria control activities in the country. Decrees No. 256 of May 31, 1999, No. 47 of May 29, 1999, and No. 245 of April 30, 1999, "On malaria and preventive and control activities" were issued by the Ministry of Health, the Ministry of Defense, and the Ministry of Internal Affairs and National Security to serve as a guideline for planning and implementing activities. The Ministry of Agriculture undertook to clean the collective irrigation (drainage) system covering 102 and 77 km in the Ararat and Armavir marzes, the Ministry of Health provided a list of endemic foci where cleaning was a priority. Taking into account the importance of the people's participation in ensuring effective prevention and control, emphasis was laid on health education activities: publication of leaflets, as well as articles in local newspapers, radio broadcasts and TV shows. Throughout the season, the early detection of malaria cases, timely hospitalization (in no later than 1-3 days) for at least 5 days and subsequent treatment under direct supervision of a physician were successfully carried out due to home-to-home visits. Entomological studies conducted in the malaria foci show an increase in the presence and density of a malaria vector in the buildings. As far as treatment is concerned, the overall surface of stagnant waters comprised 2642 ha in 1999 (2733 ha in 1998), including 1285 ha of anophelogenic stagnant waters (2276 ha in 1998). The biggest stagnant water surfaces were in the Ararat and Armavir marzes--2209 ha, where the majority of malaria cases were recorded. A total of 1,283,111 and 559,213 sq. m. of constructions were treated in 1999 and 1998, respectively, out them there were 1,259,637 sq. m. in 5 endemic regions. Stagnant water surfaces were treated with bacticulicides on 250.7 and 743.8 (almost 3 times more) in 1998 and 1999, respectively. In 1999, 740 ha of surface were biologically treated using Gambusia compared to 900 ha treated in 1998. There is no highly qualified diagnostic specialists in many regions of the country, which necessitates the holding of further seminars involving relevant specialists, in all malaria regions. There is a tendency of geographical spread of malaria: malaria cases occur in new regions and dwellings. A country-wide action plan was drafted for 2000, mainly focusing on staff training. With WHO assistance, a seminar was held for 324 specialists from endemic regions. During the first quarter of 2000, 13 cases of tertian malaria were recorded as compared 59 cases during the same period of last year. All these patients contacted malaria in the previous season and demonstrated long incubation periods. Thus, the malaria control plan recommended by WHO and the rational and targeted use of its assistance has shown a 2-fold decrease in the incidence of malaria.