In 2012, it was estimated that about 45.0% of the population of the Eastern Mediterranean Region countries was living in areas with risk of local malaria transmission. In that year, countries in the Region reported 1240900 confirmed malaria cases which is 17.6% of the total reported malaria cases in the Region. The Eastern Mediterranean Region spans three different eco-epidemiological zones and includes countries with wide variation in socioeconomic development status. The diversity of environment influences the malaria situation and is a major determinant of success in malaria control between and even within countries.
Malaria diagnosis is free of charge in the public sector in all malaria-endemic countries. three countries reported that RDTs are used at the community level. Access to diagnostic facilities for malaria is still limited. The health facility survey in Sudan 2009 showed that only 43% of facilities had functional microscopy and 15.8% had RDTs. The 2009 Pakistan survey showed 34% of health facilities had arrangements for diagnosis of malaria either through malaria microscopy or RDT. A total of more than 3.8 million RDTs were delivered in 2012 for malaria diagnosis in six countries (Pakistan, Saudi Arabia, Somalia, South Sudan, Sudan and Yemen). In 2012, based on the surveillance reports from all countries of the Region, only 17.6% of cases were diagnosed either by microscopy or RDT and the rest were treated on clinical basis.
Artemisinin-based combination therapies (ACTs) have been adopted as the first-line treatment in all countries of the Region where falciparum malaria is endemic. In 2012 nine endemic countries reported that ACTs are free of charge for all age groups in the public sector. In five countries ACTs are delivered at community level. Six countries reported that they have adopted pre-referral treatment with quinine/artemether/artesunate suppositories. A 2012 survey in Sudan showed that 56.3% of fever cases among children under 5 years of age who were treated for malaria received ACTs. In some countries many patients are still being treated with artemisinin monotherapies, particularly in the private sector. Access to diagnostic testing is insufficient, resulting in unnecessary use of artemisinin-based combination therapy for patients without malaria. Guided by a pilot project in South Kordofan, Sudan developed a national strategy of community-based management of malaria and other fevers using the services of trained volunteers. Afghanistan developed the national community-based strategy for malaria in late 2010.