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Malaria outbreak among illegal Ethiopian immigrants in Al-barzah village of Makkah province, KSA, December 2002; A study of environmental and behavioral risk factors


Malaria is prevalent in different parts of Saudi Arabia starting from the hyperendemic area (Jizan) and extending along the red sea coast to the north (Tihamah and Alhijaz plateau), but in lower prevalence. In the period November 2002 to January 2003, there was an abnormal increase in the malaria cases reported from Al-barzah village. Our objective was to study the distribution and determinants of this problem in order to control for it and prevent occurrence of similar events in the future.


A cross-sectional study was conducted to evaluate the problem. A self-administered questionnaire was used and distributed on a simple random sampling basis and those who are illiterates or non-Arabic speakers were interviewed directly. Epi info software was used in data entry and analysis.


The trend of malaria prevalence in Albarzah was found to follow that of Makkah region and the whole Kingdom. The Majority of cases were illegal Ethiopian immigrants. The percentages of some important risk factors for malaria transmission in Albarzah were as follows: 21.6% stated presence of malaria cases among their close contacts, 96.3% stated presence of mosquitoes, 94.6% were subjected to mosquitoes bites, 18.6% slept in exposed areas, 33.5% did not use anti-mosquito methods, 45.6% resided close to stagnant water spots and 13% worked as farmers. Significant statistical associations were found between prevalence of malaria and the following risk factors: residing in Albarzah (Mawed village) (OR = 6.57, 95% CI = 3.58-12.10), being close to stagnant water (OR=2.03, 95% CI = 1.14-3.62), sleeping outside rooms (OR = 4.65, 95% CI = 2.41-9.00) and working as a farmer (OR=7.3, 95% CI = 3.40-16.22). Using anti-mosquito methods was protective against infection (OR=0.01, 95% CI = 0.05-0.20). This study showed no significant statistical associations between prevalence of malaria and presence of mosquitoes (OR=0.26, 95% CI = 0.06-1.00), or getting mosquito bites (OR=0.53, 95% CI = 0.17-1.72).


Albarzah is a malaria hypoendemic area, and all environmental risk factors for maintaining malaria transmission are available there, along with deficient control and preventive measures. The outbreak took place when the illegal Ethiopians immigrants started to gather in Albarzah beside the farms without practicing any anti-mosquitoes methods and the source case was most probably from the local malaria cases of Albarzah. This study ensures that illegal immigrants and those who remain after Hajj and Omrah seasons to settle in such rural areas are the main restraint for malaria control efforts in Saudi Arabia.