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Original Article

Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia

Yousry Hawash1,2,*, Khadiga Ismail1,3, Khalaf Alsharif1, Walaa Alsanie1
The Korean Journal of Parasitology 2019;57(3):233-242.
Published online: June 30, 2019

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*Corresponding author (yousryhawash@gmail.com)
• Received: November 13, 2018   • Revised: March 24, 2019   • Accepted: May 3, 2019

Copyright © 2019 by The Korean Society for Parasitology and Tropical Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia
Korean J Parasitol. 2019;57(3):233-242.   Published online June 30, 2019
DOI: https://doi.org/10.3347/kjp.2019.57.3.233
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Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia
Korean J Parasitol. 2019;57(3):233-242.   Published online June 30, 2019
DOI: https://doi.org/10.3347/kjp.2019.57.3.233
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Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia
Image Image Image Image
Fig. 1 Map of Saudi Arabia showing the district of Jazan.
Fig. 2 Characteristics of the species distribution 30 malaria cases (A). (B) Proportions of imported and indigenous malaria in Jazan, 2016–2018. (C) Source countries/regions of imported malaria. (D) Age distribution of seven sub-microscopic malaria cases.
Fig. 3 Month-wise distribution of the reported malaria cases in Jazan, 2016–2018.
Fig. 4 A flowchart diagram shows results of three tests used for detection and characterization of the malaria cases in this study. RDT (Paramax-3TM rapid detection test), LM (light microscopy) and PCR (nested PCR). a1 P. falciparum, 1 P. vivax and 1 mixed infections. b2 P. falciparum infections. c10 P. falciparum and 4 P. vivax. d2 P. falciparum and 2 P. vivax. e18 P. falciparum, 2 P. vivax and 1 as mixed infection.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Malaria Prevalence in a Low Transmission Area, Jazan District of Southwestern Saudi Arabia

Description of the 275’s participants

Character Category Proportion (%)
Age groups (year) 5–14 22.9
15–24 49.8
25–44 18.6
≥45 8.7
Fever Yes 54.5
No 45.5
Gender Male 40
Female 60
Residency Rural 64
Urban 36
Travel history Yes 73
No 27
Nationality Saudi 51.3
Non-Saudi 48.7

Mixed infection 6%

Characteristics of PCR-confirmed malaria cases

Variable Category Positive (%) No. of cases P-value
Age group (year) 5–14 12.6 63 0.6415
15–24 11.6 137
25–44 5.8 51
≥45 12.5 24
Fever Yes 14.6 150 0.0285*
No 6.4 125
Gender Male 16.3 110 0.0178*
Female 7.2 165
Residency Rural 13.6 176 0.053
Urban 6.0 99
Travel history Yes 11.9 201 0.3659
No 8.1 74
Nationality Saudi 7.8 141 0.0899
Non-Saudi 14.2 134

*Statistically-significant.

Distribution of symptomatic and asymptomatic malaria cases by age group

Category Species Positive age group (year) Subtotal
5–14 15–24 25–44 ≥45
Symptomatic (n=150) P. f mono-infection 4.6 8.6 0 0 13.3
P. v mono-infection 0.0 0.6 0 0 0.6
(P. f. + P. v.) Mixed 0.0 0.6 0 0 0.6
Subtotal 4.6 10.0 0 0 14.6
Asymptomatic (n=125) P. f mono-infection 0.0 0.8 0.8 0.8 2.4
P. v mono-infection 0.8 0.0 1.6 0.8 3.2
(P. f. + P. v.) Mixed 0.0 0.0 0.0 0.8 0.8
Total 0.8 0.8 2.4 2.4 6.4

P. f, Plasmodium falciparum; P. v., Plasmodium vivax.

The diagnostic performance of microscopy and the RDT versus the nested PCR

Assay Result Diagnostic performance
Positive No. (%) Negative No. (%) Se % (95% CI) Sp% (95% CI) PPV% (95% CI) NPV% (95% CI)
Microscopy 23 (8.3) 252 (91.7) 76.6 (0.57–0.89) 100 (0.97–1.00) 100 (0.82–1.00) 97 (0.93–0.98)
RDT 39 (14.1) 236 (85.9) 83.3 (0.64–0.93) 94.2 (0.90–0.96) 64.1 (0.47–0.78) 97.8 (0.94–0.99)
Nested PCR 30 (10.9) 245 (89.1) - - - -

CI, confidence interval; Se, sensitivity; Sp, specificity; NPV, negative predictive value; PPV, positive predictive value; RDT, rapid detection test (Paramax-3TM); PCR, polymerase chain reaction.

Agreement between Paramax-3TM and microscopy tests on 275 patients

Test Paramax-3TM rapid detection test Agreements (%) Kappa (κ) test 95% CI
Positive (39) Negative (236) Prevalence (14.1%) PPA NPA ORA
Light microscopy 23 252 8.30% 53.80% 99.10% 92.70% κ=0.63 (0.49–0.78)

PPA, positive percent agreement; NPA, negative percent agreement; ORA, overall rates of agreement; CI, confidence interval.

Table 1 Description of the 275’s participants

Mixed infection 6%

Table 2 Characteristics of PCR-confirmed malaria cases

Statistically-significant.

Table 3 Distribution of symptomatic and asymptomatic malaria cases by age group

P. f, Plasmodium falciparum; P. v., Plasmodium vivax.

Table 4 The diagnostic performance of microscopy and the RDT versus the nested PCR

CI, confidence interval; Se, sensitivity; Sp, specificity; NPV, negative predictive value; PPV, positive predictive value; RDT, rapid detection test (Paramax-3TM); PCR, polymerase chain reaction.

Table 5 Agreement between Paramax-3TM and microscopy tests on 275 patients

PPA, positive percent agreement; NPA, negative percent agreement; ORA, overall rates of agreement; CI, confidence interval.

Table 1

Table 2

Table 3

Table 4

Table 5

PHD : Parasites, Hosts and Diseases

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