1. Vector-borne diseases contribute significantly to the disease burden in the Eastern Mediterranean Region, accounting for 11% of the total burden and 17% of communicable diseases. Malaria alone contributes the greatest burden. 2. There are many challenges to implementing effective vector control in the region, including conflicts that disrupt health services, operational issues in applying interventions, weak entomological surveillance systems, and the emergence of insecticide resistance in vector populations. 3. An integrated vector management (IVM) approach is recommended to plan and deliver targeted, cost-effective and sustainable vector control. National IVM plans need to be developed and capacity for vector control, monitoring and evaluation, and research need to be strengthened.

1. IVM IN EMR: Progress and Challenges Abraham Mnzava Scientist, Vector Control RBM WHO/EMRO CAIRO, EGYPT

2. EMR-where three continents converge ……………… Implications for VBDs

3. Oriental Palaearctic Sub-saharan

6. † E nteric infections causing diarrhoeal diseases are only partly transmitted by vectors, being more often acquired directly from faecal/oral route or via contaminated water and foodstuffs * Source. World Health Report - 2002 Table 1 Vector-Borne Disease EMR Burden: DALYs* Member States Endemic Epidemic Prone Non-Endemic † Diarrhoeal diseases 10,784,000 ALL ALL 0 Malaria 2,050,000 AFG, DJI, SOM, SUD, YEM ALL 18 Trachoma 602,000 AFG, DJI, EGY, IRA, IRQ, LIB, MOR, OMA, PAK, SOM, SUD, UAE, YEM - BAH, CYP, JOR, KUW, LEB, PAL, QAT, SAA, SYR, TUN Lymphatic Filariasis 489,000 EGY, SUD, YEM - 20 Countries Leishmaniasis 278,000 17 SUD, PAK, AFG UAE, BAH, QAT, KUW, DJI, CYP Schistosomiasis 202,000 EGY, IRQ, SAA, SOM, SUD, YEM, MOR LIB, OMA, JOR, SYR- AFG, BAH, CYP, DJI, IRA, KUW, PAL, PAK, QAT, TUN, UAE Dengue 85,000 DJI, PAK YEM 20 Japanese Encephalitis 81,000 - AFG, PAK 21 Onchocerciasis 46,000 SUD, YEM - 21 Countries Trypanosomiasis 40,000 SUD - 22 Countries Top 10 VBDs total 14,657,000 = 11% of DALYs attributed to VBDs globally =17% of DALYs attributed to communicable diseases regionally

7. Group 1: 10 countries interrupted transmission: Bah, Cyp, Jor, Kuw, Leb, Lib, Pal, Tun, UAE Group 2: 4 countries targeting elimination: Egy, Mor, Oma, Syr Group 3: 4 countries low- moderate endemicity: Ira, Iraq, Pak, SAA Group 4: 5 countries high burden: Afghanistan, Dji, Som, Sud, Yem

13. 5. Problem of Insecticide Resistance

15. Insecticide Resistance Status

25. Whereas IVM can be entertaining ……..

26. And really …..amusing

27. Can be quite terrifying!!!!

28. THANK YOU