Geographically, Turkey is situated in an area where malaria is very risky. The climatic conditions in the region are suitable for the malaria vector to proliferate. Due to agricultural infrastructural changes, GAP and other similar projects, insufficient environmental conditions, urbanization, national and international population moves, are a key to manage malaria control activities. It is estimated that malaria will be a potential danger for Turkey in the forthcoming years. The disease is located largely in south-eastern Anatolia. The Diyarbakir, Batman, Sanliurfa, Siirt, and Mardin districts are the most affected areas. In western districts, like Aydin and Manisa, an increase in the number of indigenous cases can be observed from time to time. This is due to workers moving from malaria districts to western parts to final work. Since these workers cannot be controlled, the population living in these regions get infected from indigenous cases. There were 84,345 malaria cases in 1994 and 82,096 in 1995, they decreased to 60,884 in 1996 and numbered 35,456 in 1997. They accounted for 36,842 and 20,963 in 1998 and 1999, respectively. In Turkey there are almost all cases of P. vivax malaria. There are also P. vivax and P. falciparum malaria cases coming from other countries: There were 321 P. vivax cases, including 2 P. falciparum ones, arriving to Turkey from Iraq in 1995. The P. vivax malaria cases accounted for 229 in 1996, and 67, cases P. vivax including 12 P. falciparum cases, in 1997, and 4 P. vivax cases in 1998 that came from that country. One P. vivax case entered Turkey from Georgia in 1998. The cause of higher incidence of P. vivax cases in 1995, it decreasing in 1999, is the lack of border controls over workers coming to Turkey. The other internationally imported cases are from Syria, Sudan, Pakistan, Afghanistan, Nigeria, India, Azerbaijan, Malaysia, Ghana, Indonesia, Yemen. Our examinations have shown that none of these internationally imported cases are important in transmitting the diseases. The districts where malaria cases occur are the places where population moves are rapid, agriculture is the main occupation, the increase in the population is high and the education/cultural level is low. Within years, the districts with high malaria cases also differ. Before 1990 Cucurova and Amikova were the places that showed the highest incidence of malaria. Since 1990, the number of cases from south-eastern Anatolia has started to rise. The main reasons for this change are a comprehensive malaria prevention programme, regional development, developed agricultural systems, and lower population movements. The 1999 statistical data indicate that 83 and 17% of all malaria cases are observed in the GAP and other districts, respectively. The distribution of malaria cases in Turkey differs by months and climatic conditions. The incidence of malaria starts to rise in March, reaching its peak in July, August and September, begins to fall in October. In other words, the number of malaria cases is lowest in winter and reaches its peak in summer and autumn. This is not due to the parasite itself, but a climatic change is a main reason. In the past years the comprehensive malaria prevention programme has started bearing its fruits. Within the WHO Roll Back Malaria strategies, Turkey has started to implement its national malaria control projects, the meeting held on March 22, 2000, coordinated the country's international cooperation for this purpose. The meeting considered the aim of the project to be introduced into other organizations. In this regards, the target for 2002 is to halve the incidence of malaria as compared to 1999. The middle--and long-term incidence of malaria will be lowered to even smaller figures. The objectives of this project are as follows: to integrate malaria services with primary health care services to prove more effective studies; to develop early diagnosis and treatment systems, to provide better diagnostic services, and to develop mobile diagnostic ones; to make radical treatment and monitoring patients; to conduct regular active case surveillance studies; to conduct regular vector control studies; to monitor the sensitivity of vectors to insecticides and to provide their alternatives; to design malaria control studies for the specialists of districts; to implement educational programmes among the population and attract it in controlling malaria.
Turkey is the last country in the temperate zone on the edge of the European continent in which malaria is prevalent at endemic and occasionally epidemic proportions. Malaria was the most significant vector borne disease constituting a serious healthy problem until it was suppressed in 1965. Following the establishment of malaria eradication program in 1957 which began operation in 1960 after many years of malaria control, the incidence of malaria decreased annually and the stricken areas became more and more restricted. Unfortunately, an agricultural development program initiated in mid 70's in the Cukurova Plain caused a substantial migration of workers from the eastern areas where malaria at that time was more prevalent. This population movement together with the industrial expansion that took place resulted in a serious epidemic of vivax malaria in 1977 in the provinces of Adana, Icel and Hatay, where 101,867 cases were reported. The following years, Turkey targeted to reduce the number of malaria cases to less than 800 by 1984. After 1985, the number of malaria cases in the country has continued to increase and in the past five and six years a serious malaria epidemics has been building up in the southeastern provinces. The gravitational center of the disease has now moved from the Cukurova to the GAP area in South East Anatolia and beyond. The indicator of this movement is that 89% of total cases in 1998 is concerning to the GAP region. By the year 1998 the number of reported cases were 36,842. The common parasite type is P. vivax in the country. The other types are generally imported from other countries. These are Syria, S. Arabia, Pakistan, Afghanistan, Yemen, Nigeria, India, Malaysia, Ghana, Indonesia, Sudan etc. Malaria cases are registered in bordering areas of the country constantly. The suggested solutions for Malaria control in bordering areas are: 1. To establish control laboratories in customs in order to take blood from persons who come from risky areas for malaria. When positive cases are found these laboratories will also provide free treatment. 2. East country should give information about the malaria situation in their country to the other countries.