"العراق والخليج الفارسي" [و‎‎٢‎٧‎٠] (٨٦٢/٥٤٢)

PUBLIC HEALTH AND DISEASE 415
age of sufferers from malaria among patients seeking relief from all
causes of sickness is the only available measure of malaria endemicity
in the provinces, though it is not a very satisfactory index. In 1939
the percentages in the different provinces were:
Baghdad
47
Dulaim
9‘4
Basra
220
Hilla .
25-9
Mosul .
• i 7'9
Karbala
206
Amara .
102
Kirkuk
127
Erbil .
lo-p
Kut .
8-3
Diwaniya
. 14-4
Muntafiq
12-8
Diyala .
21-4
Sulaimaniya
130
The spleen-rate,
or the percentage of children with enlargem<
the spleen, is one of the most valuable indices of endemic malaria.
The most comprehensive figures available for Iraq are given by
Christophers and Shortt. 1 They examined 7,981 children in many
parts of the country. The results showed that the Shatt al Arab and
the lower Tigris and Euphrates deltas had a moderate spleen-rate
indicative of moderate endemicity. In the upper plain of the rivers as
far as the Jabal Hamrin, spleen-rates were low or nil, indicative of
very feeble endemicity. At Karbala, however, a curious example of
localized hyperendemicity was found with a spleen-rate of 81 percent.
In the Mosul and Zab submontane areas spleen-rates of 77 and 66
were indicative of hyperendemic malaria. In the Diyala submontane
area the spleen-rate was only 6. The Persian plateau had a nil spleen-
rate. The experience of British troops in these areas was in general
in keeping with these findings. Baghdad city has a nil spleen-rate and
no endemic malaria.
Annual Cycle. Cases of malaria occur in all months of the year.
They are least numerous in the first three months. Thereafter the
incidence curve rises to a maximum in July. In August and September
there is usually a slight remission followed by a secondary rise in
October. The percentage monthly incidence of all cases of malaria
treated over a period of 17 years was:
January
46
April 6-i
July 12-9
October
107
February
4-2
May 79
August 107
November
9'9
March
5'2
June 11-8
September 8'8
December
7’2
These figures of clinically diagnosed malaria undoubtedly include
a proportion of other febrile conditions such as sandfly fever or
influenza. Moreover, it is impossible to distinguish in all cases
primary infections of malaria from relapses. The monthly fluctuations
in incidence indicate, however, that malaria is the preponderant
1 See Bibliography, Appendix F.