Malaria Situation in an Endemic Area, Southeastern Iran
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J Arthropod-Borne Dis, S Fekri et al.: Malaria Situation in … Original Article Malaria Situation in an Endemic Area, Southeastern Iran Sajjad Fekri 1, Hassan Vatandoost 2, Ali Daryanavard 3, Mehran Shahi 1, Reza Safari 3, Ahmad Raeisi 4, Abdiqani Sheikh Omar 5, Mohammad Sharif 6, Abdollah Azizi 7, Aref Ah- 8 9 10 2 mad Ali , Aboud Nasser , Ibrahim Hasaballah , *Ahmad Ali Hanafi-Bojd 1Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran 2Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 3Hormozgan Province Health Center, Bandar Abbas, Iran 4Malaria Control Program, CDC, Ministry of Health, Tehran, Iran 5Malaria Control Program, Somalia 6Malaria Control Program, Afghanistan 7Health Center, Zarrindasht, Iran 8Roll Back Malaria Program, Aden, Yemen 9Roll Back Malaria Program, Hadramaut, Yemen 10State Malaria Program Manager, North Kordofan, Sudan (Received 21 Oct 2012; accepted 30 Sep 2013) Abstract Background: Malaria is an endemic infectious disease in southeastern parts of Iran. Despite years of efforts and intervention programs against malaria, transmission still occurs in Jask County. Methods: The epidemiological perspective of malaria in Jask County was conducted by gathering data from Jask County health center, during 2006-2010. A knowledge, attitude and practice study was also carried out. Data analysis was conducted using SPSS ver. 11.5. Results: A total of 2875 malaria cases were recorded, with highest and lowest numbers in 2007 and 2010, respec- tively. The number of cases had a decreasing trend from 1022 cases in 2006 to 114 cases in 2010. The main causa- tive parasitic agent was Plasmodium vivax. Blood examination rate and slide positive rate were also decreased from 39.5% and 4.3% in 2006 to 15.6% and 1.4% in 2010, respectively. Most of people interviewed in the KAP study had a good knowledge about malaria transmission and symptoms but their use of the bed net for prevention was low (35%). Conclusion: Malaria incidence had significant reduction during the study years. The main reason for this may be due to changing environmental condition for Anopheline breeding and survival because of drought. Another reason may be integration of vector management by using long lasting insecticide treated bed nets, active case detection and treatment by implementation of mobile teams and increasing in financial sources of malaria control program. Knowledge, attitude and practice of people were good in malaria control and prevention, but needs to do more activities for health education and awareness. Keywords: Malaria situation, Jask County, Iran Introduction More than half of the world's population of the global population live in areas where in approximately 100 countries is exposed to there is risk of malaria transmission, 7% reside malaria. According to figures provided by the in areas where malaria has never been under World Health Organization (WHO 2011a), 36% meaningful control, and 29% live in areas *Corresponding author: Dr Ahmad Ali Hanafi-Bojd, E-mail: [email protected] J Arthropod-Borne Dis, S Fekri et al.: Malaria Situation in … where malaria was once transmitted at low ology of an area in a very short space of time levels or not at all, but where significant trans- and the health status, system and resource mission has been re-established. available for controlling the disease (WHO In Iran, the total population at risk of ma- 2011b). A successful planning for the County, laria is 2,714,648 (4% of the total popula- needs to use of the information that is al- tion) mainly living in southeastern provinces, ready available and analyzing in such a way namely Sistan and Baluchistan, Kerman and as to understand the problems. On the other Hormozgan (WHO 2011a). There are some hand, the main point of the beginning of the studies in last decade focused on malaria sit- situational analysis is to collect the data from uation analysis (Hanafi-Bojd et al. 2010, respective references such as, health network Vatandoost et al. 2010, 2011), as well as epi- office, hospital, health centers, communities, demiological features and community based meteorology department and others. These studies in malarious areas of southern parts items are covered by international diploma of Iran (Rakhshani et al. 2003, Salehi et al. courses on malaria planning and manage- 2010, Hanafi-Bojd et al. 2011a, Youssefi and ment, as a joint training course by WHO and Rahimi 2011, McKelvie et al. 2012, Zoghi et Tehran University of Medical Sciences al. 2012). (Mesdaghinia et al. 2013). According to the national strategy plan for The general objective of this study was to malaria control, in respect to malaria status the facilitate the development of friendly-user total country has been classified in four strata: implementation plan for Jask County to iden- 1. Areas where local transmission of malaria tify malaria-relevant gaps with its possible occurs such as areas in Sistan and Baluchistan, solutions. Hormozgan and south parts of Kerman, and occasionally some-areas in Ardebil, Bushehr, Materials and Methods Fars and Khorassan-e-Razavi Provinces. 2. Areas where the imported cases are found Study area and the potential risk of malaria transmission Jask County (25° 64’ N, 57° 77’ E) is a exists such as areas in Guilan, Mazandaran, sea port located in South-Eastern corner of and Golestan Provinces. Iran adjacent to the Oman Sea, with a sur- 3. Areas where the imported cases are found, face area of 16063 km2 (Fig. 1). Total pop- but there is no risk of malaria transmission ulation of the County is 50070 (74% are liv- such as Yazd, Kurdestan, and Hamedan Prov- ing in rural areas). There are scattered inhab- inces. itants and their occupation is mainly fishing 4. Areas where no malaria case was reported and trade. during the last three years. It seems there was no such area in Iran. Data collection Malaria remains an important public health In this retrospective study, the needed da- concern in Jask County, where transmission ta for 2006-2010 were obtained from health occurs regularly, and infected immigrants can center of Jask, published papers and reports, play an important role as mobile reservoirs weather forecasting organization of the city (Personal communication with health center and annual reports of Hormozgan official au- authorities). Therefore it is important to do a thorities. An excel databank was created and situation analysis of the disease for planning analysis was conducted using this software. A the control activities in future. The aim of knowledge, attitude and practice (KAP) study conducting a situational analysis is to sys- was conducted to evaluate the knowledge, at- tematically understand the malaria epidemi- titude and practice of people who referred to J Arthropod-Borne Dis, S Fekri et al.: Malaria Situation in … the urban health center of Touhid, about ma- ceptibility and parasitic infection of Ano- laria using structured questionnaire and in- pheline mosquitoes. terviewing. The health facilities and personnel of the County were included: one urban heath cen- Data analysis ter, 6 rural health centers, one sub health cen- For this purpose SPSS ver. 11.5 was used ter, 27 health houses, one hospital, 11 physi- and graphs were prepared by excel 2007. cians, 6 public health officers and 49 health care workers (Behvarz). Furthermore, malaria Results control program has had a total of 25 mobile teams. A total of 2875 malaria cases were rec- Based on the national protocol, malaria orded and treated during the study period control interventions in the area are includ- (Fig. 2). Plasmodium vivax is the main ma- ing case detection and treatment, indoor re- laria parasite (94.92%) in the County fol- sidual spraying by Deltamethrin WP 10% in lowed by P. falciparum (5.08%). Average of rural area with 90% coverage, distributing malaria morbidity in months of the years Long Lasting Insecticide impregnated Nets during the study period showed two peaks in (LLINs) in rural areas with 80% coverage, as May and November, respectively. The max- well as larviciding. Data obtained from the imum and minimum of Annual Parasitic In- Jask County health center shows high IRS dex (API) were observed in 2006 (22.1) and coverage during the study period and dis- 2010 (2.1), respectively (Table 1). Most of tribution of LLINs during 2009 and 2010. cases were reported to be autochthonous dur- These vector control activities along with ing 2006-2009, while in 2010 the imported other measures such as good active case de- cases were higher. Blood Examination Rate tection (Table 2) and increasing the financial (BER) has increased to 2007 and then col- resources of malaria control program for the lapsed, but Slide Positive Rate has a decreas- study area are the main reasons for the de- ing trend during the study period, although it cline of the disease. shows a peak in 2008 (Table 1). Autochtho- A total of 41 people (64.3% males, 35.7% nous cases of malaria have decreased during females) participated in the KAP study, 96.4 the study period, while the imported cases % under 45 years old. The education level was had an increasing trend (Table 1). Figure 2 categorized in four levels: illiterate (10.7%), shows the distribution of malaria cases based primary school (32.1%), high school (25%), on rural districts of the Jask County during and university degree (32.1%). Among the the study period. respondents just 17.9% had a history of ma- During April-May and October-Novem- laria infection. Most of the study population ber the temperature is between 25-30 oC (82.1%) believed that mosquito bite is the with a relative humidity of more than 60% transmission route of malaria and fever is the (Fig.